|
HC DYNAMIC STABILITY CONTRL LE
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
CPT L5999
|
| Hospital Charge Code |
905380023
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,000.00 |
| Max. Negotiated Rate |
$4,500.00 |
| Rate for Payer: Adventist Health Commercial |
$1,000.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,010.00
|
| Rate for Payer: Blue Shield of California EPN |
$2,520.00
|
| Rate for Payer: Cash Price |
$2,250.00
|
| Rate for Payer: Central Health Plan Commercial |
$4,000.00
|
| Rate for Payer: Cigna of CA HMO |
$3,500.00
|
| Rate for Payer: Cigna of CA PPO |
$3,500.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,500.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,000.00
|
| Rate for Payer: Galaxy Health WC |
$4,250.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,000.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,500.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,175.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,950.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,000.00
|
| Rate for Payer: Multiplan Commercial |
$3,750.00
|
| Rate for Payer: Networks By Design Commercial |
$3,250.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,250.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,876.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,826.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,787.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,637.50
|
|
|
HC DYNAMIC STABILITY CONTRL LE
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
CPT L5999
|
| Hospital Charge Code |
915380023
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,637.50 |
| Max. Negotiated Rate |
$4,500.00 |
| Rate for Payer: United Healthcare HMO Rider |
$1,787.00
|
| Rate for Payer: Adventist Health Commercial |
$2,050.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,250.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,750.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,750.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,908.50
|
| Rate for Payer: Blue Shield of California Commercial |
$4,010.00
|
| Rate for Payer: Blue Shield of California EPN |
$2,520.00
|
| Rate for Payer: Cash Price |
$2,250.00
|
| Rate for Payer: Central Health Plan Commercial |
$4,000.00
|
| Rate for Payer: Cigna of CA HMO |
$3,500.00
|
| Rate for Payer: Cigna of CA PPO |
$3,500.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,250.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,250.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,250.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,500.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,000.00
|
| Rate for Payer: Galaxy Health WC |
$4,250.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,000.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,500.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,175.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,815.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,950.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,050.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,500.00
|
| Rate for Payer: Multiplan Commercial |
$3,750.00
|
| Rate for Payer: Networks By Design Commercial |
$2,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,250.00
|
| Rate for Payer: Riverside University Health System MISP |
$2,000.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,000.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,876.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,826.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,637.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,250.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,250.00
|
| Rate for Payer: Vantage Medical Group Senior |
$4,250.00
|
|
|
HC DYNAMIC STABILITY CONTRL LE
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
CPT L5999
|
| Hospital Charge Code |
905380023
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,637.50 |
| Max. Negotiated Rate |
$4,500.00 |
| Rate for Payer: Adventist Health Commercial |
$2,050.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,250.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,750.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,750.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,908.50
|
| Rate for Payer: Blue Shield of California Commercial |
$4,010.00
|
| Rate for Payer: Blue Shield of California EPN |
$2,520.00
|
| Rate for Payer: Cash Price |
$2,250.00
|
| Rate for Payer: Central Health Plan Commercial |
$4,000.00
|
| Rate for Payer: Cigna of CA HMO |
$3,500.00
|
| Rate for Payer: Cigna of CA PPO |
$3,500.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,250.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,250.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,250.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,500.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,000.00
|
| Rate for Payer: Galaxy Health WC |
$4,250.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,000.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,500.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,175.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,815.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,950.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,050.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,500.00
|
| Rate for Payer: Multiplan Commercial |
$3,750.00
|
| Rate for Payer: Networks By Design Commercial |
$2,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,250.00
|
| Rate for Payer: Riverside University Health System MISP |
$2,000.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,000.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,876.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,826.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,787.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,637.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,250.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,250.00
|
| Rate for Payer: Vantage Medical Group Senior |
$4,250.00
|
|
|
HC EA ADDL LESION MAMMO
|
Facility
|
IP
|
$1,048.00
|
|
|
Service Code
|
CPT 19282
|
| Hospital Charge Code |
909019282
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$209.60 |
| Max. Negotiated Rate |
$943.20 |
| Rate for Payer: Adventist Health Commercial |
$209.60
|
| Rate for Payer: Cash Price |
$471.60
|
| Rate for Payer: Central Health Plan Commercial |
$838.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$733.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$419.20
|
| Rate for Payer: EPIC Health Plan Senior |
$419.20
|
| Rate for Payer: Galaxy Health WC |
$890.80
|
| Rate for Payer: Global Benefits Group Commercial |
$628.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$943.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$665.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$618.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$209.60
|
| Rate for Payer: Multiplan Commercial |
$786.00
|
| Rate for Payer: Networks By Design Commercial |
$681.20
|
| Rate for Payer: Prime Health Services Commercial |
$890.80
|
|
|
HC EA ADDL LESION MAMMO
|
Facility
|
OP
|
$1,048.00
|
|
|
Service Code
|
CPT 19282
|
| Hospital Charge Code |
909019282
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$209.60 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$209.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$272.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$890.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$576.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$786.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$660.24
|
| Rate for Payer: Blue Shield of California EPN |
$416.06
|
| Rate for Payer: Cash Price |
$471.60
|
| Rate for Payer: Cash Price |
$471.60
|
| Rate for Payer: Cash Price |
$471.60
|
| Rate for Payer: Central Health Plan Commercial |
$838.40
|
| Rate for Payer: Cigna of CA HMO |
$670.72
|
| Rate for Payer: Cigna of CA PPO |
$775.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$890.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$890.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$890.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$733.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$419.20
|
| Rate for Payer: EPIC Health Plan Senior |
$419.20
|
| Rate for Payer: Galaxy Health WC |
$890.80
|
| Rate for Payer: Global Benefits Group Commercial |
$628.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$943.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$260.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$665.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$287.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$618.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$209.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$733.60
|
| Rate for Payer: Multiplan Commercial |
$786.00
|
| Rate for Payer: Networks By Design Commercial |
$681.20
|
| Rate for Payer: Prime Health Services Commercial |
$890.80
|
| Rate for Payer: Riverside University Health System MISP |
$419.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$628.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$628.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$524.00
|
| Rate for Payer: United Healthcare All Other HMO |
$524.00
|
| Rate for Payer: United Healthcare HMO Rider |
$524.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$524.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$890.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$890.80
|
| Rate for Payer: Vantage Medical Group Senior |
$890.80
|
|
|
HC EA ADDL LESION STEREO
|
Facility
|
OP
|
$2,805.00
|
|
|
Service Code
|
CPT 19284
|
| Hospital Charge Code |
909019284
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$320.18 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$561.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,384.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,542.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,103.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$1,262.25
|
| Rate for Payer: Cash Price |
$1,262.25
|
| Rate for Payer: Cash Price |
$1,262.25
|
| Rate for Payer: Central Health Plan Commercial |
$2,244.00
|
| Rate for Payer: Cigna of CA HMO |
$1,795.20
|
| Rate for Payer: Cigna of CA PPO |
$2,075.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,384.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,384.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,384.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,963.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,122.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,122.00
|
| Rate for Payer: Galaxy Health WC |
$2,384.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,683.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,524.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$320.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,781.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$353.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,654.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$561.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,963.50
|
| Rate for Payer: Multiplan Commercial |
$2,103.75
|
| Rate for Payer: Networks By Design Commercial |
$1,823.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,384.25
|
| Rate for Payer: Riverside University Health System MISP |
$1,122.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,683.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,402.50
|
| 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: Vantage Medical Group Commercial/Exchange |
$2,384.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,384.25
|
| Rate for Payer: Vantage Medical Group Senior |
$2,384.25
|
|
|
HC EA ADDL LESION STEREO
|
Facility
|
IP
|
$2,805.00
|
|
|
Service Code
|
CPT 19284
|
| Hospital Charge Code |
909019284
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$561.00 |
| Max. Negotiated Rate |
$2,524.50 |
| Rate for Payer: Adventist Health Commercial |
$561.00
|
| Rate for Payer: Cash Price |
$1,262.25
|
| Rate for Payer: Central Health Plan Commercial |
$2,244.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,963.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,122.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,122.00
|
| Rate for Payer: Galaxy Health WC |
$2,384.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,683.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,524.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,781.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,654.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$561.00
|
| Rate for Payer: Multiplan Commercial |
$2,103.75
|
| Rate for Payer: Networks By Design Commercial |
$1,823.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,384.25
|
|
|
HC EA ADDL MAGNETIC RESONANCE
|
Facility
|
IP
|
$298.00
|
|
|
Service Code
|
CPT 19288
|
| Hospital Charge Code |
908819288
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$59.60 |
| Max. Negotiated Rate |
$268.20 |
| Rate for Payer: Adventist Health Commercial |
$59.60
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Central Health Plan Commercial |
$238.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$208.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$119.20
|
| Rate for Payer: EPIC Health Plan Senior |
$119.20
|
| Rate for Payer: Galaxy Health WC |
$253.30
|
| Rate for Payer: Global Benefits Group Commercial |
$178.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$268.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$189.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$175.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.60
|
| Rate for Payer: Multiplan Commercial |
$223.50
|
| Rate for Payer: Networks By Design Commercial |
$193.70
|
| Rate for Payer: Prime Health Services Commercial |
$253.30
|
|
|
HC EA ADDL MAGNETIC RESONANCE
|
Facility
|
OP
|
$298.00
|
|
|
Service Code
|
CPT 19288
|
| Hospital Charge Code |
908819288
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$59.60 |
| Max. Negotiated Rate |
$6,587.00 |
| Rate for Payer: Adventist Health Commercial |
$59.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$352.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$253.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$163.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$223.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Blue Shield of California Commercial |
$187.74
|
| Rate for Payer: Blue Shield of California EPN |
$118.31
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Central Health Plan Commercial |
$238.40
|
| Rate for Payer: Cigna of CA HMO |
$190.72
|
| Rate for Payer: Cigna of CA PPO |
$220.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$253.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$253.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$253.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$208.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$119.20
|
| Rate for Payer: EPIC Health Plan Senior |
$119.20
|
| Rate for Payer: Galaxy Health WC |
$253.30
|
| Rate for Payer: Global Benefits Group Commercial |
$178.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$268.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$94.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$189.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$104.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$175.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$208.60
|
| Rate for Payer: Multiplan Commercial |
$223.50
|
| Rate for Payer: Networks By Design Commercial |
$193.70
|
| Rate for Payer: Prime Health Services Commercial |
$253.30
|
| Rate for Payer: Riverside University Health System MISP |
$119.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$178.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$178.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$149.00
|
| Rate for Payer: United Healthcare All Other HMO |
$149.00
|
| Rate for Payer: United Healthcare HMO Rider |
$149.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$149.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$253.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$253.30
|
| Rate for Payer: Vantage Medical Group Senior |
$253.30
|
|
|
HC EA ADDL ULTRASOUND
|
Facility
|
IP
|
$354.00
|
|
|
Service Code
|
CPT 19286
|
| Hospital Charge Code |
906619286
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$70.80 |
| Max. Negotiated Rate |
$318.60 |
| Rate for Payer: Adventist Health Commercial |
$70.80
|
| Rate for Payer: Cash Price |
$159.30
|
| Rate for Payer: Central Health Plan Commercial |
$283.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$247.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$141.60
|
| Rate for Payer: EPIC Health Plan Senior |
$141.60
|
| Rate for Payer: Galaxy Health WC |
$300.90
|
| Rate for Payer: Global Benefits Group Commercial |
$212.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$318.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$224.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$208.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.80
|
| Rate for Payer: Multiplan Commercial |
$265.50
|
| Rate for Payer: Networks By Design Commercial |
$230.10
|
| Rate for Payer: Prime Health Services Commercial |
$300.90
|
|
|
HC EA ADDL ULTRASOUND
|
Facility
|
OP
|
$354.00
|
|
|
Service Code
|
CPT 19286
|
| Hospital Charge Code |
906619286
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$70.80 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$70.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$235.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$300.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$194.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$265.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$223.02
|
| Rate for Payer: Blue Shield of California EPN |
$140.54
|
| Rate for Payer: Cash Price |
$159.30
|
| Rate for Payer: Cash Price |
$159.30
|
| Rate for Payer: Cash Price |
$159.30
|
| Rate for Payer: Central Health Plan Commercial |
$283.20
|
| Rate for Payer: Cigna of CA HMO |
$226.56
|
| Rate for Payer: Cigna of CA PPO |
$261.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$300.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$300.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$300.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$247.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$141.60
|
| Rate for Payer: EPIC Health Plan Senior |
$141.60
|
| Rate for Payer: Galaxy Health WC |
$300.90
|
| Rate for Payer: Global Benefits Group Commercial |
$212.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$318.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$719.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$224.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$794.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$208.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$247.80
|
| Rate for Payer: Multiplan Commercial |
$265.50
|
| Rate for Payer: Networks By Design Commercial |
$230.10
|
| Rate for Payer: Prime Health Services Commercial |
$300.90
|
| Rate for Payer: Riverside University Health System MISP |
$141.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$212.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$212.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$177.00
|
| Rate for Payer: United Healthcare All Other HMO |
$177.00
|
| Rate for Payer: United Healthcare HMO Rider |
$177.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$177.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$300.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$300.90
|
| Rate for Payer: Vantage Medical Group Senior |
$300.90
|
|
|
HC EBER
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
CPT 88365
|
| Hospital Charge Code |
903800319
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$36.20 |
| Max. Negotiated Rate |
$688.73 |
| Rate for Payer: Adventist Health Commercial |
$36.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$219.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$688.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$219.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$70.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$97.85
|
| Rate for Payer: Blue Shield of California Commercial |
$114.03
|
| Rate for Payer: Blue Shield of California EPN |
$71.86
|
| Rate for Payer: Cash Price |
$81.45
|
| Rate for Payer: Cash Price |
$81.45
|
| Rate for Payer: Central Health Plan Commercial |
$144.80
|
| Rate for Payer: Cigna of CA HMO |
$115.84
|
| Rate for Payer: Cigna of CA PPO |
$133.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$328.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$241.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$219.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$126.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.55
|
| Rate for Payer: EPIC Health Plan Senior |
$241.03
|
| Rate for Payer: Galaxy Health WC |
$153.85
|
| Rate for Payer: Global Benefits Group Commercial |
$108.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$162.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$359.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$150.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$219.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$114.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$166.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$306.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$293.62
|
| Rate for Payer: Multiplan Commercial |
$135.75
|
| Rate for Payer: Networks By Design Commercial |
$117.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$219.12
|
| Rate for Payer: Prime Health Services Commercial |
$153.85
|
| Rate for Payer: Prime Health Services Medicare |
$232.27
|
| Rate for Payer: Riverside University Health System MISP |
$241.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$108.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$108.60
|
| 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 |
$219.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Vantage Medical Group Senior |
$219.12
|
|
|
HC EBER
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
CPT 88365
|
| Hospital Charge Code |
903800319
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$36.20 |
| Max. Negotiated Rate |
$162.90 |
| Rate for Payer: Adventist Health Commercial |
$36.20
|
| Rate for Payer: Cash Price |
$81.45
|
| Rate for Payer: Central Health Plan Commercial |
$144.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$126.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.40
|
| Rate for Payer: EPIC Health Plan Senior |
$72.40
|
| Rate for Payer: Galaxy Health WC |
$153.85
|
| Rate for Payer: Global Benefits Group Commercial |
$108.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$162.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$114.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$106.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.20
|
| Rate for Payer: Multiplan Commercial |
$135.75
|
| Rate for Payer: Networks By Design Commercial |
$117.65
|
| Rate for Payer: Prime Health Services Commercial |
$153.85
|
|
|
HC EBER, KAPPA, LAMBA
|
Facility
|
IP
|
$426.00
|
|
|
Service Code
|
CPT 88364
|
| Hospital Charge Code |
903800320
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$85.20 |
| Max. Negotiated Rate |
$383.40 |
| Rate for Payer: Adventist Health Commercial |
$85.20
|
| Rate for Payer: Cash Price |
$191.70
|
| Rate for Payer: Central Health Plan Commercial |
$340.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$298.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$170.40
|
| Rate for Payer: EPIC Health Plan Senior |
$170.40
|
| Rate for Payer: Galaxy Health WC |
$362.10
|
| Rate for Payer: Global Benefits Group Commercial |
$255.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$383.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$270.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$251.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.20
|
| Rate for Payer: Multiplan Commercial |
$319.50
|
| Rate for Payer: Networks By Design Commercial |
$276.90
|
| Rate for Payer: Prime Health Services Commercial |
$362.10
|
|
|
HC EBER, KAPPA, LAMBA
|
Facility
|
OP
|
$426.00
|
|
|
Service Code
|
CPT 88364
|
| Hospital Charge Code |
903800320
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$85.20 |
| Max. Negotiated Rate |
$688.87 |
| Rate for Payer: Adventist Health Commercial |
$85.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$423.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$362.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$234.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$319.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$495.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$688.87
|
| Rate for Payer: Blue Shield of California Commercial |
$268.38
|
| Rate for Payer: Blue Shield of California EPN |
$169.12
|
| Rate for Payer: Cash Price |
$191.70
|
| Rate for Payer: Cash Price |
$191.70
|
| Rate for Payer: Central Health Plan Commercial |
$340.80
|
| Rate for Payer: Cigna of CA HMO |
$272.64
|
| Rate for Payer: Cigna of CA PPO |
$315.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$362.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$362.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$362.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$298.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$170.40
|
| Rate for Payer: EPIC Health Plan Senior |
$170.40
|
| Rate for Payer: Galaxy Health WC |
$362.10
|
| Rate for Payer: Global Benefits Group Commercial |
$255.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$383.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$150.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$270.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$166.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$251.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$298.20
|
| Rate for Payer: Multiplan Commercial |
$319.50
|
| Rate for Payer: Networks By Design Commercial |
$276.90
|
| Rate for Payer: Prime Health Services Commercial |
$362.10
|
| Rate for Payer: Riverside University Health System MISP |
$170.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$255.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$255.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$85.77
|
| Rate for Payer: United Healthcare All Other HMO |
$85.77
|
| Rate for Payer: United Healthcare HMO Rider |
$85.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$85.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$362.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$362.10
|
| Rate for Payer: Vantage Medical Group Senior |
$362.10
|
|
|
HC EBNA IGG
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
CPT 86664
|
| Hospital Charge Code |
900913537
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$54.00 |
| Max. Negotiated Rate |
$243.00 |
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Central Health Plan Commercial |
$216.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$189.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.00
|
| Rate for Payer: EPIC Health Plan Senior |
$108.00
|
| Rate for Payer: Galaxy Health WC |
$229.50
|
| Rate for Payer: Global Benefits Group Commercial |
$162.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$243.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$171.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$159.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.00
|
| Rate for Payer: Multiplan Commercial |
$202.50
|
| Rate for Payer: Networks By Design Commercial |
$175.50
|
| Rate for Payer: Prime Health Services Commercial |
$229.50
|
|
|
HC EBNA IGG
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
CPT 86664
|
| Hospital Charge Code |
900913537
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.38 |
| Max. Negotiated Rate |
$243.00 |
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Adventist Health Commercial |
$14.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$15.29
|
| Rate for Payer: Adventist Health Medi-Cal |
$15.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$112.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$112.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$112.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$112.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.02
|
| Rate for Payer: Blue Shield of California Commercial |
$44.10
|
| Rate for Payer: Blue Shield of California Commercial |
$170.10
|
| Rate for Payer: Blue Shield of California EPN |
$27.79
|
| Rate for Payer: Blue Shield of California EPN |
$107.19
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Central Health Plan Commercial |
$216.00
|
| Rate for Payer: Central Health Plan Commercial |
$56.00
|
| Rate for Payer: Cigna of CA HMO |
$44.80
|
| Rate for Payer: Cigna of CA HMO |
$172.80
|
| Rate for Payer: Cigna of CA PPO |
$51.80
|
| Rate for Payer: Cigna of CA PPO |
$199.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$189.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.23
|
| Rate for Payer: EPIC Health Plan Senior |
$16.82
|
| Rate for Payer: EPIC Health Plan Senior |
$16.82
|
| Rate for Payer: Galaxy Health WC |
$59.50
|
| Rate for Payer: Galaxy Health WC |
$229.50
|
| Rate for Payer: Global Benefits Group Commercial |
$42.00
|
| Rate for Payer: Global Benefits Group Commercial |
$162.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$243.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$25.08
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$25.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$171.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$44.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.49
|
| Rate for Payer: Multiplan Commercial |
$52.50
|
| Rate for Payer: Multiplan Commercial |
$202.50
|
| Rate for Payer: Networks By Design Commercial |
$175.50
|
| Rate for Payer: Networks By Design Commercial |
$45.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$15.29
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$15.29
|
| Rate for Payer: Prime Health Services Commercial |
$59.50
|
| Rate for Payer: Prime Health Services Commercial |
$229.50
|
| Rate for Payer: Prime Health Services Medicare |
$16.21
|
| Rate for Payer: Prime Health Services Medicare |
$16.21
|
| Rate for Payer: Riverside University Health System MISP |
$16.82
|
| Rate for Payer: Riverside University Health System MISP |
$16.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$162.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$162.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.38
|
| Rate for Payer: United Healthcare All Other HMO |
$12.38
|
| Rate for Payer: United Healthcare All Other HMO |
$12.38
|
| Rate for Payer: United Healthcare HMO Rider |
$12.38
|
| Rate for Payer: United Healthcare HMO Rider |
$12.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.38
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.29
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.82
|
| Rate for Payer: Vantage Medical Group Senior |
$15.29
|
| Rate for Payer: Vantage Medical Group Senior |
$15.29
|
|
|
HC EBOL SPINAL ART FOR AVM
|
Facility
|
IP
|
$3,309.00
|
|
|
Service Code
|
CPT 62294
|
| Hospital Charge Code |
909080025
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$661.80 |
| Max. Negotiated Rate |
$2,978.10 |
| Rate for Payer: Adventist Health Commercial |
$661.80
|
| Rate for Payer: Cash Price |
$1,489.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,647.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,316.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,323.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,323.60
|
| Rate for Payer: Galaxy Health WC |
$2,812.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,985.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,978.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,101.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,952.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$661.80
|
| Rate for Payer: Multiplan Commercial |
$2,481.75
|
| Rate for Payer: Networks By Design Commercial |
$2,150.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,812.65
|
|
|
HC EBOL SPINAL ART FOR AVM
|
Facility
|
OP
|
$3,309.00
|
|
|
Service Code
|
CPT 62294
|
| Hospital Charge Code |
909080025
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$661.80 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$661.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,137.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,137.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,802.37
|
| Rate for Payer: Blue Shield of California Commercial |
$5,036.70
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$1,489.05
|
| Rate for Payer: Cash Price |
$1,489.05
|
| Rate for Payer: Cash Price |
$1,489.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,647.20
|
| Rate for Payer: Cigna of CA HMO |
$2,117.76
|
| Rate for Payer: Cigna of CA PPO |
$2,448.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,251.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,137.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,316.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,877.01
|
| Rate for Payer: EPIC Health Plan Senior |
$1,251.34
|
| Rate for Payer: Galaxy Health WC |
$2,812.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,985.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,978.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,865.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,061.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,137.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,101.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,172.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,592.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$661.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,524.36
|
| Rate for Payer: Multiplan Commercial |
$2,481.75
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: Networks By Design Commercial |
$2,150.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,137.58
|
| Rate for Payer: Preferred Health Network WC |
$1,839.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,812.65
|
| Rate for Payer: Prime Health Services Medicare |
$1,205.83
|
| Rate for Payer: Prime Health Services WC |
$1,783.98
|
| Rate for Payer: Riverside University Health System MISP |
$1,251.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,985.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,654.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,137.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Vantage Medical Group Senior |
$1,137.58
|
|
|
HC EBV DNA PCR TEST
|
Facility
|
IP
|
$144.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
900913690
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.80 |
| Max. Negotiated Rate |
$129.60 |
| Rate for Payer: Adventist Health Commercial |
$28.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Central Health Plan Commercial |
$115.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$100.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.60
|
| Rate for Payer: EPIC Health Plan Senior |
$57.60
|
| Rate for Payer: Galaxy Health WC |
$122.40
|
| Rate for Payer: Global Benefits Group Commercial |
$86.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$129.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$91.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$84.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.80
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: Networks By Design Commercial |
$93.60
|
| Rate for Payer: Prime Health Services Commercial |
$122.40
|
|
|
HC EBV DNA PCR TEST
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
900913690
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$314.39 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Adventist Health Commercial |
$28.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$42.84
|
| Rate for Payer: Adventist Health Medi-Cal |
$42.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$314.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$314.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$188.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$188.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$261.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$261.67
|
| Rate for Payer: Blue Shield of California Commercial |
$90.72
|
| Rate for Payer: Blue Shield of California Commercial |
$69.30
|
| Rate for Payer: Blue Shield of California EPN |
$57.17
|
| Rate for Payer: Blue Shield of California EPN |
$43.67
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Central Health Plan Commercial |
$88.00
|
| Rate for Payer: Central Health Plan Commercial |
$115.20
|
| Rate for Payer: Cigna of CA HMO |
$92.16
|
| Rate for Payer: Cigna of CA HMO |
$70.40
|
| Rate for Payer: Cigna of CA PPO |
$106.56
|
| Rate for Payer: Cigna of CA PPO |
$81.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$77.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$100.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.69
|
| Rate for Payer: EPIC Health Plan Senior |
$47.12
|
| Rate for Payer: EPIC Health Plan Senior |
$47.12
|
| Rate for Payer: Galaxy Health WC |
$122.40
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$86.40
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$129.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$70.26
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$70.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$65.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$65.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$69.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$91.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$72.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$72.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$57.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$57.41
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
| Rate for Payer: Networks By Design Commercial |
$71.50
|
| Rate for Payer: Networks By Design Commercial |
$93.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$42.84
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$42.84
|
| Rate for Payer: Prime Health Services Commercial |
$122.40
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
| Rate for Payer: Prime Health Services Medicare |
$45.41
|
| Rate for Payer: Prime Health Services Medicare |
$45.41
|
| Rate for Payer: Riverside University Health System MISP |
$47.12
|
| Rate for Payer: Riverside University Health System MISP |
$47.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$66.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$86.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$86.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.70
|
| Rate for Payer: United Healthcare All Other HMO |
$34.70
|
| Rate for Payer: United Healthcare All Other HMO |
$34.70
|
| Rate for Payer: United Healthcare HMO Rider |
$34.70
|
| Rate for Payer: United Healthcare HMO Rider |
$34.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$42.84
|
| Rate for Payer: Upland Medical Group Pediatric |
$42.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
|
|
HC EBV IGG EARLY AB
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
CPT 86663
|
| Hospital Charge Code |
900913538
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.63 |
| Max. Negotiated Rate |
$133.39 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Adventist Health Commercial |
$18.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.12
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$96.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$96.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$95.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$95.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.39
|
| Rate for Payer: Blue Shield of California Commercial |
$57.96
|
| Rate for Payer: Blue Shield of California Commercial |
$34.65
|
| Rate for Payer: Blue Shield of California EPN |
$36.52
|
| Rate for Payer: Blue Shield of California EPN |
$21.84
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Central Health Plan Commercial |
$44.00
|
| Rate for Payer: Central Health Plan Commercial |
$73.60
|
| Rate for Payer: Cigna of CA HMO |
$58.88
|
| Rate for Payer: Cigna of CA HMO |
$35.20
|
| Rate for Payer: Cigna of CA PPO |
$68.08
|
| Rate for Payer: Cigna of CA PPO |
$40.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$38.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$64.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.65
|
| Rate for Payer: EPIC Health Plan Senior |
$14.43
|
| Rate for Payer: EPIC Health Plan Senior |
$14.43
|
| Rate for Payer: Galaxy Health WC |
$78.20
|
| Rate for Payer: Galaxy Health WC |
$46.75
|
| Rate for Payer: Global Benefits Group Commercial |
$55.20
|
| Rate for Payer: Global Benefits Group Commercial |
$33.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$82.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$49.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.52
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$58.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.58
|
| Rate for Payer: Multiplan Commercial |
$69.00
|
| Rate for Payer: Multiplan Commercial |
$41.25
|
| Rate for Payer: Networks By Design Commercial |
$35.75
|
| Rate for Payer: Networks By Design Commercial |
$59.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.12
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.12
|
| Rate for Payer: Prime Health Services Commercial |
$78.20
|
| Rate for Payer: Prime Health Services Commercial |
$46.75
|
| Rate for Payer: Prime Health Services Medicare |
$13.91
|
| Rate for Payer: Prime Health Services Medicare |
$13.91
|
| Rate for Payer: Riverside University Health System MISP |
$14.43
|
| Rate for Payer: Riverside University Health System MISP |
$14.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$55.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$55.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.63
|
| Rate for Payer: United Healthcare All Other HMO |
$10.63
|
| Rate for Payer: United Healthcare All Other HMO |
$10.63
|
| Rate for Payer: United Healthcare HMO Rider |
$10.63
|
| Rate for Payer: United Healthcare HMO Rider |
$10.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.63
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.12
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.43
|
| Rate for Payer: Vantage Medical Group Senior |
$13.12
|
| Rate for Payer: Vantage Medical Group Senior |
$13.12
|
|
|
HC EBV IGG EARLY AB
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
CPT 86663
|
| Hospital Charge Code |
900913538
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$82.80 |
| Rate for Payer: Adventist Health Commercial |
$18.40
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Central Health Plan Commercial |
$73.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$64.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.80
|
| Rate for Payer: EPIC Health Plan Senior |
$36.80
|
| Rate for Payer: Galaxy Health WC |
$78.20
|
| Rate for Payer: Global Benefits Group Commercial |
$55.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$82.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$58.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$54.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.40
|
| Rate for Payer: Multiplan Commercial |
$69.00
|
| Rate for Payer: Networks By Design Commercial |
$59.80
|
| Rate for Payer: Prime Health Services Commercial |
$78.20
|
|
|
HC EBV PCR
|
Facility
|
OP
|
$277.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
900912315
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.70 |
| Max. Negotiated Rate |
$314.39 |
| Rate for Payer: Adventist Health Commercial |
$55.40
|
| Rate for Payer: Adventist Health Commercial |
$118.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$42.84
|
| Rate for Payer: Adventist Health Medi-Cal |
$42.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$314.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$314.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$188.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$188.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$261.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$261.67
|
| Rate for Payer: Blue Shield of California Commercial |
$373.59
|
| Rate for Payer: Blue Shield of California Commercial |
$174.51
|
| Rate for Payer: Blue Shield of California EPN |
$235.42
|
| Rate for Payer: Blue Shield of California EPN |
$109.97
|
| Rate for Payer: Cash Price |
$266.85
|
| Rate for Payer: Cash Price |
$266.85
|
| Rate for Payer: Cash Price |
$124.65
|
| Rate for Payer: Cash Price |
$124.65
|
| Rate for Payer: Central Health Plan Commercial |
$221.60
|
| Rate for Payer: Central Health Plan Commercial |
$474.40
|
| Rate for Payer: Cigna of CA HMO |
$379.52
|
| Rate for Payer: Cigna of CA HMO |
$177.28
|
| Rate for Payer: Cigna of CA PPO |
$438.82
|
| Rate for Payer: Cigna of CA PPO |
$204.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$193.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$415.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.69
|
| Rate for Payer: EPIC Health Plan Senior |
$47.12
|
| Rate for Payer: EPIC Health Plan Senior |
$47.12
|
| Rate for Payer: Galaxy Health WC |
$504.05
|
| Rate for Payer: Galaxy Health WC |
$235.45
|
| Rate for Payer: Global Benefits Group Commercial |
$355.80
|
| Rate for Payer: Global Benefits Group Commercial |
$166.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$533.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$249.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$70.26
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$70.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$65.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$65.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$175.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$376.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$72.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$72.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$57.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$57.41
|
| Rate for Payer: Multiplan Commercial |
$444.75
|
| Rate for Payer: Multiplan Commercial |
$207.75
|
| Rate for Payer: Networks By Design Commercial |
$180.05
|
| Rate for Payer: Networks By Design Commercial |
$385.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$42.84
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$42.84
|
| Rate for Payer: Prime Health Services Commercial |
$504.05
|
| Rate for Payer: Prime Health Services Commercial |
$235.45
|
| Rate for Payer: Prime Health Services Medicare |
$45.41
|
| Rate for Payer: Prime Health Services Medicare |
$45.41
|
| Rate for Payer: Riverside University Health System MISP |
$47.12
|
| Rate for Payer: Riverside University Health System MISP |
$47.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$166.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$355.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$355.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$166.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.70
|
| Rate for Payer: United Healthcare All Other HMO |
$34.70
|
| Rate for Payer: United Healthcare All Other HMO |
$34.70
|
| Rate for Payer: United Healthcare HMO Rider |
$34.70
|
| Rate for Payer: United Healthcare HMO Rider |
$34.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$42.84
|
| Rate for Payer: Upland Medical Group Pediatric |
$42.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
|
|
HC EBV PCR
|
Facility
|
IP
|
$593.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
900912315
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$118.60 |
| Max. Negotiated Rate |
$533.70 |
| Rate for Payer: Adventist Health Commercial |
$118.60
|
| Rate for Payer: Cash Price |
$266.85
|
| Rate for Payer: Central Health Plan Commercial |
$474.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$415.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$237.20
|
| Rate for Payer: EPIC Health Plan Senior |
$237.20
|
| Rate for Payer: Galaxy Health WC |
$504.05
|
| Rate for Payer: Global Benefits Group Commercial |
$355.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$533.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$376.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$349.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.60
|
| Rate for Payer: Multiplan Commercial |
$444.75
|
| Rate for Payer: Networks By Design Commercial |
$385.45
|
| Rate for Payer: Prime Health Services Commercial |
$504.05
|
|
