|
HC ACT HMS (POC)
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 85347
|
| Hospital Charge Code |
900912038
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$37.76 |
| Rate for Payer: Adventist Health Medi-Cal |
$4.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.23
|
| 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 |
$37.76
|
| Rate for Payer: Blue Distinction Transplant |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$24.10
|
| Rate for Payer: Blue Shield of California EPN |
$18.95
|
| Rate for Payer: Caremore Medicare Advantage |
$4.28
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Central Health Plan Commercial |
$31.20
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.42
|
| Rate for Payer: Dignity Health Media |
$4.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.78
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.28
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.06
|
| 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 |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.80
|
| 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 |
$29.25
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| 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 |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| 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: 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
|
OP
|
$176.00
|
|
|
Service Code
|
CPT 95803
|
| Hospital Charge Code |
903695803
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$35.20 |
| Max. Negotiated Rate |
$969.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$76.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$701.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$76.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$534.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$103.98
|
| Rate for Payer: Blue Distinction Transplant |
$105.60
|
| Rate for Payer: Blue Shield of California Commercial |
$108.77
|
| Rate for Payer: Blue Shield of California EPN |
$85.54
|
| Rate for Payer: Caremore Medicare Advantage |
$76.42
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Central Health Plan Commercial |
$140.80
|
| Rate for Payer: Cigna of CA HMO |
$112.64
|
| Rate for Payer: Cigna of CA PPO |
$130.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.63
|
| Rate for Payer: Dignity Health Media |
$76.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$76.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$76.42
|
| Rate for Payer: Galaxy Health WC |
$149.60
|
| Rate for Payer: Global Benefits Group Commercial |
$105.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$158.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$132.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$125.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$126.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$76.42
|
| Rate for Payer: InnovAge PACE Commercial |
$114.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$117.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$102.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$102.40
|
| Rate for Payer: Multiplan Commercial |
$132.00
|
| Rate for Payer: Networks By Design Commercial |
$114.40
|
| Rate for Payer: Prime Health Services Commercial |
$149.60
|
| Rate for Payer: Prime Health Services Medicare |
$81.01
|
| Rate for Payer: Riverside University Health System MISP |
$84.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$105.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$105.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$969.00
|
| Rate for Payer: United Healthcare All Other HMO |
$765.00
|
| Rate for Payer: United Healthcare HMO Rider |
$579.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$530.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Vantage Medical Group Senior |
$76.42
|
|
|
HC ACTIGRAPHY RECORDING ANALYSIS I & R
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
CPT 95803
|
| Hospital Charge Code |
903695803
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$35.20 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Central Health Plan Commercial |
$140.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.40
|
| Rate for Payer: Galaxy Health WC |
$149.60
|
| Rate for Payer: Global Benefits Group Commercial |
$105.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$158.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$117.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.20
|
| Rate for Payer: Multiplan Commercial |
$132.00
|
| Rate for Payer: Networks By Design Commercial |
$114.40
|
| Rate for Payer: Prime Health Services Commercial |
$149.60
|
|
|
HC ACT LOW RANGE/PLUS (POC)
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
CPT 85347
|
| Hospital Charge Code |
900912013
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Adventist Health Medi-Cal |
$4.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.23
|
| 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 |
$37.76
|
| Rate for Payer: Blue Distinction Transplant |
$135.00
|
| Rate for Payer: Blue Shield of California Commercial |
$139.05
|
| Rate for Payer: Blue Shield of California EPN |
$109.35
|
| Rate for Payer: Caremore Medicare Advantage |
$4.28
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Central Health Plan Commercial |
$180.00
|
| Rate for Payer: Cigna of CA HMO |
$144.00
|
| Rate for Payer: Cigna of CA PPO |
$166.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.42
|
| Rate for Payer: Dignity Health Media |
$4.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.78
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.28
|
| Rate for Payer: Galaxy Health WC |
$191.25
|
| Rate for Payer: Global Benefits Group Commercial |
$135.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$202.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$168.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.06
|
| 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 |
$150.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.00
|
| 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 |
$168.75
|
| Rate for Payer: Networks By Design Commercial |
$146.25
|
| Rate for Payer: Prime Health Services Commercial |
$191.25
|
| 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 |
$135.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$135.00
|
| 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: 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
|
$225.00
|
|
|
Service Code
|
CPT 85347
|
| Hospital Charge Code |
900912013
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Central Health Plan Commercial |
$180.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.00
|
| Rate for Payer: Galaxy Health WC |
$191.25
|
| Rate for Payer: Global Benefits Group Commercial |
$135.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$202.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$150.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.00
|
| Rate for Payer: Multiplan Commercial |
$168.75
|
| Rate for Payer: Networks By Design Commercial |
$146.25
|
| Rate for Payer: Prime Health Services Commercial |
$191.25
|
|
|
HC ACUTE ABD SERIES
|
Facility
|
OP
|
$560.00
|
|
|
Service Code
|
CPT 74022
|
| Hospital Charge Code |
909001701
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$74.90 |
| Max. Negotiated Rate |
$504.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$137.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$184.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$154.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$188.24
|
| Rate for Payer: Blue Distinction Transplant |
$336.00
|
| Rate for Payer: Blue Shield of California Commercial |
$346.08
|
| Rate for Payer: Blue Shield of California EPN |
$272.16
|
| Rate for Payer: Caremore Medicare Advantage |
$137.36
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$252.00
|
| 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 |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| 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: Health Plan of Nevada (Sierra) Other |
$420.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$226.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: InnovAge PACE Commercial |
$206.04
|
| 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 |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| 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
|
| Rate for Payer: Prime Health Services Medicare |
$145.60
|
| Rate for Payer: Riverside University Health System MISP |
$151.10
|
| 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: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
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: Cash Price |
$252.00
|
| Rate for Payer: Central Health Plan Commercial |
$448.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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
|
$73.00
|
|
|
Service Code
|
CPT 80074
|
| Hospital Charge Code |
900910701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.60 |
| Max. Negotiated Rate |
$358.86 |
| Rate for Payer: Adventist Health Medi-Cal |
$47.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$349.49
|
| 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 |
$358.86
|
| Rate for Payer: Blue Distinction Transplant |
$43.80
|
| Rate for Payer: Blue Shield of California Commercial |
$45.11
|
| Rate for Payer: Blue Shield of California EPN |
$35.48
|
| Rate for Payer: Caremore Medicare Advantage |
$47.63
|
| Rate for Payer: Cash Price |
$32.85
|
| Rate for Payer: Cash Price |
$32.85
|
| Rate for Payer: Central Health Plan Commercial |
$58.40
|
| Rate for Payer: Cigna of CA HMO |
$46.72
|
| Rate for Payer: Cigna of CA PPO |
$54.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$71.44
|
| Rate for Payer: Dignity Health Media |
$47.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.30
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$47.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$47.63
|
| Rate for Payer: Galaxy Health WC |
$62.05
|
| Rate for Payer: Global Benefits Group Commercial |
$43.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$65.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$54.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$78.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$78.59
|
| 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 |
$48.69
|
| 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 |
$14.60
|
| 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 |
$54.75
|
| Rate for Payer: Networks By Design Commercial |
$47.45
|
| Rate for Payer: Prime Health Services Commercial |
$62.05
|
| 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 |
$43.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$43.80
|
| 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: 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
|
$927.00
|
|
|
Service Code
|
CPT 80074
|
| Hospital Charge Code |
900910701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$185.40 |
| Max. Negotiated Rate |
$834.30 |
| Rate for Payer: Cash Price |
$417.15
|
| Rate for Payer: Central Health Plan Commercial |
$741.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$370.80
|
| Rate for Payer: Galaxy Health WC |
$787.95
|
| Rate for Payer: Global Benefits Group Commercial |
$556.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$834.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$618.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$353.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.40
|
| Rate for Payer: Multiplan Commercial |
$695.25
|
| Rate for Payer: Networks By Design Commercial |
$602.55
|
| Rate for Payer: Prime Health Services Commercial |
$787.95
|
|
|
HC ADAPTER RT ANGLE Y PORT 12" AMT BUTTON
|
Facility
|
IP
|
$66.42
|
|
| Hospital Charge Code |
901698132
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.28 |
| Max. Negotiated Rate |
$59.78 |
| Rate for Payer: Cash Price |
$29.89
|
| Rate for Payer: Central Health Plan Commercial |
$53.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.57
|
| Rate for Payer: Galaxy Health WC |
$56.46
|
| Rate for Payer: Global Benefits Group Commercial |
$39.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$59.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.28
|
| Rate for Payer: Multiplan Commercial |
$49.82
|
| Rate for Payer: Networks By Design Commercial |
$43.17
|
| Rate for Payer: Prime Health Services Commercial |
$56.46
|
|
|
HC ADAPTER RT ANGLE Y PORT 12" AMT BUTTON
|
Facility
|
OP
|
$66.42
|
|
| Hospital Charge Code |
901698132
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.28 |
| Max. Negotiated Rate |
$59.78 |
| Rate for Payer: Aetna of CA HMO/PPO |
$40.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$56.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$36.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$32.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.24
|
| Rate for Payer: Blue Distinction Transplant |
$39.85
|
| Rate for Payer: Blue Shield of California Commercial |
$41.78
|
| Rate for Payer: Blue Shield of California EPN |
$32.48
|
| Rate for Payer: Cash Price |
$29.89
|
| Rate for Payer: Central Health Plan Commercial |
$53.14
|
| Rate for Payer: Cigna of CA HMO |
$42.51
|
| Rate for Payer: Cigna of CA PPO |
$49.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.46
|
| Rate for Payer: Dignity Health Media |
$56.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.57
|
| Rate for Payer: EPIC Health Plan Transplant |
$26.57
|
| Rate for Payer: Galaxy Health WC |
$56.46
|
| Rate for Payer: Global Benefits Group Commercial |
$39.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$59.78
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$49.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.28
|
| Rate for Payer: Multiplan Commercial |
$49.82
|
| Rate for Payer: Networks By Design Commercial |
$43.17
|
| Rate for Payer: Prime Health Services Commercial |
$56.46
|
| Rate for Payer: Riverside University Health System MISP |
$26.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.21
|
| Rate for Payer: United Healthcare All Other HMO |
$33.21
|
| Rate for Payer: United Healthcare HMO Rider |
$33.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$33.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.46
|
| Rate for Payer: Vantage Medical Group Senior |
$56.46
|
|
|
HC ADAPTION/TRAIN SPEECH DEVICE
|
Facility
|
IP
|
$229.00
|
|
|
Service Code
|
CPT 92606
|
| Hospital Charge Code |
905601756
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$45.80 |
| Max. Negotiated Rate |
$206.10 |
| Rate for Payer: Cash Price |
$103.05
|
| Rate for Payer: Central Health Plan Commercial |
$183.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.60
|
| Rate for Payer: Galaxy Health WC |
$194.65
|
| Rate for Payer: Global Benefits Group Commercial |
$137.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$206.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$152.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.80
|
| Rate for Payer: Multiplan Commercial |
$171.75
|
| Rate for Payer: Networks By Design Commercial |
$148.85
|
| Rate for Payer: Prime Health Services Commercial |
$194.65
|
|
|
HC ADAPTION/TRAIN SPEECH DEVICE
|
Facility
|
OP
|
$229.00
|
|
|
Service Code
|
CPT 92606
|
| Hospital Charge Code |
905601756
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$66.04 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$406.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$194.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$125.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$125.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$137.40
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$103.05
|
| Rate for Payer: Cash Price |
$103.05
|
| Rate for Payer: Cash Price |
$103.05
|
| Rate for Payer: Cash Price |
$103.05
|
| Rate for Payer: Central Health Plan Commercial |
$183.20
|
| Rate for Payer: Cigna of CA HMO |
$146.56
|
| Rate for Payer: Cigna of CA PPO |
$169.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$194.65
|
| Rate for Payer: Dignity Health Media |
$194.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$194.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$91.60
|
| Rate for Payer: Galaxy Health WC |
$194.65
|
| Rate for Payer: Global Benefits Group Commercial |
$137.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$206.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$171.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$80.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$152.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.89
|
| Rate for Payer: Multiplan Commercial |
$171.75
|
| Rate for Payer: Networks By Design Commercial |
$148.85
|
| Rate for Payer: Prime Health Services Commercial |
$194.65
|
| Rate for Payer: Riverside University Health System MISP |
$91.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$137.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$137.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$194.65
|
| Rate for Payer: Vantage Medical Group Senior |
$194.65
|
|
|
HC ADAPTION/TRAIN SPEECH DEVICE MCAL
|
Facility
|
OP
|
$229.00
|
|
|
Service Code
|
CPT 92606
|
| Hospital Charge Code |
907000001
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$66.04 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$406.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$194.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$125.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$125.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$137.40
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$103.05
|
| Rate for Payer: Cash Price |
$103.05
|
| Rate for Payer: Cash Price |
$103.05
|
| Rate for Payer: Cash Price |
$103.05
|
| Rate for Payer: Central Health Plan Commercial |
$183.20
|
| Rate for Payer: Cigna of CA HMO |
$146.56
|
| Rate for Payer: Cigna of CA PPO |
$169.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$194.65
|
| Rate for Payer: Dignity Health Media |
$194.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$194.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$91.60
|
| Rate for Payer: Galaxy Health WC |
$194.65
|
| Rate for Payer: Global Benefits Group Commercial |
$137.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$206.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$171.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$80.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$152.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.89
|
| Rate for Payer: Multiplan Commercial |
$171.75
|
| Rate for Payer: Networks By Design Commercial |
$148.85
|
| Rate for Payer: Prime Health Services Commercial |
$194.65
|
| Rate for Payer: Riverside University Health System MISP |
$91.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$137.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$137.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$194.65
|
| Rate for Payer: Vantage Medical Group Senior |
$194.65
|
|
|
HC ADAPTION/TRAIN SPEECH DEVICE MCAL
|
Facility
|
IP
|
$229.00
|
|
|
Service Code
|
CPT 92606
|
| Hospital Charge Code |
907000001
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$45.80 |
| Max. Negotiated Rate |
$206.10 |
| Rate for Payer: Cash Price |
$103.05
|
| Rate for Payer: Central Health Plan Commercial |
$183.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.60
|
| Rate for Payer: Galaxy Health WC |
$194.65
|
| Rate for Payer: Global Benefits Group Commercial |
$137.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$206.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$152.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.80
|
| Rate for Payer: Multiplan Commercial |
$171.75
|
| Rate for Payer: Networks By Design Commercial |
$148.85
|
| Rate for Payer: Prime Health Services Commercial |
$194.65
|
|
|
HC ADC LLUH CURR/FORMER EMP RATE
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT S5102
|
| Hospital Charge Code |
908000003
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$762.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$306.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$45.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$39.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.45
|
| Rate for Payer: Blue Distinction Transplant |
$49.20
|
| Rate for Payer: Blue Shield of California Commercial |
$51.58
|
| Rate for Payer: Blue Shield of California EPN |
$40.10
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.70
|
| Rate for Payer: Dignity Health Media |
$69.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$61.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Riverside University Health System MISP |
$32.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$762.00
|
| Rate for Payer: United Healthcare All Other HMO |
$515.00
|
| Rate for Payer: United Healthcare HMO Rider |
$312.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$285.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.70
|
| Rate for Payer: Vantage Medical Group Senior |
$69.70
|
|
|
HC ADC LLUH CURR/FORMER EMP RATE
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT S5102
|
| Hospital Charge Code |
908000003
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
|
|
HC ADC W ADDL SERVICE
|
Facility
|
IP
|
$158.00
|
|
|
Service Code
|
CPT S5102
|
| Hospital Charge Code |
908000015
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$31.60 |
| Max. Negotiated Rate |
$142.20 |
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Central Health Plan Commercial |
$126.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.20
|
| Rate for Payer: Galaxy Health WC |
$134.30
|
| Rate for Payer: Global Benefits Group Commercial |
$94.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$142.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$105.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.60
|
| Rate for Payer: Multiplan Commercial |
$118.50
|
| Rate for Payer: Networks By Design Commercial |
$102.70
|
| Rate for Payer: Prime Health Services Commercial |
$134.30
|
|
|
HC ADC W ADDL SERVICE
|
Facility
|
OP
|
$158.00
|
|
|
Service Code
|
CPT S5102
|
| Hospital Charge Code |
908000015
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$31.60 |
| Max. Negotiated Rate |
$762.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$306.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$134.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$86.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$86.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$76.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$93.35
|
| Rate for Payer: Blue Distinction Transplant |
$94.80
|
| Rate for Payer: Blue Shield of California Commercial |
$99.38
|
| Rate for Payer: Blue Shield of California EPN |
$77.26
|
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Central Health Plan Commercial |
$126.40
|
| Rate for Payer: Cigna of CA HMO |
$101.12
|
| Rate for Payer: Cigna of CA PPO |
$116.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$134.30
|
| Rate for Payer: Dignity Health Media |
$134.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$134.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$63.20
|
| Rate for Payer: Galaxy Health WC |
$134.30
|
| Rate for Payer: Global Benefits Group Commercial |
$94.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$142.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$118.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$55.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$105.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.60
|
| Rate for Payer: Multiplan Commercial |
$118.50
|
| Rate for Payer: Networks By Design Commercial |
$102.70
|
| Rate for Payer: Prime Health Services Commercial |
$134.30
|
| Rate for Payer: Riverside University Health System MISP |
$63.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$94.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$94.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$762.00
|
| Rate for Payer: United Healthcare All Other HMO |
$515.00
|
| Rate for Payer: United Healthcare HMO Rider |
$312.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$285.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$134.30
|
| Rate for Payer: Vantage Medical Group Senior |
$134.30
|
|
|
HC ADD ABDOMINAL BAND/STAP
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
CPT L2660
|
| Hospital Charge Code |
905352660
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$212.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$137.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$121.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.70
|
| Rate for Payer: Blue Distinction Transplant |
$150.00
|
| Rate for Payer: Blue Shield of California Commercial |
$187.50
|
| Rate for Payer: Blue Shield of California EPN |
$136.00
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Central Health Plan Commercial |
$200.00
|
| Rate for Payer: Cigna of CA HMO |
$175.00
|
| Rate for Payer: Cigna of CA PPO |
$175.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$212.50
|
| Rate for Payer: Dignity Health Media |
$212.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$212.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$100.00
|
| Rate for Payer: Galaxy Health WC |
$212.50
|
| Rate for Payer: Global Benefits Group Commercial |
$150.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$225.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$187.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$87.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.50
|
| Rate for Payer: Multiplan Commercial |
$187.50
|
| Rate for Payer: Networks By Design Commercial |
$125.00
|
| Rate for Payer: Prime Health Services Commercial |
$212.50
|
| Rate for Payer: Riverside University Health System MISP |
$100.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$150.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$150.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO |
$125.00
|
| Rate for Payer: United Healthcare HMO Rider |
$125.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$125.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$212.50
|
| Rate for Payer: Vantage Medical Group Senior |
$212.50
|
|
|
HC ADD ABDOMINAL BAND/STAP
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
CPT L2660
|
| Hospital Charge Code |
905352660
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Blue Shield of California EPN |
$133.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Central Health Plan Commercial |
$200.00
|
| Rate for Payer: Cigna of CA HMO |
$175.00
|
| Rate for Payer: Cigna of CA PPO |
$175.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$100.00
|
| Rate for Payer: Galaxy Health WC |
$212.50
|
| Rate for Payer: Global Benefits Group Commercial |
$150.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$225.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.00
|
| Rate for Payer: Multiplan Commercial |
$187.50
|
| Rate for Payer: Networks By Design Commercial |
$125.00
|
| Rate for Payer: Prime Health Services Commercial |
$212.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$94.40
|
| Rate for Payer: United Healthcare All Other HMO |
$92.20
|
| Rate for Payer: United Healthcare HMO Rider |
$90.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$82.50
|
|
|
HC ADD ENOSK KNEE SHIN SYS STNC
|
Facility
|
IP
|
$9,077.00
|
|
|
Service Code
|
CPT L5845
|
| Hospital Charge Code |
905355845
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,815.40 |
| Max. Negotiated Rate |
$8,169.30 |
| Rate for Payer: Blue Shield of California EPN |
$4,847.12
|
| Rate for Payer: Cash Price |
$4,084.65
|
| Rate for Payer: Central Health Plan Commercial |
$7,261.60
|
| Rate for Payer: Cigna of CA HMO |
$6,353.90
|
| Rate for Payer: Cigna of CA PPO |
$6,353.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,630.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,630.80
|
| Rate for Payer: Galaxy Health WC |
$7,715.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5,446.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,169.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,054.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,458.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,815.40
|
| Rate for Payer: Multiplan Commercial |
$6,807.75
|
| Rate for Payer: Networks By Design Commercial |
$4,538.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,715.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,427.48
|
| Rate for Payer: United Healthcare All Other HMO |
$3,347.60
|
| Rate for Payer: United Healthcare HMO Rider |
$3,274.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,995.41
|
|
|
HC ADD ENOSK KNEE SHIN SYS STNC
|
Facility
|
OP
|
$9,077.00
|
|
|
Service Code
|
CPT L5845
|
| Hospital Charge Code |
905355845
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,144.89 |
| Max. Negotiated Rate |
$8,169.30 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,715.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,992.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,992.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,395.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,362.69
|
| Rate for Payer: Blue Distinction Transplant |
$5,446.20
|
| Rate for Payer: Blue Shield of California Commercial |
$6,807.75
|
| Rate for Payer: Blue Shield of California EPN |
$4,937.89
|
| Rate for Payer: Cash Price |
$4,084.65
|
| Rate for Payer: Cash Price |
$4,084.65
|
| Rate for Payer: Central Health Plan Commercial |
$7,261.60
|
| Rate for Payer: Cigna of CA HMO |
$6,353.90
|
| Rate for Payer: Cigna of CA PPO |
$6,353.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,715.45
|
| Rate for Payer: Dignity Health Media |
$7,715.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,715.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,630.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,630.80
|
| Rate for Payer: Galaxy Health WC |
$7,715.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5,446.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,169.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,807.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,176.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,054.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,144.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,721.57
|
| Rate for Payer: Multiplan Commercial |
$6,807.75
|
| Rate for Payer: Networks By Design Commercial |
$4,538.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,715.45
|
| Rate for Payer: Riverside University Health System MISP |
$3,630.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,446.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,446.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,538.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,538.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,538.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,538.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,715.45
|
| Rate for Payer: Vantage Medical Group Senior |
$7,715.45
|
|
|
HC ADDITIONAL FROZEN SECTIONS
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
CPT 88332
|
| Hospital Charge Code |
903800036
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$82.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$62.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$78.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$50.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$50.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$60.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$74.02
|
| Rate for Payer: Blue Distinction Transplant |
$55.20
|
| Rate for Payer: Blue Shield of California Commercial |
$56.86
|
| Rate for Payer: Blue Shield of California EPN |
$44.71
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Central Health Plan Commercial |
$73.60
|
| Rate for Payer: Cigna of CA HMO |
$58.88
|
| Rate for Payer: Cigna of CA PPO |
$68.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$78.20
|
| Rate for Payer: Dignity Health Media |
$78.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$78.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$36.80
|
| Rate for Payer: Galaxy Health WC |
$78.20
|
| Rate for Payer: Global Benefits Group Commercial |
$55.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$82.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$69.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$32.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$61.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.40
|
| Rate for Payer: Multiplan Commercial |
$69.00
|
| Rate for Payer: Networks By Design Commercial |
$59.80
|
| Rate for Payer: Prime Health Services Commercial |
$78.20
|
| Rate for Payer: Riverside University Health System MISP |
$36.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$55.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$55.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.90
|
| Rate for Payer: United Healthcare All Other HMO |
$19.90
|
| Rate for Payer: United Healthcare HMO Rider |
$19.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$78.20
|
| Rate for Payer: Vantage Medical Group Senior |
$78.20
|
|
|
HC ADDITIONAL FROZEN SECTIONS
|
Facility
|
IP
|
$389.00
|
|
|
Service Code
|
CPT 88332
|
| Hospital Charge Code |
903800036
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$77.80 |
| Max. Negotiated Rate |
$350.10 |
| Rate for Payer: Cash Price |
$175.05
|
| Rate for Payer: Central Health Plan Commercial |
$311.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$155.60
|
| Rate for Payer: Galaxy Health WC |
$330.65
|
| Rate for Payer: Global Benefits Group Commercial |
$233.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$350.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$259.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$148.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.80
|
| Rate for Payer: Multiplan Commercial |
$291.75
|
| Rate for Payer: Networks By Design Commercial |
$252.85
|
| Rate for Payer: Prime Health Services Commercial |
$330.65
|
|
