|
HC CELL COUNT & DIFF
|
Facility
|
OP
|
$59.00
|
|
|
Service Code
|
CPT 89051
|
| Hospital Charge Code |
900910124
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.54 |
| Max. Negotiated Rate |
$53.10 |
| Rate for Payer: Adventist Health Commercial |
$11.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$35.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$40.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.14
|
| Rate for Payer: Blue Shield of California Commercial |
$35.81
|
| Rate for Payer: Blue Shield of California EPN |
$23.42
|
| Rate for Payer: Cash Price |
$32.45
|
| Rate for Payer: Cash Price |
$32.45
|
| Rate for Payer: Central Health Plan Commercial |
$47.20
|
| Rate for Payer: Cigna of CA HMO |
$37.76
|
| Rate for Payer: Cigna of CA PPO |
$43.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.56
|
| Rate for Payer: EPIC Health Plan Senior |
$5.60
|
| Rate for Payer: Galaxy Health WC |
$50.15
|
| Rate for Payer: Global Benefits Group Commercial |
$35.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.60
|
| Rate for Payer: InnovAge PACE Commercial |
$8.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.50
|
| Rate for Payer: Multiplan Commercial |
$44.25
|
| Rate for Payer: Networks By Design Commercial |
$38.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.60
|
| Rate for Payer: Prime Health Services Commercial |
$50.15
|
| Rate for Payer: Prime Health Services Medicare |
$5.94
|
| Rate for Payer: Riverside University Health System MISP |
$6.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.54
|
| Rate for Payer: United Healthcare All Other HMO |
$4.54
|
| Rate for Payer: United Healthcare HMO Rider |
$4.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.16
|
| Rate for Payer: Vantage Medical Group Senior |
$5.60
|
|
|
HC CELL EXPANSION
|
Facility
|
IP
|
$346.00
|
|
|
Service Code
|
CPT 88233
|
| Hospital Charge Code |
900918001
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$69.20 |
| Max. Negotiated Rate |
$311.40 |
| Rate for Payer: Adventist Health Commercial |
$69.20
|
| Rate for Payer: Cash Price |
$190.30
|
| Rate for Payer: Central Health Plan Commercial |
$276.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$138.40
|
| Rate for Payer: EPIC Health Plan Senior |
$138.40
|
| Rate for Payer: Galaxy Health WC |
$294.10
|
| Rate for Payer: Global Benefits Group Commercial |
$207.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$311.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$230.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$131.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$214.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.20
|
| Rate for Payer: Multiplan Commercial |
$259.50
|
| Rate for Payer: Networks By Design Commercial |
$224.90
|
| Rate for Payer: Prime Health Services Commercial |
$294.10
|
|
|
HC CELL EXPANSION
|
Facility
|
OP
|
$346.00
|
|
|
Service Code
|
CPT 88233
|
| Hospital Charge Code |
900918001
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$69.20 |
| Max. Negotiated Rate |
$869.10 |
| Rate for Payer: Adventist Health Commercial |
$69.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$140.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$210.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$211.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$154.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$140.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$869.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$176.39
|
| Rate for Payer: Blue Shield of California Commercial |
$210.02
|
| Rate for Payer: Blue Shield of California EPN |
$137.36
|
| Rate for Payer: Cash Price |
$190.30
|
| Rate for Payer: Cash Price |
$190.30
|
| Rate for Payer: Central Health Plan Commercial |
$276.80
|
| Rate for Payer: Cigna of CA HMO |
$221.44
|
| Rate for Payer: Cigna of CA PPO |
$256.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$211.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$154.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$140.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$189.99
|
| Rate for Payer: EPIC Health Plan Senior |
$140.73
|
| Rate for Payer: Galaxy Health WC |
$294.10
|
| Rate for Payer: Global Benefits Group Commercial |
$207.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$311.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$230.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$215.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$140.73
|
| Rate for Payer: InnovAge PACE Commercial |
$211.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$230.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$237.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$140.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$188.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$188.58
|
| Rate for Payer: Multiplan Commercial |
$259.50
|
| Rate for Payer: Networks By Design Commercial |
$224.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$140.73
|
| Rate for Payer: Prime Health Services Commercial |
$294.10
|
| Rate for Payer: Prime Health Services Medicare |
$149.17
|
| Rate for Payer: Riverside University Health System MISP |
$154.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$207.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$207.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$113.99
|
| Rate for Payer: United Healthcare All Other HMO |
$113.99
|
| Rate for Payer: United Healthcare HMO Rider |
$113.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$113.99
|
| Rate for Payer: Upland Medical Group Pediatric |
$140.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$211.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$154.80
|
| Rate for Payer: Vantage Medical Group Senior |
$140.73
|
|
|
HC CELL EXPANSION
|
Facility
|
OP
|
$334.00
|
|
|
Service Code
|
CPT 88233
|
| Hospital Charge Code |
900912601
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$66.80 |
| Max. Negotiated Rate |
$869.10 |
| Rate for Payer: Adventist Health Commercial |
$66.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$140.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$202.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$211.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$154.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$140.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$869.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$176.39
|
| Rate for Payer: Blue Shield of California Commercial |
$202.74
|
| Rate for Payer: Blue Shield of California EPN |
$132.60
|
| Rate for Payer: Cash Price |
$183.70
|
| Rate for Payer: Cash Price |
$183.70
|
| Rate for Payer: Central Health Plan Commercial |
$267.20
|
| Rate for Payer: Cigna of CA HMO |
$213.76
|
| Rate for Payer: Cigna of CA PPO |
$247.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$211.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$154.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$140.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$189.99
|
| Rate for Payer: EPIC Health Plan Senior |
$140.73
|
| Rate for Payer: Galaxy Health WC |
$283.90
|
| Rate for Payer: Global Benefits Group Commercial |
$200.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$300.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$230.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$215.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$140.73
|
| Rate for Payer: InnovAge PACE Commercial |
$211.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$222.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$237.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$140.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$188.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$188.58
|
| Rate for Payer: Multiplan Commercial |
$250.50
|
| Rate for Payer: Networks By Design Commercial |
$217.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$140.73
|
| Rate for Payer: Prime Health Services Commercial |
$283.90
|
| Rate for Payer: Prime Health Services Medicare |
$149.17
|
| Rate for Payer: Riverside University Health System MISP |
$154.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$200.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$200.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$113.99
|
| Rate for Payer: United Healthcare All Other HMO |
$113.99
|
| Rate for Payer: United Healthcare HMO Rider |
$113.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$113.99
|
| Rate for Payer: Upland Medical Group Pediatric |
$140.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$211.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$154.80
|
| Rate for Payer: Vantage Medical Group Senior |
$140.73
|
|
|
HC CELL EXPANSION
|
Facility
|
IP
|
$334.00
|
|
|
Service Code
|
CPT 88233
|
| Hospital Charge Code |
900912601
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$66.80 |
| Max. Negotiated Rate |
$300.60 |
| Rate for Payer: Adventist Health Commercial |
$66.80
|
| Rate for Payer: Cash Price |
$183.70
|
| Rate for Payer: Central Health Plan Commercial |
$267.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$133.60
|
| Rate for Payer: EPIC Health Plan Senior |
$133.60
|
| Rate for Payer: Galaxy Health WC |
$283.90
|
| Rate for Payer: Global Benefits Group Commercial |
$200.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$300.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$222.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$127.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$206.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.80
|
| Rate for Payer: Multiplan Commercial |
$250.50
|
| Rate for Payer: Networks By Design Commercial |
$217.10
|
| Rate for Payer: Prime Health Services Commercial |
$283.90
|
|
|
HC CELL MORPHOLOGY (VISUAL)
|
Facility
|
OP
|
$30.29
|
|
|
Service Code
|
CPT 85007
|
| Hospital Charge Code |
900910073
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$27.26 |
| Rate for Payer: Adventist Health Commercial |
$6.06
|
| Rate for Payer: Adventist Health Medi-Cal |
$3.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$25.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.08
|
| Rate for Payer: Blue Shield of California Commercial |
$18.39
|
| Rate for Payer: Blue Shield of California EPN |
$12.03
|
| Rate for Payer: Cash Price |
$16.66
|
| Rate for Payer: Cash Price |
$16.66
|
| Rate for Payer: Central Health Plan Commercial |
$24.23
|
| Rate for Payer: Cigna of CA HMO |
$19.39
|
| Rate for Payer: Cigna of CA PPO |
$22.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.13
|
| Rate for Payer: EPIC Health Plan Senior |
$3.80
|
| Rate for Payer: Galaxy Health WC |
$25.75
|
| Rate for Payer: Global Benefits Group Commercial |
$18.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.26
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.80
|
| Rate for Payer: InnovAge PACE Commercial |
$5.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.09
|
| Rate for Payer: Multiplan Commercial |
$22.72
|
| Rate for Payer: Networks By Design Commercial |
$19.69
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3.80
|
| Rate for Payer: Prime Health Services Commercial |
$25.75
|
| Rate for Payer: Prime Health Services Medicare |
$4.03
|
| Rate for Payer: Riverside University Health System MISP |
$4.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.08
|
| Rate for Payer: United Healthcare All Other HMO |
$3.08
|
| Rate for Payer: United Healthcare HMO Rider |
$3.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.08
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.18
|
| Rate for Payer: Vantage Medical Group Senior |
$3.80
|
|
|
HC CELL MORPHOLOGY (VISUAL)
|
Facility
|
IP
|
$30.29
|
|
|
Service Code
|
CPT 85007
|
| Hospital Charge Code |
900910073
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.06 |
| Max. Negotiated Rate |
$27.26 |
| Rate for Payer: Adventist Health Commercial |
$6.06
|
| Rate for Payer: Cash Price |
$16.66
|
| Rate for Payer: Central Health Plan Commercial |
$24.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.12
|
| Rate for Payer: EPIC Health Plan Senior |
$12.12
|
| Rate for Payer: Galaxy Health WC |
$25.75
|
| Rate for Payer: Global Benefits Group Commercial |
$18.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.06
|
| Rate for Payer: Multiplan Commercial |
$22.72
|
| Rate for Payer: Networks By Design Commercial |
$19.69
|
| Rate for Payer: Prime Health Services Commercial |
$25.75
|
|
|
HC CELL MORPHOLOGY VISUAL INDIVIDUAL
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
CPT 85007
|
| Hospital Charge Code |
900912021
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$25.03 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$3.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$25.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.08
|
| Rate for Payer: Blue Shield of California Commercial |
$14.57
|
| Rate for Payer: Blue Shield of California EPN |
$9.53
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Central Health Plan Commercial |
$19.20
|
| Rate for Payer: Cigna of CA HMO |
$15.36
|
| Rate for Payer: Cigna of CA PPO |
$17.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.13
|
| Rate for Payer: EPIC Health Plan Senior |
$3.80
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.80
|
| Rate for Payer: InnovAge PACE Commercial |
$5.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.09
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3.80
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: Prime Health Services Medicare |
$4.03
|
| Rate for Payer: Riverside University Health System MISP |
$4.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.08
|
| Rate for Payer: United Healthcare All Other HMO |
$3.08
|
| Rate for Payer: United Healthcare HMO Rider |
$3.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.08
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.18
|
| Rate for Payer: Vantage Medical Group Senior |
$3.80
|
|
|
HC CELL MORPHOLOGY VISUAL INDIVIDUAL
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
CPT 85007
|
| Hospital Charge Code |
900912021
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Central Health Plan Commercial |
$19.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
|
|
HC CELLULAR THERAPY RECEIPT AND HANDLING
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
CPT 86999
|
| Hospital Charge Code |
900904800
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$109.80 |
| Rate for Payer: Adventist Health Commercial |
$24.40
|
| Rate for Payer: Cash Price |
$67.10
|
| Rate for Payer: Central Health Plan Commercial |
$97.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.80
|
| Rate for Payer: EPIC Health Plan Senior |
$48.80
|
| Rate for Payer: Galaxy Health WC |
$103.70
|
| Rate for Payer: Global Benefits Group Commercial |
$73.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$109.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$81.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.40
|
| Rate for Payer: Multiplan Commercial |
$91.50
|
| Rate for Payer: Networks By Design Commercial |
$79.30
|
| Rate for Payer: Prime Health Services Commercial |
$103.70
|
|
|
HC CELLULAR THERAPY RECEIPT AND HANDLING
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
CPT 86999
|
| Hospital Charge Code |
900904800
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.44 |
| Max. Negotiated Rate |
$109.80 |
| Rate for Payer: Adventist Health Commercial |
$24.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$31.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$74.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$59.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$71.65
|
| Rate for Payer: Blue Shield of California Commercial |
$74.05
|
| Rate for Payer: Blue Shield of California EPN |
$48.43
|
| Rate for Payer: Cash Price |
$67.10
|
| Rate for Payer: Cash Price |
$67.10
|
| Rate for Payer: Central Health Plan Commercial |
$97.60
|
| Rate for Payer: Cigna of CA HMO |
$78.08
|
| Rate for Payer: Cigna of CA PPO |
$90.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.01
|
| Rate for Payer: EPIC Health Plan Senior |
$31.12
|
| Rate for Payer: Galaxy Health WC |
$103.70
|
| Rate for Payer: Global Benefits Group Commercial |
$73.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$109.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$51.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$31.12
|
| Rate for Payer: InnovAge PACE Commercial |
$46.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$81.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.70
|
| Rate for Payer: Multiplan Commercial |
$91.50
|
| Rate for Payer: Networks By Design Commercial |
$79.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$31.12
|
| Rate for Payer: Prime Health Services Commercial |
$103.70
|
| Rate for Payer: Prime Health Services Medicare |
$32.99
|
| Rate for Payer: Riverside University Health System MISP |
$34.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$73.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$73.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.44
|
| Rate for Payer: United Healthcare All Other HMO |
$20.44
|
| Rate for Payer: United Healthcare HMO Rider |
$20.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.44
|
| Rate for Payer: Upland Medical Group Pediatric |
$31.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.23
|
| Rate for Payer: Vantage Medical Group Senior |
$31.12
|
|
|
HC CEMENTOPLASTY
|
Facility
|
IP
|
$1,065.00
|
|
|
Service Code
|
CPT 20999
|
| Hospital Charge Code |
909080999
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$213.00 |
| Max. Negotiated Rate |
$958.50 |
| Rate for Payer: Adventist Health Commercial |
$213.00
|
| Rate for Payer: Cash Price |
$585.75
|
| Rate for Payer: Central Health Plan Commercial |
$852.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$426.00
|
| Rate for Payer: EPIC Health Plan Senior |
$426.00
|
| Rate for Payer: Galaxy Health WC |
$905.25
|
| Rate for Payer: Global Benefits Group Commercial |
$639.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$958.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$710.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$405.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$659.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.00
|
| Rate for Payer: Multiplan Commercial |
$798.75
|
| Rate for Payer: Networks By Design Commercial |
$692.25
|
| Rate for Payer: Prime Health Services Commercial |
$905.25
|
|
|
HC CEMENTOPLASTY
|
Facility
|
OP
|
$1,065.00
|
|
|
Service Code
|
CPT 20999
|
| Hospital Charge Code |
909080999
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$213.00 |
| Max. Negotiated Rate |
$7,764.00 |
| Rate for Payer: Adventist Health Commercial |
$213.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$304.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,764.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$485.64
|
| Rate for Payer: Blue Shield of California Commercial |
$4,851.77
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$585.75
|
| Rate for Payer: Cash Price |
$585.75
|
| Rate for Payer: Cash Price |
$585.75
|
| Rate for Payer: Central Health Plan Commercial |
$852.00
|
| Rate for Payer: Cigna of CA HMO |
$681.60
|
| Rate for Payer: Cigna of CA PPO |
$788.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$411.47
|
| Rate for Payer: EPIC Health Plan Senior |
$304.79
|
| Rate for Payer: Galaxy Health WC |
$905.25
|
| Rate for Payer: Global Benefits Group Commercial |
$639.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$958.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$499.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.79
|
| Rate for Payer: InnovAge PACE Commercial |
$457.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$710.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$408.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.42
|
| Rate for Payer: Multiplan Commercial |
$798.75
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$692.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$304.79
|
| Rate for Payer: Preferred Health Network WC |
$495.55
|
| Rate for Payer: Prime Health Services Commercial |
$905.25
|
| Rate for Payer: Prime Health Services Medicare |
$323.08
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Riverside University Health System MISP |
$335.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$639.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$304.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Vantage Medical Group Senior |
$304.79
|
|
|
HC CENTRL MOTR STDY UPPER & LOWER
|
Facility
|
IP
|
$2,508.00
|
|
|
Service Code
|
CPT 95939
|
| Hospital Charge Code |
900600322
|
|
Hospital Revenue Code
|
929
|
| Min. Negotiated Rate |
$501.60 |
| Max. Negotiated Rate |
$2,257.20 |
| Rate for Payer: Adventist Health Commercial |
$501.60
|
| Rate for Payer: Cash Price |
$1,379.40
|
| Rate for Payer: Central Health Plan Commercial |
$2,006.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,003.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,003.20
|
| Rate for Payer: Galaxy Health WC |
$2,131.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,504.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,257.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,672.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$955.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,552.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$501.60
|
| Rate for Payer: Multiplan Commercial |
$1,881.00
|
| Rate for Payer: Networks By Design Commercial |
$1,630.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,131.80
|
|
|
HC CENTRL MOTR STDY UPPER & LOWER
|
Facility
|
OP
|
$2,508.00
|
|
|
Service Code
|
CPT 95939
|
| Hospital Charge Code |
900600322
|
|
Hospital Revenue Code
|
929
|
| Min. Negotiated Rate |
$501.60 |
| Max. Negotiated Rate |
$2,257.20 |
| Rate for Payer: Adventist Health Commercial |
$501.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,292.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,523.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,939.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,421.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,292.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,825.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,472.95
|
| Rate for Payer: Blue Shield of California Commercial |
$1,522.36
|
| Rate for Payer: Blue Shield of California EPN |
$995.68
|
| Rate for Payer: Cash Price |
$1,379.40
|
| Rate for Payer: Cash Price |
$1,379.40
|
| Rate for Payer: Cash Price |
$1,379.40
|
| Rate for Payer: Central Health Plan Commercial |
$2,006.40
|
| Rate for Payer: Cigna of CA HMO |
$1,605.12
|
| Rate for Payer: Cigna of CA PPO |
$1,855.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,939.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,421.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,292.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,745.14
|
| Rate for Payer: EPIC Health Plan Senior |
$1,292.70
|
| Rate for Payer: Galaxy Health WC |
$2,131.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,504.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,257.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,120.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$714.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,292.70
|
| Rate for Payer: InnovAge PACE Commercial |
$1,939.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,672.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$789.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,292.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$501.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,732.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,732.22
|
| Rate for Payer: Multiplan Commercial |
$1,881.00
|
| Rate for Payer: Networks By Design Commercial |
$1,630.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,292.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,131.80
|
| Rate for Payer: Prime Health Services Medicare |
$1,370.26
|
| Rate for Payer: Riverside University Health System MISP |
$1,421.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,504.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,504.80
|
| 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 |
$1,292.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,939.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,421.97
|
| Rate for Payer: Vantage Medical Group Senior |
$1,292.70
|
|
|
HC CENTROMERE AB
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900913527
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Adventist Health Commercial |
$12.80
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Central Health Plan Commercial |
$51.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.60
|
| Rate for Payer: EPIC Health Plan Senior |
$25.60
|
| Rate for Payer: Galaxy Health WC |
$54.40
|
| Rate for Payer: Global Benefits Group Commercial |
$38.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$57.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$39.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.80
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: Networks By Design Commercial |
$41.60
|
| Rate for Payer: Prime Health Services Commercial |
$54.40
|
|
|
HC CENTROMERE AB
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900913527
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$87.72 |
| Rate for Payer: Adventist Health Commercial |
$12.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$38.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$87.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.80
|
| Rate for Payer: Blue Shield of California Commercial |
$38.85
|
| Rate for Payer: Blue Shield of California EPN |
$25.41
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Central Health Plan Commercial |
$51.20
|
| Rate for Payer: Cigna of CA HMO |
$40.96
|
| Rate for Payer: Cigna of CA PPO |
$47.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Senior |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$54.40
|
| Rate for Payer: Global Benefits Group Commercial |
$38.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$57.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: InnovAge PACE Commercial |
$18.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: Networks By Design Commercial |
$41.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.05
|
| Rate for Payer: Prime Health Services Commercial |
$54.40
|
| Rate for Payer: Prime Health Services Medicare |
$12.77
|
| Rate for Payer: Riverside University Health System MISP |
$13.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$38.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$38.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC CEREBRAL BLOOD FLOW
|
Facility
|
IP
|
$2,830.00
|
|
|
Service Code
|
CPT 78610
|
| Hospital Charge Code |
909301412
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$566.00 |
| Max. Negotiated Rate |
$2,547.00 |
| Rate for Payer: Adventist Health Commercial |
$566.00
|
| Rate for Payer: Cash Price |
$1,556.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,264.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,132.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,132.00
|
| Rate for Payer: Galaxy Health WC |
$2,405.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,698.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,547.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,887.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,078.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,751.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$566.00
|
| Rate for Payer: Multiplan Commercial |
$2,122.50
|
| Rate for Payer: Networks By Design Commercial |
$1,839.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,405.50
|
|
|
HC CEREBRAL BLOOD FLOW
|
Facility
|
OP
|
$2,830.00
|
|
|
Service Code
|
CPT 78610
|
| Hospital Charge Code |
909301412
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$69.18 |
| Max. Negotiated Rate |
$2,547.00 |
| Rate for Payer: Adventist Health Commercial |
$566.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$683.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,718.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$752.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$683.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$286.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,662.06
|
| Rate for Payer: Blue Shield of California Commercial |
$1,717.81
|
| Rate for Payer: Blue Shield of California EPN |
$1,123.51
|
| Rate for Payer: Cash Price |
$1,556.50
|
| Rate for Payer: Cash Price |
$1,556.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,264.00
|
| Rate for Payer: Cigna of CA HMO |
$1,811.20
|
| Rate for Payer: Cigna of CA PPO |
$2,094.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$752.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$683.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$923.31
|
| Rate for Payer: EPIC Health Plan Senior |
$683.93
|
| Rate for Payer: Galaxy Health WC |
$2,405.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,698.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,547.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,121.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$69.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$683.93
|
| Rate for Payer: InnovAge PACE Commercial |
$1,025.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,887.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$683.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$566.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$916.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$916.47
|
| Rate for Payer: Multiplan Commercial |
$2,122.50
|
| Rate for Payer: Networks By Design Commercial |
$1,839.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$683.93
|
| Rate for Payer: Prime Health Services Commercial |
$2,405.50
|
| Rate for Payer: Prime Health Services Medicare |
$724.97
|
| Rate for Payer: Riverside University Health System MISP |
$752.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,698.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,698.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$616.06
|
| Rate for Payer: United Healthcare All Other HMO |
$616.06
|
| Rate for Payer: United Healthcare HMO Rider |
$616.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$616.06
|
| Rate for Payer: Upland Medical Group Pediatric |
$683.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$752.32
|
| Rate for Payer: Vantage Medical Group Senior |
$683.93
|
|
|
HC CERULOPLASMIN
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT 82390
|
| Hospital Charge Code |
900910839
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Cash Price |
$45.10
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| 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 CERULOPLASMIN
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT 82390
|
| Hospital Charge Code |
900910839
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.70 |
| Max. Negotiated Rate |
$78.12 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$10.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$78.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.85
|
| Rate for Payer: Blue Shield of California Commercial |
$49.77
|
| Rate for Payer: Blue Shield of California EPN |
$32.55
|
| Rate for Payer: Cash Price |
$45.10
|
| Rate for Payer: Cash Price |
$45.10
|
| 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 |
$16.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.50
|
| Rate for Payer: EPIC Health Plan Senior |
$10.74
|
| 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: Heritage Provider Network Commercial/Senior |
$17.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$16.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.74
|
| Rate for Payer: InnovAge PACE Commercial |
$16.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.39
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$10.74
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Prime Health Services Medicare |
$11.38
|
| Rate for Payer: Riverside University Health System MISP |
$11.81
|
| 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 |
$8.70
|
| Rate for Payer: United Healthcare All Other HMO |
$8.70
|
| Rate for Payer: United Healthcare HMO Rider |
$8.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$10.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.81
|
| Rate for Payer: Vantage Medical Group Senior |
$10.74
|
|
|
HC CERVICAL CAP REMOVAL
|
Facility
|
OP
|
$616.00
|
|
|
Service Code
|
CPT 59899
|
| Hospital Charge Code |
910400031
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$123.20 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Commercial |
$123.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$383.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$281.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$255.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$407.27
|
| Rate for Payer: Cash Price |
$338.80
|
| Rate for Payer: Cash Price |
$338.80
|
| Rate for Payer: Cash Price |
$338.80
|
| Rate for Payer: Cash Price |
$338.80
|
| Rate for Payer: Central Health Plan Commercial |
$492.80
|
| Rate for Payer: Cigna of CA HMO |
$394.24
|
| Rate for Payer: Cigna of CA PPO |
$455.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$383.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$281.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$255.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$345.07
|
| Rate for Payer: EPIC Health Plan Senior |
$255.61
|
| Rate for Payer: Galaxy Health WC |
$523.60
|
| Rate for Payer: Global Benefits Group Commercial |
$369.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$554.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$419.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$255.61
|
| Rate for Payer: InnovAge PACE Commercial |
$383.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$410.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$255.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$342.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$342.52
|
| Rate for Payer: Multiplan Commercial |
$462.00
|
| Rate for Payer: Multiplan WC |
$407.27
|
| Rate for Payer: Networks By Design Commercial |
$400.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$255.61
|
| Rate for Payer: Preferred Health Network WC |
$415.58
|
| Rate for Payer: Prime Health Services Commercial |
$523.60
|
| Rate for Payer: Prime Health Services Medicare |
$270.95
|
| Rate for Payer: Prime Health Services WC |
$403.11
|
| Rate for Payer: Riverside University Health System MISP |
$281.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$369.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$308.00
|
| Rate for Payer: United Healthcare All Other HMO |
$308.00
|
| Rate for Payer: United Healthcare HMO Rider |
$308.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$308.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$255.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$383.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$281.17
|
| Rate for Payer: Vantage Medical Group Senior |
$255.61
|
|
|
HC CERVICAL CAP REMOVAL
|
Facility
|
IP
|
$616.00
|
|
|
Service Code
|
CPT 59899
|
| Hospital Charge Code |
910400031
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$123.20 |
| Max. Negotiated Rate |
$554.40 |
| Rate for Payer: Adventist Health Commercial |
$123.20
|
| Rate for Payer: Cash Price |
$338.80
|
| Rate for Payer: Central Health Plan Commercial |
$492.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$246.40
|
| Rate for Payer: EPIC Health Plan Senior |
$246.40
|
| Rate for Payer: Galaxy Health WC |
$523.60
|
| Rate for Payer: Global Benefits Group Commercial |
$369.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$554.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$410.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$234.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$381.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.20
|
| Rate for Payer: Multiplan Commercial |
$462.00
|
| Rate for Payer: Networks By Design Commercial |
$400.40
|
| Rate for Payer: Prime Health Services Commercial |
$523.60
|
|
|
HC CERVICAL DILATOR INSERTION
|
Facility
|
OP
|
$2,167.00
|
|
|
Service Code
|
CPT 59200
|
| Hospital Charge Code |
902400113
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$386.50 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$433.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$386.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$386.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,049.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,272.68
|
| Rate for Payer: Blue Shield of California Commercial |
$1,324.04
|
| Rate for Payer: Blue Shield of California EPN |
$864.63
|
| Rate for Payer: Cash Price |
$1,191.85
|
| Rate for Payer: Cash Price |
$1,191.85
|
| Rate for Payer: Cash Price |
$1,191.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,733.60
|
| Rate for Payer: Cigna of CA HMO |
$1,386.88
|
| Rate for Payer: Cigna of CA PPO |
$1,603.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$579.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$425.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$386.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$521.77
|
| Rate for Payer: EPIC Health Plan Senior |
$386.50
|
| Rate for Payer: Galaxy Health WC |
$1,841.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,300.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,950.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$633.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$386.50
|
| Rate for Payer: InnovAge PACE Commercial |
$579.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,445.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$825.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$386.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$433.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$517.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$517.91
|
| Rate for Payer: Multiplan Commercial |
$1,625.25
|
| Rate for Payer: Networks By Design Commercial |
$1,408.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$386.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,841.95
|
| Rate for Payer: Prime Health Services Medicare |
$409.69
|
| Rate for Payer: Riverside University Health System MISP |
$425.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,300.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,300.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,091.00
|
| Rate for Payer: United Healthcare All Other HMO |
$839.00
|
| Rate for Payer: United Healthcare HMO Rider |
$635.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$581.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$386.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Vantage Medical Group Senior |
$386.50
|
|
|
HC CERVICAL DILATOR INSERTION
|
Facility
|
IP
|
$2,167.00
|
|
|
Service Code
|
CPT 59200
|
| Hospital Charge Code |
902400113
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$433.40 |
| Max. Negotiated Rate |
$1,950.30 |
| Rate for Payer: Adventist Health Commercial |
$433.40
|
| Rate for Payer: Cash Price |
$1,191.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,733.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$866.80
|
| Rate for Payer: EPIC Health Plan Senior |
$866.80
|
| Rate for Payer: Galaxy Health WC |
$1,841.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,300.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,950.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,445.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$825.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,341.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$433.40
|
| Rate for Payer: Multiplan Commercial |
$1,625.25
|
| Rate for Payer: Networks By Design Commercial |
$1,408.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,841.95
|
|
