|
HC CRITICAL CARE ADDL 30 MIN
|
Facility
|
IP
|
$8,331.00
|
|
|
Service Code
|
CPT 99292
|
| Hospital Charge Code |
900501641
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,666.20 |
| Max. Negotiated Rate |
$7,497.90 |
| Rate for Payer: Adventist Health Commercial |
$1,666.20
|
| Rate for Payer: Cash Price |
$4,582.05
|
| Rate for Payer: Central Health Plan Commercial |
$6,664.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,332.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,332.40
|
| Rate for Payer: Galaxy Health WC |
$7,081.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,998.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,497.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,556.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,174.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,156.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,666.20
|
| Rate for Payer: Multiplan Commercial |
$6,248.25
|
| Rate for Payer: Networks By Design Commercial |
$5,415.15
|
| Rate for Payer: Prime Health Services Commercial |
$7,081.35
|
|
|
HC CRITICAL CARE ADDL 30 MIN
|
Facility
|
OP
|
$8,331.00
|
|
|
Service Code
|
CPT 99292
|
| Hospital Charge Code |
900501641
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$111.91 |
| Max. Negotiated Rate |
$7,497.90 |
| Rate for Payer: Adventist Health Commercial |
$1,666.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,081.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,582.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,248.25
|
| 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: Cash Price |
$4,582.05
|
| Rate for Payer: Cash Price |
$4,582.05
|
| Rate for Payer: Cash Price |
$4,582.05
|
| Rate for Payer: Cash Price |
$4,582.05
|
| Rate for Payer: Central Health Plan Commercial |
$6,664.80
|
| Rate for Payer: Cigna of CA HMO |
$5,331.84
|
| Rate for Payer: Cigna of CA PPO |
$6,164.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,081.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,081.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,081.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,332.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,332.40
|
| Rate for Payer: Galaxy Health WC |
$7,081.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,998.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,497.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: InnovAge PACE Commercial |
$4,165.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,556.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,156.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,666.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,831.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,831.70
|
| Rate for Payer: Multiplan Commercial |
$6,248.25
|
| Rate for Payer: Networks By Design Commercial |
$5,415.15
|
| Rate for Payer: Prime Health Services Commercial |
$7,081.35
|
| Rate for Payer: Riverside University Health System MISP |
$3,332.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,998.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,165.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,165.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,165.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,165.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,081.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,081.35
|
| Rate for Payer: Vantage Medical Group Senior |
$7,081.35
|
|
|
HC CRITICAL CARE ADDL 30 MIN
|
Facility
|
OP
|
$8,331.00
|
|
|
Service Code
|
CPT 99292
|
| Hospital Charge Code |
900501641
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$111.91 |
| Max. Negotiated Rate |
$7,497.90 |
| Rate for Payer: Adventist Health Commercial |
$3,415.71
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5,059.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,081.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,582.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,248.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,892.80
|
| Rate for Payer: Cash Price |
$4,582.05
|
| Rate for Payer: Cash Price |
$4,582.05
|
| Rate for Payer: Cash Price |
$4,582.05
|
| Rate for Payer: Cash Price |
$4,582.05
|
| Rate for Payer: Central Health Plan Commercial |
$6,664.80
|
| Rate for Payer: Cigna of CA HMO |
$5,331.84
|
| Rate for Payer: Cigna of CA PPO |
$6,164.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,081.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,081.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,081.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,332.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,332.40
|
| Rate for Payer: Galaxy Health WC |
$7,081.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,998.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,497.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: InnovAge PACE Commercial |
$4,165.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,556.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,156.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,666.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,831.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,831.70
|
| Rate for Payer: Multiplan Commercial |
$6,248.25
|
| Rate for Payer: Networks By Design Commercial |
$5,415.15
|
| Rate for Payer: Prime Health Services Commercial |
$7,081.35
|
| Rate for Payer: Riverside University Health System MISP |
$3,332.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,998.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,998.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,081.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,081.35
|
| Rate for Payer: Vantage Medical Group Senior |
$7,081.35
|
|
|
HC CRITICAL CARE E&M 30-74 MIN
|
Facility
|
IP
|
$16,671.00
|
|
|
Service Code
|
CPT 99291
|
| Hospital Charge Code |
900509291
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$3,334.20 |
| Max. Negotiated Rate |
$15,003.90 |
| Rate for Payer: Adventist Health Commercial |
$3,334.20
|
| Rate for Payer: Cash Price |
$9,169.05
|
| Rate for Payer: Central Health Plan Commercial |
$13,336.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,668.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,668.40
|
| Rate for Payer: Galaxy Health WC |
$14,170.35
|
| Rate for Payer: Global Benefits Group Commercial |
$10,002.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,003.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,119.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,351.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,319.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,334.20
|
| Rate for Payer: Multiplan Commercial |
$12,503.25
|
| Rate for Payer: Networks By Design Commercial |
$10,836.15
|
| Rate for Payer: Prime Health Services Commercial |
$14,170.35
|
|
|
HC CRITICAL CARE E&M 30-74 MIN
|
Facility
|
OP
|
$16,671.00
|
|
|
Service Code
|
CPT 99291
|
| Hospital Charge Code |
900509291
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$231.04 |
| Max. Negotiated Rate |
$15,003.90 |
| Rate for Payer: Adventist Health Commercial |
$3,334.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,605.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,177.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,070.62
|
| 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 |
$1,705.85
|
| Rate for Payer: Cash Price |
$9,169.05
|
| Rate for Payer: Cash Price |
$9,169.05
|
| Rate for Payer: Cash Price |
$9,169.05
|
| Rate for Payer: Cash Price |
$9,169.05
|
| Rate for Payer: Central Health Plan Commercial |
$13,336.80
|
| Rate for Payer: Cigna of CA HMO |
$10,669.44
|
| Rate for Payer: Cigna of CA PPO |
$12,336.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,605.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,177.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,070.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,445.34
|
| Rate for Payer: EPIC Health Plan Senior |
$1,070.62
|
| Rate for Payer: Galaxy Health WC |
$14,170.35
|
| Rate for Payer: Global Benefits Group Commercial |
$10,002.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,003.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,755.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,070.62
|
| Rate for Payer: InnovAge PACE Commercial |
$1,605.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,119.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$231.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,070.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,334.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,434.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,434.63
|
| Rate for Payer: Multiplan Commercial |
$12,503.25
|
| Rate for Payer: Multiplan WC |
$1,705.85
|
| Rate for Payer: Networks By Design Commercial |
$10,836.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,070.62
|
| Rate for Payer: Preferred Health Network WC |
$1,740.66
|
| Rate for Payer: Prime Health Services Commercial |
$14,170.35
|
| Rate for Payer: Prime Health Services Medicare |
$1,134.86
|
| Rate for Payer: Prime Health Services WC |
$1,688.44
|
| Rate for Payer: Riverside University Health System MISP |
$1,177.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,002.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,039.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,075.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,391.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,770.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,070.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,605.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,177.68
|
| Rate for Payer: Vantage Medical Group Senior |
$1,070.62
|
|
|
HC CRITICAL CARE E&M 30-74 MIN
|
Facility
|
OP
|
$16,671.00
|
|
|
Service Code
|
CPT 99291
|
| Hospital Charge Code |
900509291
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$231.04 |
| Max. Negotiated Rate |
$15,003.90 |
| Rate for Payer: Adventist Health Commercial |
$6,835.11
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,124.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,605.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,177.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,070.62
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,572.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,705.85
|
| Rate for Payer: Cash Price |
$9,169.05
|
| Rate for Payer: Cash Price |
$9,169.05
|
| Rate for Payer: Cash Price |
$9,169.05
|
| Rate for Payer: Cash Price |
$9,169.05
|
| Rate for Payer: Central Health Plan Commercial |
$13,336.80
|
| Rate for Payer: Cigna of CA HMO |
$10,669.44
|
| Rate for Payer: Cigna of CA PPO |
$12,336.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,605.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,177.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,070.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,445.34
|
| Rate for Payer: EPIC Health Plan Senior |
$1,070.62
|
| Rate for Payer: Galaxy Health WC |
$14,170.35
|
| Rate for Payer: Global Benefits Group Commercial |
$10,002.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,003.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,755.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,070.62
|
| Rate for Payer: InnovAge PACE Commercial |
$1,605.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,119.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$231.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,070.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,334.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,434.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,434.63
|
| Rate for Payer: Multiplan Commercial |
$12,503.25
|
| Rate for Payer: Multiplan WC |
$1,705.85
|
| Rate for Payer: Networks By Design Commercial |
$10,836.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,070.62
|
| Rate for Payer: Preferred Health Network WC |
$1,740.66
|
| Rate for Payer: Prime Health Services Commercial |
$14,170.35
|
| Rate for Payer: Prime Health Services Medicare |
$1,134.86
|
| Rate for Payer: Prime Health Services WC |
$1,688.44
|
| Rate for Payer: Riverside University Health System MISP |
$1,177.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,002.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10,002.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,070.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,605.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,177.68
|
| Rate for Payer: Vantage Medical Group Senior |
$1,070.62
|
|
|
HC CRITICAL CARE E&M 30-74 MIN
|
Facility
|
IP
|
$16,671.00
|
|
|
Service Code
|
CPT 99291
|
| Hospital Charge Code |
900509291
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,334.20 |
| Max. Negotiated Rate |
$15,003.90 |
| Rate for Payer: Adventist Health Commercial |
$3,334.20
|
| Rate for Payer: Cash Price |
$9,169.05
|
| Rate for Payer: Central Health Plan Commercial |
$13,336.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,668.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,668.40
|
| Rate for Payer: Galaxy Health WC |
$14,170.35
|
| Rate for Payer: Global Benefits Group Commercial |
$10,002.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,003.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,119.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,351.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,319.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,334.20
|
| Rate for Payer: Multiplan Commercial |
$12,503.25
|
| Rate for Payer: Networks By Design Commercial |
$10,836.15
|
| Rate for Payer: Prime Health Services Commercial |
$14,170.35
|
|
|
HC CROSSMATCH COMP
|
Facility
|
OP
|
$269.00
|
|
|
Service Code
|
CPT 86923
|
| Hospital Charge Code |
900904766
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.52 |
| Max. Negotiated Rate |
$357.08 |
| Rate for Payer: Adventist Health Commercial |
$53.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$217.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$163.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$61.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.52
|
| Rate for Payer: Blue Shield of California Commercial |
$163.28
|
| Rate for Payer: Blue Shield of California EPN |
$106.79
|
| Rate for Payer: Cash Price |
$147.95
|
| Rate for Payer: Cash Price |
$147.95
|
| Rate for Payer: Central Health Plan Commercial |
$215.20
|
| Rate for Payer: Cigna of CA HMO |
$172.16
|
| Rate for Payer: Cigna of CA PPO |
$199.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$326.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$217.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$293.94
|
| Rate for Payer: EPIC Health Plan Senior |
$217.73
|
| Rate for Payer: Galaxy Health WC |
$228.65
|
| Rate for Payer: Global Benefits Group Commercial |
$161.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$242.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$357.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$217.73
|
| Rate for Payer: InnovAge PACE Commercial |
$326.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$179.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$217.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$291.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$291.76
|
| Rate for Payer: Multiplan Commercial |
$201.75
|
| Rate for Payer: Networks By Design Commercial |
$174.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$217.73
|
| Rate for Payer: Prime Health Services Commercial |
$228.65
|
| Rate for Payer: Prime Health Services Medicare |
$230.79
|
| Rate for Payer: Riverside University Health System MISP |
$239.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$161.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$161.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.38
|
| Rate for Payer: United Healthcare All Other HMO |
$123.38
|
| Rate for Payer: United Healthcare HMO Rider |
$123.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.38
|
| Rate for Payer: Upland Medical Group Pediatric |
$217.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Vantage Medical Group Senior |
$217.73
|
|
|
HC CROSSMATCH COMP
|
Facility
|
IP
|
$269.00
|
|
|
Service Code
|
CPT 86923
|
| Hospital Charge Code |
900904766
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.80 |
| Max. Negotiated Rate |
$242.10 |
| Rate for Payer: Adventist Health Commercial |
$53.80
|
| Rate for Payer: Cash Price |
$147.95
|
| Rate for Payer: Central Health Plan Commercial |
$215.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.60
|
| Rate for Payer: EPIC Health Plan Senior |
$107.60
|
| Rate for Payer: Galaxy Health WC |
$228.65
|
| Rate for Payer: Global Benefits Group Commercial |
$161.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$242.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$179.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$166.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.80
|
| Rate for Payer: Multiplan Commercial |
$201.75
|
| Rate for Payer: Networks By Design Commercial |
$174.85
|
| Rate for Payer: Prime Health Services Commercial |
$228.65
|
|
|
HC CROSSMATCH IS
|
Facility
|
IP
|
$686.00
|
|
|
Service Code
|
CPT 86920
|
| Hospital Charge Code |
900904577
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$137.20 |
| Max. Negotiated Rate |
$617.40 |
| Rate for Payer: Adventist Health Commercial |
$137.20
|
| Rate for Payer: Cash Price |
$377.30
|
| Rate for Payer: Central Health Plan Commercial |
$548.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$274.40
|
| Rate for Payer: EPIC Health Plan Senior |
$274.40
|
| Rate for Payer: Galaxy Health WC |
$583.10
|
| Rate for Payer: Global Benefits Group Commercial |
$411.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$617.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$457.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$261.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$424.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$137.20
|
| Rate for Payer: Multiplan Commercial |
$514.50
|
| Rate for Payer: Networks By Design Commercial |
$445.90
|
| Rate for Payer: Prime Health Services Commercial |
$583.10
|
|
|
HC CROSSMATCH IS
|
Facility
|
OP
|
$686.00
|
|
|
Service Code
|
CPT 86920
|
| Hospital Charge Code |
900904577
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.14 |
| Max. Negotiated Rate |
$617.40 |
| Rate for Payer: Adventist Health Commercial |
$137.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$217.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$416.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$261.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.14
|
| Rate for Payer: Blue Shield of California Commercial |
$416.40
|
| Rate for Payer: Blue Shield of California EPN |
$272.34
|
| Rate for Payer: Cash Price |
$377.30
|
| Rate for Payer: Cash Price |
$377.30
|
| Rate for Payer: Central Health Plan Commercial |
$548.80
|
| Rate for Payer: Cigna of CA HMO |
$439.04
|
| Rate for Payer: Cigna of CA PPO |
$507.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$326.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$217.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$293.94
|
| Rate for Payer: EPIC Health Plan Senior |
$217.73
|
| Rate for Payer: Galaxy Health WC |
$583.10
|
| Rate for Payer: Global Benefits Group Commercial |
$411.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$617.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$357.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$217.73
|
| Rate for Payer: InnovAge PACE Commercial |
$326.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$457.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$217.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$137.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$291.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$291.76
|
| Rate for Payer: Multiplan Commercial |
$514.50
|
| Rate for Payer: Networks By Design Commercial |
$445.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$217.73
|
| Rate for Payer: Prime Health Services Commercial |
$583.10
|
| Rate for Payer: Prime Health Services Medicare |
$230.79
|
| Rate for Payer: Riverside University Health System MISP |
$239.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$411.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$411.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.38
|
| Rate for Payer: United Healthcare All Other HMO |
$123.38
|
| Rate for Payer: United Healthcare HMO Rider |
$123.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.38
|
| Rate for Payer: Upland Medical Group Pediatric |
$217.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Vantage Medical Group Senior |
$217.73
|
|
|
HC CROSSMATCH XM
|
Facility
|
OP
|
$761.00
|
|
|
Service Code
|
CPT 86922
|
| Hospital Charge Code |
900904551
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.14 |
| Max. Negotiated Rate |
$684.90 |
| Rate for Payer: Adventist Health Commercial |
$152.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$217.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$462.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$261.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.14
|
| Rate for Payer: Blue Shield of California Commercial |
$461.93
|
| Rate for Payer: Blue Shield of California EPN |
$302.12
|
| Rate for Payer: Cash Price |
$418.55
|
| Rate for Payer: Cash Price |
$418.55
|
| Rate for Payer: Central Health Plan Commercial |
$608.80
|
| Rate for Payer: Cigna of CA HMO |
$487.04
|
| Rate for Payer: Cigna of CA PPO |
$563.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$326.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$217.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$293.94
|
| Rate for Payer: EPIC Health Plan Senior |
$217.73
|
| Rate for Payer: Galaxy Health WC |
$646.85
|
| Rate for Payer: Global Benefits Group Commercial |
$456.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$684.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$357.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$217.73
|
| Rate for Payer: InnovAge PACE Commercial |
$326.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$507.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$217.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$291.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$291.76
|
| Rate for Payer: Multiplan Commercial |
$570.75
|
| Rate for Payer: Networks By Design Commercial |
$494.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$217.73
|
| Rate for Payer: Prime Health Services Commercial |
$646.85
|
| Rate for Payer: Prime Health Services Medicare |
$230.79
|
| Rate for Payer: Riverside University Health System MISP |
$239.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$456.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$456.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.38
|
| Rate for Payer: United Healthcare All Other HMO |
$123.38
|
| Rate for Payer: United Healthcare HMO Rider |
$123.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.38
|
| Rate for Payer: Upland Medical Group Pediatric |
$217.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Vantage Medical Group Senior |
$217.73
|
|
|
HC CROSSMATCH XM
|
Facility
|
IP
|
$761.00
|
|
|
Service Code
|
CPT 86922
|
| Hospital Charge Code |
900904551
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$152.20 |
| Max. Negotiated Rate |
$684.90 |
| Rate for Payer: Adventist Health Commercial |
$152.20
|
| Rate for Payer: Cash Price |
$418.55
|
| Rate for Payer: Central Health Plan Commercial |
$608.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$304.40
|
| Rate for Payer: EPIC Health Plan Senior |
$304.40
|
| Rate for Payer: Galaxy Health WC |
$646.85
|
| Rate for Payer: Global Benefits Group Commercial |
$456.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$684.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$507.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$289.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$471.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.20
|
| Rate for Payer: Multiplan Commercial |
$570.75
|
| Rate for Payer: Networks By Design Commercial |
$494.65
|
| Rate for Payer: Prime Health Services Commercial |
$646.85
|
|
|
HC CRPRA CVRNSA-CRPS SPNGSM SHNT, UNI OR BI
|
Facility
|
IP
|
$15,131.00
|
|
|
Service Code
|
CPT 54430
|
| Hospital Charge Code |
900504430
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,026.20 |
| Max. Negotiated Rate |
$13,617.90 |
| Rate for Payer: Adventist Health Commercial |
$3,026.20
|
| Rate for Payer: Cash Price |
$8,322.05
|
| Rate for Payer: Central Health Plan Commercial |
$12,104.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,052.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,052.40
|
| Rate for Payer: Galaxy Health WC |
$12,861.35
|
| Rate for Payer: Global Benefits Group Commercial |
$9,078.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,617.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,092.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,764.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,366.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,026.20
|
| Rate for Payer: Multiplan Commercial |
$11,348.25
|
| Rate for Payer: Networks By Design Commercial |
$9,835.15
|
| Rate for Payer: Prime Health Services Commercial |
$12,861.35
|
|
|
HC CRPRA CVRNSA-CRPS SPNGSM SHNT, UNI OR BI
|
Facility
|
OP
|
$15,131.00
|
|
|
Service Code
|
CPT 54430
|
| Hospital Charge Code |
900504430
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$13,617.90 |
| Rate for Payer: Adventist Health Commercial |
$3,026.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,861.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,322.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,348.25
|
| 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: Cash Price |
$8,322.05
|
| Rate for Payer: Cash Price |
$8,322.05
|
| Rate for Payer: Cash Price |
$8,322.05
|
| Rate for Payer: Cash Price |
$8,322.05
|
| Rate for Payer: Central Health Plan Commercial |
$12,104.80
|
| Rate for Payer: Cigna of CA HMO |
$9,683.84
|
| Rate for Payer: Cigna of CA PPO |
$11,196.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,861.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,861.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12,861.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,052.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,052.40
|
| Rate for Payer: Galaxy Health WC |
$12,861.35
|
| Rate for Payer: Global Benefits Group Commercial |
$9,078.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,617.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: InnovAge PACE Commercial |
$7,565.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,092.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$929.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,366.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,026.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,591.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,591.70
|
| Rate for Payer: Multiplan Commercial |
$11,348.25
|
| Rate for Payer: Networks By Design Commercial |
$9,835.15
|
| Rate for Payer: Prime Health Services Commercial |
$12,861.35
|
| Rate for Payer: Riverside University Health System MISP |
$6,052.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,078.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,565.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7,565.50
|
| Rate for Payer: United Healthcare HMO Rider |
$7,565.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,565.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,861.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,861.35
|
| Rate for Payer: Vantage Medical Group Senior |
$12,861.35
|
|
|
HC CRYABLATION BONE
|
Facility
|
IP
|
$24,364.00
|
|
|
Service Code
|
CPT 20999
|
| Hospital Charge Code |
909020151
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,872.80 |
| Max. Negotiated Rate |
$21,927.60 |
| Rate for Payer: Adventist Health Commercial |
$4,872.80
|
| Rate for Payer: Cash Price |
$13,400.20
|
| Rate for Payer: Central Health Plan Commercial |
$19,491.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,745.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9,745.60
|
| Rate for Payer: Galaxy Health WC |
$20,709.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14,618.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$21,927.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,250.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,282.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,081.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,872.80
|
| Rate for Payer: Multiplan Commercial |
$18,273.00
|
| Rate for Payer: Networks By Design Commercial |
$15,836.60
|
| Rate for Payer: Prime Health Services Commercial |
$20,709.40
|
|
|
HC CRYABLATION BONE
|
Facility
|
OP
|
$24,364.00
|
|
|
Service Code
|
CPT 20999
|
| Hospital Charge Code |
909020151
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$304.79 |
| Max. Negotiated Rate |
$21,927.60 |
| Rate for Payer: Adventist Health Commercial |
$4,872.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| 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: Cash Price |
$13,400.20
|
| Rate for Payer: Cash Price |
$13,400.20
|
| Rate for Payer: Cash Price |
$13,400.20
|
| Rate for Payer: Cash Price |
$13,400.20
|
| Rate for Payer: Central Health Plan Commercial |
$19,491.20
|
| Rate for Payer: Cigna of CA HMO |
$15,592.96
|
| Rate for Payer: Cigna of CA PPO |
$18,029.36
|
| 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 |
$20,709.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14,618.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$21,927.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$499.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| 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 |
$16,250.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,872.80
|
| 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 |
$18,273.00
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$15,836.60
|
| 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 |
$20,709.40
|
| 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 |
$14,618.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,182.00
|
| Rate for Payer: United Healthcare All Other HMO |
$12,182.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,182.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12,182.00
|
| 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 CRYABLATION BONE
|
Facility
|
IP
|
$24,364.00
|
|
|
Service Code
|
CPT 20999
|
| Hospital Charge Code |
909020151
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$4,872.80 |
| Max. Negotiated Rate |
$21,927.60 |
| Rate for Payer: Adventist Health Commercial |
$4,872.80
|
| Rate for Payer: Cash Price |
$13,400.20
|
| Rate for Payer: Central Health Plan Commercial |
$19,491.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,745.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9,745.60
|
| Rate for Payer: Galaxy Health WC |
$20,709.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14,618.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$21,927.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,250.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,282.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,081.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,872.80
|
| Rate for Payer: Multiplan Commercial |
$18,273.00
|
| Rate for Payer: Networks By Design Commercial |
$15,836.60
|
| Rate for Payer: Prime Health Services Commercial |
$20,709.40
|
|
|
HC CRYABLATION BONE
|
Facility
|
OP
|
$24,364.00
|
|
|
Service Code
|
CPT 20999
|
| Hospital Charge Code |
909020151
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$304.79 |
| Max. Negotiated Rate |
$21,927.60 |
| Rate for Payer: Adventist Health Commercial |
$4,872.80
|
| 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 |
$13,400.20
|
| Rate for Payer: Cash Price |
$13,400.20
|
| Rate for Payer: Cash Price |
$13,400.20
|
| Rate for Payer: Central Health Plan Commercial |
$19,491.20
|
| Rate for Payer: Cigna of CA HMO |
$15,592.96
|
| Rate for Payer: Cigna of CA PPO |
$18,029.36
|
| 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 |
$20,709.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14,618.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$21,927.60
|
| 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 |
$16,250.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,872.80
|
| 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 |
$18,273.00
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$15,836.60
|
| 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 |
$20,709.40
|
| 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 |
$14,618.40
|
| 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 CRYO ABLATE BONE TUMOR(S) PERQ
|
Facility
|
IP
|
$22,916.00
|
|
|
Service Code
|
CPT 20983
|
| Hospital Charge Code |
909020983
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,583.20 |
| Max. Negotiated Rate |
$20,624.40 |
| Rate for Payer: Adventist Health Commercial |
$4,583.20
|
| Rate for Payer: Cash Price |
$12,603.80
|
| Rate for Payer: Central Health Plan Commercial |
$18,332.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,166.40
|
| Rate for Payer: EPIC Health Plan Senior |
$9,166.40
|
| Rate for Payer: Galaxy Health WC |
$19,478.60
|
| Rate for Payer: Global Benefits Group Commercial |
$13,749.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$20,624.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,284.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,731.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,185.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,583.20
|
| Rate for Payer: Multiplan Commercial |
$17,187.00
|
| Rate for Payer: Networks By Design Commercial |
$14,895.40
|
| Rate for Payer: Prime Health Services Commercial |
$19,478.60
|
|
|
HC CRYO ABLATE BONE TUMOR(S) PERQ
|
Facility
|
OP
|
$22,916.00
|
|
|
Service Code
|
CPT 20983
|
| Hospital Charge Code |
909020983
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$589.77 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$4,583.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$9,076.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,984.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,076.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,405.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,238.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$14,462.30
|
| Rate for Payer: Blue Shield of California Commercial |
$9,470.27
|
| Rate for Payer: Blue Shield of California EPN |
$6,179.04
|
| Rate for Payer: Cash Price |
$12,603.80
|
| Rate for Payer: Cash Price |
$12,603.80
|
| Rate for Payer: Cash Price |
$12,603.80
|
| Rate for Payer: Central Health Plan Commercial |
$18,332.80
|
| Rate for Payer: Cigna of CA HMO |
$14,666.24
|
| Rate for Payer: Cigna of CA PPO |
$16,957.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,984.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,076.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,253.71
|
| Rate for Payer: EPIC Health Plan Senior |
$9,076.82
|
| Rate for Payer: Galaxy Health WC |
$19,478.60
|
| Rate for Payer: Global Benefits Group Commercial |
$13,749.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$20,624.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14,885.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$589.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,076.82
|
| Rate for Payer: InnovAge PACE Commercial |
$13,615.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,284.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$651.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,076.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,583.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12,162.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,162.94
|
| Rate for Payer: Multiplan Commercial |
$17,187.00
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: Networks By Design Commercial |
$14,895.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9,076.82
|
| Rate for Payer: Preferred Health Network WC |
$14,757.45
|
| Rate for Payer: Prime Health Services Commercial |
$19,478.60
|
| Rate for Payer: Prime Health Services Medicare |
$9,621.43
|
| Rate for Payer: Prime Health Services WC |
$14,314.73
|
| Rate for Payer: Riverside University Health System MISP |
$9,984.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13,749.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$9,076.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,984.50
|
| Rate for Payer: Vantage Medical Group Senior |
$9,076.82
|
|
|
HC CRYOABLATION-LUNG
|
Facility
|
OP
|
$16,169.00
|
|
|
Service Code
|
CPT 32994
|
| Hospital Charge Code |
909020150
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,165.61 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$3,233.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$13,228.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19,842.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,551.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,228.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$21,077.25
|
| Rate for Payer: Blue Shield of California Commercial |
$4,245.30
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$8,892.95
|
| Rate for Payer: Cash Price |
$8,892.95
|
| Rate for Payer: Cash Price |
$8,892.95
|
| Rate for Payer: Central Health Plan Commercial |
$12,935.20
|
| Rate for Payer: Cigna of CA HMO |
$10,348.16
|
| Rate for Payer: Cigna of CA PPO |
$11,965.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19,842.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,551.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,228.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$17,858.47
|
| Rate for Payer: EPIC Health Plan Senior |
$13,228.50
|
| Rate for Payer: Galaxy Health WC |
$13,743.65
|
| Rate for Payer: Global Benefits Group Commercial |
$9,701.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,552.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21,694.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9,904.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,228.50
|
| Rate for Payer: InnovAge PACE Commercial |
$19,842.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,784.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,940.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,228.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,233.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,726.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,726.19
|
| Rate for Payer: Multiplan Commercial |
$12,126.75
|
| Rate for Payer: Multiplan WC |
$21,077.25
|
| Rate for Payer: Networks By Design Commercial |
$10,509.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13,228.50
|
| Rate for Payer: Preferred Health Network WC |
$21,507.40
|
| Rate for Payer: Prime Health Services Commercial |
$13,743.65
|
| Rate for Payer: Prime Health Services Medicare |
$14,022.21
|
| Rate for Payer: Prime Health Services WC |
$20,862.18
|
| Rate for Payer: Riverside University Health System MISP |
$14,551.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,701.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$13,228.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19,842.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,551.35
|
| Rate for Payer: Vantage Medical Group Senior |
$13,228.50
|
|
|
HC CRYOABLATION-LUNG
|
Facility
|
IP
|
$16,169.00
|
|
|
Service Code
|
CPT 32994
|
| Hospital Charge Code |
909020150
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,233.80 |
| Max. Negotiated Rate |
$14,552.10 |
| Rate for Payer: Adventist Health Commercial |
$3,233.80
|
| Rate for Payer: Cash Price |
$8,892.95
|
| Rate for Payer: Central Health Plan Commercial |
$12,935.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,467.60
|
| Rate for Payer: EPIC Health Plan Senior |
$6,467.60
|
| Rate for Payer: Galaxy Health WC |
$13,743.65
|
| Rate for Payer: Global Benefits Group Commercial |
$9,701.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,552.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,784.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,160.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,008.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,233.80
|
| Rate for Payer: Multiplan Commercial |
$12,126.75
|
| Rate for Payer: Networks By Design Commercial |
$10,509.85
|
| Rate for Payer: Prime Health Services Commercial |
$13,743.65
|
|
|
HC CRYOABLATION PROBE
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C2618
|
| Hospital Charge Code |
909020059
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
|
|
HC CRYOABLATION PROBE
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C2618
|
| Hospital Charge Code |
909020059
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,368.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,888.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,290.47
|
| Rate for Payer: Blue Shield of California Commercial |
$2,382.90
|
| Rate for Payer: Blue Shield of California EPN |
$1,556.10
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: Cigna of CA HMO |
$2,496.00
|
| Rate for Payer: Cigna of CA PPO |
$2,886.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: InnovAge PACE Commercial |
$1,950.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,730.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,560.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,340.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,950.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,950.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,950.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,950.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
