|
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: 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 Permanente of CA Commercial/Self Funded |
$198.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$184.46
|
| 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 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: 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 Permanente of CA Commercial/Self Funded |
$236.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$134.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$219.13
|
| 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 |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$70.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| 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 |
$171.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$207.90
|
| Rate for Payer: Blue Shield of California Commercial |
$214.88
|
| 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: 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: InnovAge PACE Commercial |
$177.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$236.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$794.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$219.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$247.80
|
| Rate for Payer: Molina Healthcare of CA 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 |
$14.28 |
| Max. Negotiated Rate |
$357.08 |
| Rate for Payer: Adventist Health Commercial |
$36.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$217.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$109.92
|
| 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 |
$70.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.28
|
| Rate for Payer: Blue Shield of California Commercial |
$109.87
|
| 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 |
$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 |
$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 |
$357.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$150.64
|
| 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 |
$120.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$166.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$217.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.20
|
| 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 |
$135.75
|
| Rate for Payer: Networks By Design Commercial |
$117.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$217.73
|
| Rate for Payer: Prime Health Services Commercial |
$153.85
|
| 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 |
$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 |
$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 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: 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 Permanente of CA Commercial/Self Funded |
$120.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$112.04
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$284.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$162.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$263.69
|
| 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 |
$495.50 |
| Rate for Payer: Adventist Health Commercial |
$85.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$258.71
|
| 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 |
$100.56
|
| Rate for Payer: Blue Shield of California Commercial |
$258.58
|
| 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: 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: InnovAge PACE Commercial |
$213.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$284.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$166.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$263.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$298.20
|
| Rate for Payer: Molina Healthcare of CA 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
|
OP
|
$70.00
|
|
|
Service Code
|
CPT 86664
|
| Hospital Charge Code |
900913537
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.38 |
| Max. Negotiated Rate |
$112.94 |
| Rate for Payer: Adventist Health Commercial |
$14.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$15.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$42.51
|
| 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 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 HMO/PPO |
$22.92
|
| Rate for Payer: Blue Shield of California Commercial |
$42.49
|
| Rate for Payer: Blue Shield of California EPN |
$27.79
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Central Health Plan Commercial |
$56.00
|
| Rate for Payer: Cigna of CA HMO |
$44.80
|
| Rate for Payer: Cigna of CA PPO |
$51.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.64
|
| Rate for Payer: EPIC Health Plan Senior |
$15.29
|
| Rate for Payer: Galaxy Health WC |
$59.50
|
| Rate for Payer: Global Benefits Group Commercial |
$42.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.00
|
| 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) Medicare Advantage |
$15.29
|
| Rate for Payer: InnovAge PACE Commercial |
$22.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.49
|
| Rate for Payer: Multiplan Commercial |
$52.50
|
| Rate for Payer: Networks By Design Commercial |
$45.50
|
| 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 Medicare |
$16.21
|
| Rate for Payer: Riverside University Health System MISP |
$16.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.00
|
| 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 HMO Rider |
$12.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.38
|
| 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 Medi-Cal |
$16.82
|
| Rate for Payer: Vantage Medical Group Senior |
$15.29
|
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$180.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$167.13
|
| 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 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 |
$8,114.00 |
| Rate for Payer: Adventist Health Commercial |
$661.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,131.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,131.20
|
| 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 |
$1,802.37
|
| 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 |
$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 |
$1,696.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,244.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,131.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,527.12
|
| Rate for Payer: EPIC Health Plan Senior |
$1,131.20
|
| 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 |
$1,855.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,061.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,131.20
|
| Rate for Payer: InnovAge PACE Commercial |
$1,696.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,207.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,172.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,131.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$661.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,515.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,515.81
|
| 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 |
$1,131.20
|
| 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 |
$1,199.07
|
| Rate for Payer: Prime Health Services WC |
$1,783.98
|
| Rate for Payer: Riverside University Health System MISP |
$1,244.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,985.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| 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 |
$1,131.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1,131.20
|
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$2,207.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,260.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,048.27
|
| 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 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 |
$188.22 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$42.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$66.80
|
| 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 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 HMO/PPO |
$38.20
|
| Rate for Payer: Blue Shield of California Commercial |
$66.77
|
| Rate for Payer: Blue Shield of California EPN |
$43.67
|
| 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: Cigna of CA HMO |
$70.40
|
| Rate for Payer: Cigna of CA PPO |
$81.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.83
|
| Rate for Payer: EPIC Health Plan Senior |
$42.84
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.00
|
| 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) Medicare Advantage |
$42.84
|
| Rate for Payer: InnovAge PACE Commercial |
$64.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$42.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.41
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
| Rate for Payer: Networks By Design Commercial |
$71.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$42.84
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
| Rate for Payer: Prime Health Services Medicare |
$45.41
|
| Rate for Payer: Riverside University Health System MISP |
$47.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$66.00
|
| 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 HMO |
$34.70
|
| Rate for Payer: United Healthcare HMO Rider |
$34.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.70
|
| 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 Medi-Cal |
$47.12
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$96.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$89.14
|
| 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 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: 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 Permanente of CA Commercial/Self Funded |
$61.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$56.95
|
| 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 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 |
$95.95 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$33.40
|
| 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 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 HMO/PPO |
$19.47
|
| Rate for Payer: Blue Shield of California Commercial |
$33.38
|
| Rate for Payer: Blue Shield of California EPN |
$21.84
|
| 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: Cigna of CA HMO |
$35.20
|
| Rate for Payer: Cigna of CA PPO |
$40.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.71
|
| Rate for Payer: EPIC Health Plan Senior |
$13.12
|
| Rate for Payer: Galaxy Health WC |
$46.75
|
| Rate for Payer: Global Benefits Group Commercial |
$33.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$49.50
|
| 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) Medicare Advantage |
$13.12
|
| Rate for Payer: InnovAge PACE Commercial |
$19.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.58
|
| Rate for Payer: Multiplan Commercial |
$41.25
|
| Rate for Payer: Networks By Design Commercial |
$35.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.12
|
| Rate for Payer: Prime Health Services Commercial |
$46.75
|
| Rate for Payer: Prime Health Services Medicare |
$13.91
|
| Rate for Payer: Riverside University Health System MISP |
$14.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.00
|
| 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 HMO |
$10.63
|
| Rate for Payer: United Healthcare HMO Rider |
$10.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.63
|
| 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 Medi-Cal |
$14.43
|
| Rate for Payer: Vantage Medical Group Senior |
$13.12
|
|
|
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 |
$249.30 |
| Rate for Payer: Adventist Health Commercial |
$55.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$42.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$168.22
|
| 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 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 HMO/PPO |
$38.20
|
| Rate for Payer: Blue Shield of California Commercial |
$168.14
|
| Rate for Payer: Blue Shield of California EPN |
$109.97
|
| 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: Cigna of CA HMO |
$177.28
|
| Rate for Payer: Cigna of CA PPO |
$204.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.83
|
| Rate for Payer: EPIC Health Plan Senior |
$42.84
|
| Rate for Payer: Galaxy Health WC |
$235.45
|
| Rate for Payer: Global Benefits Group Commercial |
$166.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$249.30
|
| 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) Medicare Advantage |
$42.84
|
| Rate for Payer: InnovAge PACE Commercial |
$64.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$184.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$42.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.41
|
| Rate for Payer: Multiplan Commercial |
$207.75
|
| Rate for Payer: Networks By Design Commercial |
$180.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$42.84
|
| Rate for Payer: Prime Health Services Commercial |
$235.45
|
| Rate for Payer: Prime Health Services Medicare |
$45.41
|
| Rate for Payer: Riverside University Health System MISP |
$47.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$166.20
|
| 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 HMO |
$34.70
|
| Rate for Payer: United Healthcare HMO Rider |
$34.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.70
|
| 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 Medi-Cal |
$47.12
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$395.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$225.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$367.07
|
| 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
|
|
|
HC EBV-VCA IGG/IGM
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
900913535
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$117.30 |
| Rate for Payer: Adventist Health Commercial |
$15.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$18.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$46.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$117.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.81
|
| Rate for Payer: Blue Shield of California Commercial |
$46.13
|
| Rate for Payer: Blue Shield of California EPN |
$30.17
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Central Health Plan Commercial |
$60.80
|
| Rate for Payer: Cigna of CA HMO |
$48.64
|
| Rate for Payer: Cigna of CA PPO |
$56.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.49
|
| Rate for Payer: EPIC Health Plan Senior |
$18.14
|
| Rate for Payer: Galaxy Health WC |
$64.60
|
| Rate for Payer: Global Benefits Group Commercial |
$45.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$68.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.14
|
| Rate for Payer: InnovAge PACE Commercial |
$27.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.31
|
| Rate for Payer: Multiplan Commercial |
$57.00
|
| Rate for Payer: Networks By Design Commercial |
$49.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18.14
|
| Rate for Payer: Prime Health Services Commercial |
$64.60
|
| Rate for Payer: Prime Health Services Medicare |
$19.23
|
| Rate for Payer: Riverside University Health System MISP |
$19.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.70
|
| Rate for Payer: United Healthcare All Other HMO |
$14.70
|
| Rate for Payer: United Healthcare HMO Rider |
$14.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.95
|
| Rate for Payer: Vantage Medical Group Senior |
$18.14
|
|
|
HC EBV-VCA IGG/IGM
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
900913535
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$180.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$167.13
|
| 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 ECG 48 HR MONITOR-RECORDING
|
Facility
|
OP
|
$1,745.00
|
|
|
Service Code
|
CPT 93225
|
| Hospital Charge Code |
900200113
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$51.29 |
| Max. Negotiated Rate |
$1,570.50 |
| Rate for Payer: Adventist Health Commercial |
$349.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$163.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,059.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$316.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,024.84
|
| Rate for Payer: Blue Shield of California Commercial |
$1,059.21
|
| Rate for Payer: Blue Shield of California EPN |
$692.76
|
| Rate for Payer: Cash Price |
$785.25
|
| Rate for Payer: Cash Price |
$785.25
|
| Rate for Payer: Cash Price |
$785.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,396.00
|
| Rate for Payer: Cigna of CA HMO |
$1,116.80
|
| Rate for Payer: Cigna of CA PPO |
$1,291.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.10
|
| Rate for Payer: EPIC Health Plan Senior |
$163.78
|
| Rate for Payer: Galaxy Health WC |
$1,483.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,047.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,570.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$51.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: InnovAge PACE Commercial |
$245.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,163.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$349.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$219.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.47
|
| Rate for Payer: Multiplan Commercial |
$1,308.75
|
| Rate for Payer: Networks By Design Commercial |
$1,134.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$163.78
|
| Rate for Payer: Prime Health Services Commercial |
$1,483.25
|
| Rate for Payer: Prime Health Services Medicare |
$173.61
|
| Rate for Payer: Riverside University Health System MISP |
$180.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,047.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,047.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,477.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,006.00
|
| Rate for Payer: United Healthcare HMO Rider |
$765.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$701.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$163.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
|
HC ECG 48 HR MONITOR-RECORDING
|
Facility
|
IP
|
$1,745.00
|
|
|
Service Code
|
CPT 93225
|
| Hospital Charge Code |
900200113
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$349.00 |
| Max. Negotiated Rate |
$1,570.50 |
| Rate for Payer: Adventist Health Commercial |
$349.00
|
| Rate for Payer: Cash Price |
$785.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,396.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$698.00
|
| Rate for Payer: EPIC Health Plan Senior |
$698.00
|
| Rate for Payer: Galaxy Health WC |
$1,483.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,047.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,570.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,163.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$664.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,080.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$349.00
|
| Rate for Payer: Multiplan Commercial |
$1,308.75
|
| Rate for Payer: Networks By Design Commercial |
$1,134.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,483.25
|
|
|
HC ECG 48 HR MONITOR-RECORDING EC
|
Facility
|
IP
|
$1,745.00
|
|
|
Service Code
|
CPT 93225
|
| Hospital Charge Code |
900100041
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$349.00 |
| Max. Negotiated Rate |
$1,570.50 |
| Rate for Payer: Adventist Health Commercial |
$349.00
|
| Rate for Payer: Cash Price |
$785.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,396.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$698.00
|
| Rate for Payer: EPIC Health Plan Senior |
$698.00
|
| Rate for Payer: Galaxy Health WC |
$1,483.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,047.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,570.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,163.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$664.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,080.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$349.00
|
| Rate for Payer: Multiplan Commercial |
$1,308.75
|
| Rate for Payer: Networks By Design Commercial |
$1,134.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,483.25
|
|
|
HC ECG 48 HR MONITOR-RECORDING EC
|
Facility
|
OP
|
$1,745.00
|
|
|
Service Code
|
CPT 93225
|
| Hospital Charge Code |
900100041
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$51.29 |
| Max. Negotiated Rate |
$1,570.50 |
| Rate for Payer: Adventist Health Commercial |
$349.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$163.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,059.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$316.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,024.84
|
| Rate for Payer: Blue Shield of California Commercial |
$1,059.21
|
| Rate for Payer: Blue Shield of California EPN |
$692.76
|
| Rate for Payer: Cash Price |
$785.25
|
| Rate for Payer: Cash Price |
$785.25
|
| Rate for Payer: Cash Price |
$785.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,396.00
|
| Rate for Payer: Cigna of CA HMO |
$1,116.80
|
| Rate for Payer: Cigna of CA PPO |
$1,291.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.10
|
| Rate for Payer: EPIC Health Plan Senior |
$163.78
|
| Rate for Payer: Galaxy Health WC |
$1,483.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,047.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,570.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$51.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: InnovAge PACE Commercial |
$245.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,163.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$349.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$219.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.47
|
| Rate for Payer: Multiplan Commercial |
$1,308.75
|
| Rate for Payer: Networks By Design Commercial |
$1,134.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$163.78
|
| Rate for Payer: Prime Health Services Commercial |
$1,483.25
|
| Rate for Payer: Prime Health Services Medicare |
$173.61
|
| Rate for Payer: Riverside University Health System MISP |
$180.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,047.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,047.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,477.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,006.00
|
| Rate for Payer: United Healthcare HMO Rider |
$765.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$701.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$163.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
|
HC ECG 48 HR MONITOR-RECORDING HSH
|
Facility
|
IP
|
$1,745.00
|
|
|
Service Code
|
CPT 93225
|
| Hospital Charge Code |
900100042
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$349.00 |
| Max. Negotiated Rate |
$1,570.50 |
| Rate for Payer: Adventist Health Commercial |
$349.00
|
| Rate for Payer: Cash Price |
$785.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,396.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$698.00
|
| Rate for Payer: EPIC Health Plan Senior |
$698.00
|
| Rate for Payer: Galaxy Health WC |
$1,483.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,047.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,570.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,163.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$664.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,080.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$349.00
|
| Rate for Payer: Multiplan Commercial |
$1,308.75
|
| Rate for Payer: Networks By Design Commercial |
$1,134.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,483.25
|
|
|
HC ECG 48 HR MONITOR-RECORDING HSH
|
Facility
|
OP
|
$1,745.00
|
|
|
Service Code
|
CPT 93225
|
| Hospital Charge Code |
900100042
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$51.29 |
| Max. Negotiated Rate |
$1,570.50 |
| Rate for Payer: Adventist Health Commercial |
$349.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$163.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,059.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$316.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,024.84
|
| Rate for Payer: Blue Shield of California Commercial |
$1,059.21
|
| Rate for Payer: Blue Shield of California EPN |
$692.76
|
| Rate for Payer: Cash Price |
$785.25
|
| Rate for Payer: Cash Price |
$785.25
|
| Rate for Payer: Cash Price |
$785.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,396.00
|
| Rate for Payer: Cigna of CA HMO |
$1,116.80
|
| Rate for Payer: Cigna of CA PPO |
$1,291.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.10
|
| Rate for Payer: EPIC Health Plan Senior |
$163.78
|
| Rate for Payer: Galaxy Health WC |
$1,483.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,047.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,570.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$51.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: InnovAge PACE Commercial |
$245.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,163.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$349.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$219.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.47
|
| Rate for Payer: Multiplan Commercial |
$1,308.75
|
| Rate for Payer: Networks By Design Commercial |
$1,134.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$163.78
|
| Rate for Payer: Prime Health Services Commercial |
$1,483.25
|
| Rate for Payer: Prime Health Services Medicare |
$173.61
|
| Rate for Payer: Riverside University Health System MISP |
$180.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,047.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,047.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,477.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,006.00
|
| Rate for Payer: United Healthcare HMO Rider |
$765.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$701.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$163.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
