|
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
|
|
|
HC ACQ-LIVE DONOR-LIVER
|
Facility
|
IP
|
$93,569.00
|
|
| Hospital Charge Code |
904700501
|
|
Hospital Revenue Code
|
811
|
| 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: 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: Inland Empire Health Plan (IEHP) medi-cal |
$61,034.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$55,477.00
|
| 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-LIVER
|
Facility
|
OP
|
$93,569.00
|
|
| Hospital Charge Code |
904700501
|
|
Hospital Revenue Code
|
811
|
| 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 PANCREAS FOR KIP
|
Facility
|
IP
|
$79,296.00
|
|
| Hospital Charge Code |
904701005
|
|
Hospital Revenue Code
|
812
|
| Min. Negotiated Rate |
$15,859.20 |
| Max. Negotiated Rate |
$71,366.40 |
| Rate for Payer: Adventist Health Commercial |
$15,859.20
|
| Rate for Payer: Cash Price |
$43,612.80
|
| Rate for Payer: Cash Price |
$43,612.80
|
| Rate for Payer: Central Health Plan Commercial |
$63,436.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$31,718.40
|
| Rate for Payer: EPIC Health Plan Senior |
$31,718.40
|
| Rate for Payer: Galaxy Health WC |
$67,401.60
|
| Rate for Payer: Global Benefits Group Commercial |
$47,577.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$71,366.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52,890.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30,211.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49,084.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15,859.20
|
| Rate for Payer: Multiplan Commercial |
$59,472.00
|
| Rate for Payer: Networks By Design Commercial |
$51,542.40
|
| Rate for Payer: Prime Health Services Commercial |
$67,401.60
|
|
|
HC ACQ PANCREAS FOR KIP
|
Facility
|
IP
|
$79,296.00
|
|
| Hospital Charge Code |
905800001
|
|
Hospital Revenue Code
|
812
|
| Min. Negotiated Rate |
$15,859.20 |
| Max. Negotiated Rate |
$71,366.40 |
| Rate for Payer: Adventist Health Commercial |
$15,859.20
|
| Rate for Payer: Cash Price |
$43,612.80
|
| Rate for Payer: Cash Price |
$43,612.80
|
| Rate for Payer: Central Health Plan Commercial |
$63,436.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$31,718.40
|
| Rate for Payer: EPIC Health Plan Senior |
$31,718.40
|
| Rate for Payer: Galaxy Health WC |
$67,401.60
|
| Rate for Payer: Global Benefits Group Commercial |
$47,577.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$71,366.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52,890.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30,211.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49,084.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15,859.20
|
| Rate for Payer: Multiplan Commercial |
$59,472.00
|
| Rate for Payer: Networks By Design Commercial |
$51,542.40
|
| Rate for Payer: Prime Health Services Commercial |
$67,401.60
|
|
|
HC ACQ PANCREAS FOR KIP
|
Facility
|
OP
|
$79,296.00
|
|
| Hospital Charge Code |
905800001
|
|
Hospital Revenue Code
|
812
|
| Min. Negotiated Rate |
$15,859.20 |
| Max. Negotiated Rate |
$71,366.40 |
| Rate for Payer: Adventist Health Commercial |
$15,859.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$48,156.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$67,401.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$43,612.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$59,472.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$38,395.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46,570.54
|
| Rate for Payer: Blue Shield of California Commercial |
$48,449.86
|
| Rate for Payer: Blue Shield of California EPN |
$31,639.10
|
| Rate for Payer: Cash Price |
$43,612.80
|
| Rate for Payer: Central Health Plan Commercial |
$63,436.80
|
| Rate for Payer: Cigna of CA HMO |
$50,749.44
|
| Rate for Payer: Cigna of CA PPO |
$58,679.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$67,401.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$67,401.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67,401.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$31,718.40
|
| Rate for Payer: EPIC Health Plan Senior |
$31,718.40
|
| Rate for Payer: Galaxy Health WC |
$67,401.60
|
| Rate for Payer: Global Benefits Group Commercial |
$47,577.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$71,366.40
|
| Rate for Payer: InnovAge PACE Commercial |
$39,648.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52,890.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30,211.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49,084.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15,859.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$55,507.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$55,507.20
|
| Rate for Payer: Multiplan Commercial |
$59,472.00
|
| Rate for Payer: Networks By Design Commercial |
$51,542.40
|
| Rate for Payer: Prime Health Services Commercial |
$67,401.60
|
| Rate for Payer: Riverside University Health System MISP |
$31,718.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$47,577.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$47,577.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$39,648.00
|
| Rate for Payer: United Healthcare All Other HMO |
$39,648.00
|
| Rate for Payer: United Healthcare HMO Rider |
$39,648.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39,648.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$67,401.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$67,401.60
|
| Rate for Payer: Vantage Medical Group Senior |
$67,401.60
|
|
|
HC ACQ PANCREAS FOR KIP
|
Facility
|
OP
|
$79,296.00
|
|
| Hospital Charge Code |
904701005
|
|
Hospital Revenue Code
|
812
|
| Min. Negotiated Rate |
$15,859.20 |
| Max. Negotiated Rate |
$71,366.40 |
| Rate for Payer: Adventist Health Commercial |
$15,859.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$48,156.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$67,401.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$43,612.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$59,472.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$38,395.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46,570.54
|
| Rate for Payer: Blue Shield of California Commercial |
$48,449.86
|
| Rate for Payer: Blue Shield of California EPN |
$31,639.10
|
| Rate for Payer: Cash Price |
$43,612.80
|
| Rate for Payer: Central Health Plan Commercial |
$63,436.80
|
| Rate for Payer: Cigna of CA HMO |
$50,749.44
|
| Rate for Payer: Cigna of CA PPO |
$58,679.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$67,401.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$67,401.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67,401.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$31,718.40
|
| Rate for Payer: EPIC Health Plan Senior |
$31,718.40
|
| Rate for Payer: Galaxy Health WC |
$67,401.60
|
| Rate for Payer: Global Benefits Group Commercial |
$47,577.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$71,366.40
|
| Rate for Payer: InnovAge PACE Commercial |
$39,648.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52,890.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30,211.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49,084.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15,859.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$55,507.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$55,507.20
|
| Rate for Payer: Multiplan Commercial |
$59,472.00
|
| Rate for Payer: Networks By Design Commercial |
$51,542.40
|
| Rate for Payer: Prime Health Services Commercial |
$67,401.60
|
| Rate for Payer: Riverside University Health System MISP |
$31,718.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$47,577.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$47,577.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$39,648.00
|
| Rate for Payer: United Healthcare All Other HMO |
$39,648.00
|
| Rate for Payer: United Healthcare HMO Rider |
$39,648.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39,648.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$67,401.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$67,401.60
|
| Rate for Payer: Vantage Medical Group Senior |
$67,401.60
|
|
|
HC ACTH
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
CPT 82024
|
| Hospital Charge Code |
900912120
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.80 |
| Max. Negotiated Rate |
$111.60 |
| Rate for Payer: Adventist Health Commercial |
$24.80
|
| Rate for Payer: Cash Price |
$68.20
|
| Rate for Payer: Central Health Plan Commercial |
$99.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.60
|
| Rate for Payer: EPIC Health Plan Senior |
$49.60
|
| Rate for Payer: Galaxy Health WC |
$105.40
|
| Rate for Payer: Global Benefits Group Commercial |
$74.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$111.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$82.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.80
|
| Rate for Payer: Multiplan Commercial |
$93.00
|
| Rate for Payer: Networks By Design Commercial |
$80.60
|
| Rate for Payer: Prime Health Services Commercial |
$105.40
|
|
|
HC ACTH
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT 82024
|
| Hospital Charge Code |
900912120
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.80 |
| Max. Negotiated Rate |
$280.98 |
| Rate for Payer: Adventist Health Commercial |
$24.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$38.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$75.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$57.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$42.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$38.62
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$280.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.03
|
| Rate for Payer: Blue Shield of California Commercial |
$75.27
|
| Rate for Payer: Blue Shield of California EPN |
$49.23
|
| Rate for Payer: Cash Price |
$68.20
|
| Rate for Payer: Cash Price |
$68.20
|
| Rate for Payer: Central Health Plan Commercial |
$99.20
|
| Rate for Payer: Cigna of CA HMO |
$79.36
|
| Rate for Payer: Cigna of CA PPO |
$91.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$57.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$38.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.14
|
| Rate for Payer: EPIC Health Plan Senior |
$38.62
|
| Rate for Payer: Galaxy Health WC |
$105.40
|
| Rate for Payer: Global Benefits Group Commercial |
$74.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$111.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$63.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$59.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$38.62
|
| Rate for Payer: InnovAge PACE Commercial |
$57.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$82.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$38.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$51.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$51.75
|
| Rate for Payer: Multiplan Commercial |
$93.00
|
| Rate for Payer: Networks By Design Commercial |
$80.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$38.62
|
| Rate for Payer: Prime Health Services Commercial |
$105.40
|
| Rate for Payer: Prime Health Services Medicare |
$40.94
|
| Rate for Payer: Riverside University Health System MISP |
$42.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$74.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$74.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.28
|
| Rate for Payer: United Healthcare All Other HMO |
$31.28
|
| Rate for Payer: United Healthcare HMO Rider |
$31.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.28
|
| Rate for Payer: Upland Medical Group Pediatric |
$38.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$57.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.48
|
| Rate for Payer: Vantage Medical Group Senior |
$38.62
|
|
|
HC ACT HMS (POC)
|
Facility
|
IP
|
$37.00
|
|
|
Service Code
|
CPT 85347
|
| Hospital Charge Code |
900912038
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.40 |
| Max. Negotiated Rate |
$33.30 |
| Rate for Payer: Adventist Health Commercial |
$7.40
|
| Rate for Payer: Cash Price |
$20.35
|
| Rate for Payer: Central Health Plan Commercial |
$29.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.80
|
| Rate for Payer: EPIC Health Plan Senior |
$14.80
|
| Rate for Payer: Galaxy Health WC |
$31.45
|
| Rate for Payer: Global Benefits Group Commercial |
$22.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.40
|
| Rate for Payer: Multiplan Commercial |
$27.75
|
| Rate for Payer: Networks By Design Commercial |
$24.05
|
| Rate for Payer: Prime Health Services Commercial |
$31.45
|
|
|
HC ACT HMS (POC)
|
Facility
|
OP
|
$37.00
|
|
|
Service Code
|
CPT 85347
|
| Hospital Charge Code |
900912038
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$33.30 |
| Rate for Payer: Adventist Health Commercial |
$7.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.28
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$30.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.28
|
| Rate for Payer: Blue Shield of California Commercial |
$22.46
|
| Rate for Payer: Blue Shield of California EPN |
$14.69
|
| Rate for Payer: Cash Price |
$20.35
|
| Rate for Payer: Cash Price |
$20.35
|
| Rate for Payer: Central Health Plan Commercial |
$29.60
|
| Rate for Payer: Cigna of CA HMO |
$23.68
|
| Rate for Payer: Cigna of CA PPO |
$27.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.78
|
| Rate for Payer: EPIC Health Plan Senior |
$4.28
|
| Rate for Payer: Galaxy Health WC |
$31.45
|
| Rate for Payer: Global Benefits Group Commercial |
$22.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.28
|
| Rate for Payer: InnovAge PACE Commercial |
$6.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.74
|
| Rate for Payer: Multiplan Commercial |
$27.75
|
| Rate for Payer: Networks By Design Commercial |
$24.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.28
|
| Rate for Payer: Prime Health Services Commercial |
$31.45
|
| Rate for Payer: Prime Health Services Medicare |
$4.54
|
| Rate for Payer: Riverside University Health System MISP |
$4.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.46
|
| Rate for Payer: United Healthcare All Other HMO |
$3.46
|
| Rate for Payer: United Healthcare HMO Rider |
$3.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.71
|
| Rate for Payer: Vantage Medical Group Senior |
$4.28
|
|
|
HC ACTIGRAPHY RECORDING ANALYSIS I & R
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
CPT 95803
|
| Hospital Charge Code |
903695803
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$34.40 |
| Max. Negotiated Rate |
$154.80 |
| Rate for Payer: Adventist Health Commercial |
$34.40
|
| Rate for Payer: Cash Price |
$94.60
|
| Rate for Payer: Central Health Plan Commercial |
$137.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.80
|
| Rate for Payer: EPIC Health Plan Senior |
$68.80
|
| Rate for Payer: Galaxy Health WC |
$146.20
|
| Rate for Payer: Global Benefits Group Commercial |
$103.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$154.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$114.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$106.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.40
|
| Rate for Payer: Multiplan Commercial |
$129.00
|
| Rate for Payer: Networks By Design Commercial |
$111.80
|
| Rate for Payer: Prime Health Services Commercial |
$146.20
|
|
|
HC ACTIGRAPHY RECORDING ANALYSIS I & R
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
CPT 95803
|
| Hospital Charge Code |
903695803
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$34.40 |
| Max. Negotiated Rate |
$1,021.00 |
| Rate for Payer: Adventist Health Commercial |
$34.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$75.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$104.46
|
| 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 Exchange |
$534.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$101.02
|
| Rate for Payer: Blue Shield of California Commercial |
$104.40
|
| Rate for Payer: Blue Shield of California EPN |
$68.28
|
| Rate for Payer: Cash Price |
$94.60
|
| Rate for Payer: Cash Price |
$94.60
|
| Rate for Payer: Cash Price |
$94.60
|
| Rate for Payer: Central Health Plan Commercial |
$137.60
|
| Rate for Payer: Cigna of CA HMO |
$110.08
|
| Rate for Payer: Cigna of CA PPO |
$127.28
|
| 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 |
$146.20
|
| Rate for Payer: Global Benefits Group Commercial |
$103.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$154.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$123.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.47
|
| Rate for Payer: InnovAge PACE Commercial |
$113.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$114.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$101.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.13
|
| Rate for Payer: Multiplan Commercial |
$129.00
|
| Rate for Payer: Networks By Design Commercial |
$111.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$75.47
|
| Rate for Payer: Prime Health Services Commercial |
$146.20
|
| Rate for Payer: Prime Health Services Medicare |
$80.00
|
| Rate for Payer: Riverside University Health System MISP |
$83.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$103.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$103.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,021.00
|
| Rate for Payer: United Healthcare All Other HMO |
$803.00
|
| Rate for Payer: United Healthcare HMO Rider |
$608.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$558.00
|
| 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 ACTIVITY THERAPY PER SESSION 45 MIN OR MORE
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G0176
|
| Hospital Charge Code |
908880176
|
|
Hospital Revenue Code
|
904
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
HC ACTIVITY THERAPY PER SESSION 45 MIN OR MORE
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G0176
|
| Hospital Charge Code |
908880176
|
|
Hospital Revenue Code
|
904
|
| Max. Negotiated Rate |
$66.50 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$60.20
|
| Rate for Payer: InnovAge PACE Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Riverside University Health System MISP |
$0.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO |
$0.01
|
| Rate for Payer: United Healthcare HMO Rider |
$0.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC ACT LOW RANGE/PLUS (POC)
|
Facility
|
OP
|
$214.00
|
|
|
Service Code
|
CPT 85347
|
| Hospital Charge Code |
900912013
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$192.60 |
| Rate for Payer: Adventist Health Commercial |
$42.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$129.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.28
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$30.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.28
|
| Rate for Payer: Blue Shield of California Commercial |
$129.90
|
| Rate for Payer: Blue Shield of California EPN |
$84.96
|
| Rate for Payer: Cash Price |
$117.70
|
| Rate for Payer: Cash Price |
$117.70
|
| Rate for Payer: Central Health Plan Commercial |
$171.20
|
| Rate for Payer: Cigna of CA HMO |
$136.96
|
| Rate for Payer: Cigna of CA PPO |
$158.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.78
|
| Rate for Payer: EPIC Health Plan Senior |
$4.28
|
| Rate for Payer: Galaxy Health WC |
$181.90
|
| Rate for Payer: Global Benefits Group Commercial |
$128.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$192.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.28
|
| Rate for Payer: InnovAge PACE Commercial |
$6.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$142.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.74
|
| Rate for Payer: Multiplan Commercial |
$160.50
|
| Rate for Payer: Networks By Design Commercial |
$139.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.28
|
| Rate for Payer: Prime Health Services Commercial |
$181.90
|
| Rate for Payer: Prime Health Services Medicare |
$4.54
|
| Rate for Payer: Riverside University Health System MISP |
$4.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$128.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$128.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.46
|
| Rate for Payer: United Healthcare All Other HMO |
$3.46
|
| Rate for Payer: United Healthcare HMO Rider |
$3.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.71
|
| Rate for Payer: Vantage Medical Group Senior |
$4.28
|
|
|
HC ACT LOW RANGE/PLUS (POC)
|
Facility
|
IP
|
$214.00
|
|
|
Service Code
|
CPT 85347
|
| Hospital Charge Code |
900912013
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.80 |
| Max. Negotiated Rate |
$192.60 |
| Rate for Payer: Adventist Health Commercial |
$42.80
|
| Rate for Payer: Cash Price |
$117.70
|
| Rate for Payer: Central Health Plan Commercial |
$171.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.60
|
| Rate for Payer: EPIC Health Plan Senior |
$85.60
|
| Rate for Payer: Galaxy Health WC |
$181.90
|
| Rate for Payer: Global Benefits Group Commercial |
$128.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$192.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$142.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$132.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.80
|
| Rate for Payer: Multiplan Commercial |
$160.50
|
| Rate for Payer: Networks By Design Commercial |
$139.10
|
| Rate for Payer: Prime Health Services Commercial |
$181.90
|
|
|
HC ACUPUNCTURE/TENS
|
Facility
|
IP
|
$150.00
|
|
| Hospital Charge Code |
901500002
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Central Health Plan Commercial |
$120.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.00
|
| Rate for Payer: EPIC Health Plan Senior |
$60.00
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$135.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$100.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$92.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
| Rate for Payer: Networks By Design Commercial |
$97.50
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
|
|
HC ACUPUNCTURE/TENS
|
Facility
|
OP
|
$150.00
|
|
| Hospital Charge Code |
901500002
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$57.15 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$61.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$91.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$127.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$82.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$112.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Central Health Plan Commercial |
$120.00
|
| Rate for Payer: Cigna of CA HMO |
$96.00
|
| Rate for Payer: Cigna of CA PPO |
$111.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$127.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$127.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$127.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.00
|
| Rate for Payer: EPIC Health Plan Senior |
$60.00
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$135.00
|
| Rate for Payer: InnovAge PACE Commercial |
$75.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$100.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$92.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$105.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$105.00
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
| Rate for Payer: Networks By Design Commercial |
$97.50
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
| Rate for Payer: Riverside University Health System MISP |
$60.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$90.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$90.00
|
| 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 |
$127.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$127.50
|
| Rate for Payer: Vantage Medical Group Senior |
$127.50
|
|
|
HC ACUTE ABD SERIES
|
Facility
|
OP
|
$560.00
|
|
|
Service Code
|
CPT 74022
|
| Hospital Charge Code |
909001701
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$31.32 |
| Max. Negotiated Rate |
$504.00 |
| Rate for Payer: Adventist Health Commercial |
$112.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$135.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$340.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$154.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.32
|
| Rate for Payer: Blue Shield of California Commercial |
$339.92
|
| Rate for Payer: Blue Shield of California EPN |
$222.32
|
| Rate for Payer: Cash Price |
$308.00
|
| Rate for Payer: Cash Price |
$308.00
|
| Rate for Payer: Central Health Plan Commercial |
$448.00
|
| Rate for Payer: Cigna of CA HMO |
$358.40
|
| Rate for Payer: Cigna of CA PPO |
$414.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$476.00
|
| Rate for Payer: Global Benefits Group Commercial |
$336.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$504.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$67.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: InnovAge PACE Commercial |
$202.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$373.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$181.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$420.00
|
| Rate for Payer: Networks By Design Commercial |
$364.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$135.12
|
| Rate for Payer: Prime Health Services Commercial |
$476.00
|
| Rate for Payer: Prime Health Services Medicare |
$143.23
|
| Rate for Payer: Riverside University Health System MISP |
$148.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$336.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$336.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$193.23
|
| Rate for Payer: United Healthcare All Other HMO |
$193.23
|
| Rate for Payer: United Healthcare HMO Rider |
$193.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$193.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC ACUTE ABD SERIES
|
Facility
|
IP
|
$560.00
|
|
|
Service Code
|
CPT 74022
|
| Hospital Charge Code |
909001701
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$112.00 |
| Max. Negotiated Rate |
$504.00 |
| Rate for Payer: Adventist Health Commercial |
$112.00
|
| Rate for Payer: Cash Price |
$308.00
|
| Rate for Payer: Central Health Plan Commercial |
$448.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$224.00
|
| Rate for Payer: EPIC Health Plan Senior |
$224.00
|
| Rate for Payer: Galaxy Health WC |
$476.00
|
| Rate for Payer: Global Benefits Group Commercial |
$336.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$504.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$373.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$213.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$346.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.00
|
| Rate for Payer: Multiplan Commercial |
$420.00
|
| Rate for Payer: Networks By Design Commercial |
$364.00
|
| Rate for Payer: Prime Health Services Commercial |
$476.00
|
|
|
HC ACUTE HEPATITIS PANEL
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT 80074
|
| Hospital Charge Code |
900910701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$294.20 |
| Rate for Payer: Adventist Health Commercial |
$33.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$47.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$102.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$71.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$47.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$294.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.71
|
| Rate for Payer: Blue Shield of California Commercial |
$101.98
|
| Rate for Payer: Blue Shield of California EPN |
$66.70
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Central Health Plan Commercial |
$134.40
|
| Rate for Payer: Cigna of CA HMO |
$107.52
|
| Rate for Payer: Cigna of CA PPO |
$124.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$71.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$47.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.30
|
| Rate for Payer: EPIC Health Plan Senior |
$47.63
|
| Rate for Payer: Galaxy Health WC |
$142.80
|
| Rate for Payer: Global Benefits Group Commercial |
$100.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$151.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$78.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$59.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$47.63
|
| Rate for Payer: InnovAge PACE Commercial |
$71.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$112.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$63.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$63.82
|
| Rate for Payer: Multiplan Commercial |
$126.00
|
| Rate for Payer: Networks By Design Commercial |
$109.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$47.63
|
| Rate for Payer: Prime Health Services Commercial |
$142.80
|
| Rate for Payer: Prime Health Services Medicare |
$50.49
|
| Rate for Payer: Riverside University Health System MISP |
$52.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$100.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$38.58
|
| Rate for Payer: United Healthcare All Other HMO |
$38.58
|
| Rate for Payer: United Healthcare HMO Rider |
$38.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$38.58
|
| Rate for Payer: Upland Medical Group Pediatric |
$47.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$71.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.39
|
| Rate for Payer: Vantage Medical Group Senior |
$47.63
|
|
|
HC ACUTE HEPATITIS PANEL
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
CPT 80074
|
| Hospital Charge Code |
900910701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$151.20 |
| Rate for Payer: Adventist Health Commercial |
$33.60
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Central Health Plan Commercial |
$134.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.20
|
| Rate for Payer: EPIC Health Plan Senior |
$67.20
|
| Rate for Payer: Galaxy Health WC |
$142.80
|
| Rate for Payer: Global Benefits Group Commercial |
$100.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$151.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$112.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$103.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.60
|
| Rate for Payer: Multiplan Commercial |
$126.00
|
| Rate for Payer: Networks By Design Commercial |
$109.20
|
| Rate for Payer: Prime Health Services Commercial |
$142.80
|
|
|
HC ADAPTER MED KIT LEAD 5866-38M
|
Facility
|
IP
|
$1,093.00
|
|
|
Service Code
|
CPT C1883
|
| Hospital Charge Code |
906812499
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$218.60 |
| Max. Negotiated Rate |
$983.70 |
| Rate for Payer: Adventist Health Commercial |
$218.60
|
| Rate for Payer: Cash Price |
$601.15
|
| Rate for Payer: Central Health Plan Commercial |
$874.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$437.20
|
| Rate for Payer: EPIC Health Plan Senior |
$437.20
|
| Rate for Payer: Galaxy Health WC |
$929.05
|
| Rate for Payer: Global Benefits Group Commercial |
$655.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$983.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$729.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$416.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$676.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.60
|
| Rate for Payer: Multiplan Commercial |
$819.75
|
| Rate for Payer: Networks By Design Commercial |
$710.45
|
| Rate for Payer: Prime Health Services Commercial |
$929.05
|
|
|
HC ADAPTER MED KIT LEAD 5866-38M
|
Facility
|
OP
|
$1,093.00
|
|
|
Service Code
|
CPT C1883
|
| Hospital Charge Code |
906812499
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$218.60 |
| Max. Negotiated Rate |
$983.70 |
| Rate for Payer: Adventist Health Commercial |
$218.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$663.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$929.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$601.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$819.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$529.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$641.92
|
| Rate for Payer: Blue Shield of California Commercial |
$667.82
|
| Rate for Payer: Blue Shield of California EPN |
$436.11
|
| Rate for Payer: Cash Price |
$601.15
|
| Rate for Payer: Central Health Plan Commercial |
$874.40
|
| Rate for Payer: Cigna of CA HMO |
$699.52
|
| Rate for Payer: Cigna of CA PPO |
$808.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$929.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$929.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$929.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$437.20
|
| Rate for Payer: EPIC Health Plan Senior |
$437.20
|
| Rate for Payer: Galaxy Health WC |
$929.05
|
| Rate for Payer: Global Benefits Group Commercial |
$655.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$983.70
|
| Rate for Payer: InnovAge PACE Commercial |
$546.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$729.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$416.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$676.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$765.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$765.10
|
| Rate for Payer: Multiplan Commercial |
$819.75
|
| Rate for Payer: Networks By Design Commercial |
$710.45
|
| Rate for Payer: Prime Health Services Commercial |
$929.05
|
| Rate for Payer: Riverside University Health System MISP |
$437.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$655.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$655.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$546.50
|
| Rate for Payer: United Healthcare All Other HMO |
$546.50
|
| Rate for Payer: United Healthcare HMO Rider |
$546.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$546.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$929.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$929.05
|
| Rate for Payer: Vantage Medical Group Senior |
$929.05
|
|
