|
HC CHROM ANLZ 15-20 CELLS 2 KARYO
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
CPT 88262
|
| Hospital Charge Code |
900918020
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$49.00 |
| Max. Negotiated Rate |
$220.50 |
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: Central Health Plan Commercial |
$196.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.00
|
| Rate for Payer: Galaxy Health WC |
$208.25
|
| Rate for Payer: Global Benefits Group Commercial |
$147.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$220.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$163.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.00
|
| Rate for Payer: Multiplan Commercial |
$183.75
|
| Rate for Payer: Networks By Design Commercial |
$159.25
|
| Rate for Payer: Prime Health Services Commercial |
$208.25
|
|
|
HC CHROM ANLZ 20-25 CELLS
|
Facility
|
OP
|
$174.00
|
|
|
Service Code
|
CPT 88264
|
| Hospital Charge Code |
900918016
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$34.80 |
| Max. Negotiated Rate |
$1,101.07 |
| Rate for Payer: Adventist Health Medi-Cal |
$144.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$914.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$216.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$159.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$144.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$902.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,101.07
|
| Rate for Payer: Blue Distinction Transplant |
$104.40
|
| Rate for Payer: Blue Shield of California Commercial |
$107.53
|
| Rate for Payer: Blue Shield of California EPN |
$84.56
|
| Rate for Payer: Caremore Medicare Advantage |
$144.61
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Central Health Plan Commercial |
$139.20
|
| Rate for Payer: Cigna of CA HMO |
$111.36
|
| Rate for Payer: Cigna of CA PPO |
$128.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$216.92
|
| Rate for Payer: Dignity Health Media |
$144.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$159.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$195.22
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$144.61
|
| Rate for Payer: EPIC Health Plan Transplant |
$144.61
|
| Rate for Payer: Galaxy Health WC |
$147.90
|
| Rate for Payer: Global Benefits Group Commercial |
$104.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$156.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$130.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$237.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$238.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$144.61
|
| Rate for Payer: InnovAge PACE Commercial |
$216.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$116.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$219.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$144.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$193.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$193.78
|
| Rate for Payer: Multiplan Commercial |
$130.50
|
| Rate for Payer: Networks By Design Commercial |
$113.10
|
| Rate for Payer: Prime Health Services Commercial |
$147.90
|
| Rate for Payer: Prime Health Services Medicare |
$153.29
|
| Rate for Payer: Riverside University Health System MISP |
$159.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$104.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$104.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$117.14
|
| Rate for Payer: United Healthcare All Other HMO |
$117.14
|
| Rate for Payer: United Healthcare HMO Rider |
$117.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$117.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$216.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$159.07
|
| Rate for Payer: Vantage Medical Group Senior |
$144.61
|
|
|
HC CHROM ANLZ 20-25 CELLS
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
CPT 88264
|
| Hospital Charge Code |
900918016
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$49.00 |
| Max. Negotiated Rate |
$220.50 |
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: Central Health Plan Commercial |
$196.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.00
|
| Rate for Payer: Galaxy Health WC |
$208.25
|
| Rate for Payer: Global Benefits Group Commercial |
$147.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$220.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$163.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.00
|
| Rate for Payer: Multiplan Commercial |
$183.75
|
| Rate for Payer: Networks By Design Commercial |
$159.25
|
| Rate for Payer: Prime Health Services Commercial |
$208.25
|
|
|
HC CHROM ANLZ 45 CEL MSAIC 2 KRYO
|
Facility
|
OP
|
$213.00
|
|
|
Service Code
|
CPT 88263
|
| Hospital Charge Code |
900918017
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$42.60 |
| Max. Negotiated Rate |
$1,290.26 |
| Rate for Payer: Adventist Health Medi-Cal |
$150.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$762.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$225.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$165.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$150.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,057.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,290.26
|
| Rate for Payer: Blue Distinction Transplant |
$127.80
|
| Rate for Payer: Blue Shield of California Commercial |
$131.63
|
| Rate for Payer: Blue Shield of California EPN |
$103.52
|
| Rate for Payer: Caremore Medicare Advantage |
$150.29
|
| Rate for Payer: Cash Price |
$95.85
|
| Rate for Payer: Cash Price |
$95.85
|
| Rate for Payer: Central Health Plan Commercial |
$170.40
|
| Rate for Payer: Cigna of CA HMO |
$136.32
|
| Rate for Payer: Cigna of CA PPO |
$157.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.44
|
| Rate for Payer: Dignity Health Media |
$150.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$165.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.89
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$150.29
|
| Rate for Payer: EPIC Health Plan Transplant |
$150.29
|
| Rate for Payer: Galaxy Health WC |
$181.05
|
| Rate for Payer: Global Benefits Group Commercial |
$127.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$191.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$159.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$246.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$247.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$150.29
|
| Rate for Payer: InnovAge PACE Commercial |
$225.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$142.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$253.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$150.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$201.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$201.39
|
| Rate for Payer: Multiplan Commercial |
$159.75
|
| Rate for Payer: Networks By Design Commercial |
$138.45
|
| Rate for Payer: Prime Health Services Commercial |
$181.05
|
| Rate for Payer: Prime Health Services Medicare |
$159.31
|
| Rate for Payer: Riverside University Health System MISP |
$165.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$127.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$127.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$121.73
|
| Rate for Payer: United Healthcare All Other HMO |
$121.73
|
| Rate for Payer: United Healthcare HMO Rider |
$121.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$121.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$225.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$165.32
|
| Rate for Payer: Vantage Medical Group Senior |
$150.29
|
|
|
HC CHROM ANLZ 45 CEL MSAIC 2 KRYO
|
Facility
|
IP
|
$297.00
|
|
|
Service Code
|
CPT 88263
|
| Hospital Charge Code |
900918017
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$59.40 |
| Max. Negotiated Rate |
$267.30 |
| Rate for Payer: Cash Price |
$133.65
|
| Rate for Payer: Central Health Plan Commercial |
$237.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.80
|
| Rate for Payer: Galaxy Health WC |
$252.45
|
| Rate for Payer: Global Benefits Group Commercial |
$178.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$267.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$198.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.40
|
| Rate for Payer: Multiplan Commercial |
$222.75
|
| Rate for Payer: Networks By Design Commercial |
$193.05
|
| Rate for Payer: Prime Health Services Commercial |
$252.45
|
|
|
HC CHROM ANLZ 5 CELLS 1 KARYO
|
Facility
|
IP
|
$412.00
|
|
|
Service Code
|
CPT 88261
|
| Hospital Charge Code |
900918019
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$82.40 |
| Max. Negotiated Rate |
$370.80 |
| Rate for Payer: Cash Price |
$185.40
|
| Rate for Payer: Central Health Plan Commercial |
$329.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$164.80
|
| Rate for Payer: Galaxy Health WC |
$350.20
|
| Rate for Payer: Global Benefits Group Commercial |
$247.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$370.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$274.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$156.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.40
|
| Rate for Payer: Multiplan Commercial |
$309.00
|
| Rate for Payer: Networks By Design Commercial |
$267.80
|
| Rate for Payer: Prime Health Services Commercial |
$350.20
|
|
|
HC CHROM ANLZ 5 CELLS 1 KARYO
|
Facility
|
OP
|
$297.00
|
|
|
Service Code
|
CPT 88261
|
| Hospital Charge Code |
900918019
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$59.40 |
| Max. Negotiated Rate |
$1,331.31 |
| Rate for Payer: Adventist Health Medi-Cal |
$264.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,297.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$396.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$290.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$264.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,091.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,331.31
|
| Rate for Payer: Blue Distinction Transplant |
$178.20
|
| Rate for Payer: Blue Shield of California Commercial |
$183.55
|
| Rate for Payer: Blue Shield of California EPN |
$144.34
|
| Rate for Payer: Caremore Medicare Advantage |
$264.34
|
| Rate for Payer: Cash Price |
$133.65
|
| Rate for Payer: Cash Price |
$133.65
|
| Rate for Payer: Central Health Plan Commercial |
$237.60
|
| Rate for Payer: Cigna of CA HMO |
$190.08
|
| Rate for Payer: Cigna of CA PPO |
$219.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$396.51
|
| Rate for Payer: Dignity Health Media |
$264.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$290.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$356.86
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$264.34
|
| Rate for Payer: EPIC Health Plan Transplant |
$264.34
|
| Rate for Payer: Galaxy Health WC |
$252.45
|
| Rate for Payer: Global Benefits Group Commercial |
$178.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$267.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$222.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$433.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$436.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$264.34
|
| Rate for Payer: InnovAge PACE Commercial |
$396.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$198.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$361.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$264.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$354.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$354.22
|
| Rate for Payer: Multiplan Commercial |
$222.75
|
| Rate for Payer: Networks By Design Commercial |
$193.05
|
| Rate for Payer: Prime Health Services Commercial |
$252.45
|
| Rate for Payer: Prime Health Services Medicare |
$280.20
|
| Rate for Payer: Riverside University Health System MISP |
$290.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$178.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$178.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$214.12
|
| Rate for Payer: United Healthcare All Other HMO |
$214.12
|
| Rate for Payer: United Healthcare HMO Rider |
$214.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$214.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$396.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$290.77
|
| Rate for Payer: Vantage Medical Group Senior |
$264.34
|
|
|
HC CHROM ANLZ ADDL KARYO
|
Facility
|
IP
|
$58.00
|
|
|
Service Code
|
CPT 88280
|
| Hospital Charge Code |
900918018
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$11.60 |
| Max. Negotiated Rate |
$52.20 |
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Central Health Plan Commercial |
$46.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.20
|
| Rate for Payer: Galaxy Health WC |
$49.30
|
| Rate for Payer: Global Benefits Group Commercial |
$34.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$52.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.60
|
| Rate for Payer: Multiplan Commercial |
$43.50
|
| Rate for Payer: Networks By Design Commercial |
$37.70
|
| Rate for Payer: Prime Health Services Commercial |
$49.30
|
|
|
HC CHROM ANLZ ADDL KARYO
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 88280
|
| Hospital Charge Code |
900918018
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$222.71 |
| Rate for Payer: Adventist Health Medi-Cal |
$33.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$184.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$36.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$182.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$222.71
|
| Rate for Payer: Blue Distinction Transplant |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$24.10
|
| Rate for Payer: Blue Shield of California EPN |
$18.95
|
| Rate for Payer: Caremore Medicare Advantage |
$33.47
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Central Health Plan Commercial |
$31.20
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.20
|
| Rate for Payer: Dignity Health Media |
$33.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.18
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$33.47
|
| Rate for Payer: EPIC Health Plan Transplant |
$33.47
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$54.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$55.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$33.47
|
| Rate for Payer: InnovAge PACE Commercial |
$50.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44.85
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Prime Health Services Medicare |
$35.48
|
| Rate for Payer: Riverside University Health System MISP |
$36.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.11
|
| Rate for Payer: United Healthcare All Other HMO |
$27.11
|
| Rate for Payer: United Healthcare HMO Rider |
$27.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.82
|
| Rate for Payer: Vantage Medical Group Senior |
$33.47
|
|
|
HC CHW EDU TRAINING PT SELF MGMT EA 30MN
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
CPT 98960
|
| Hospital Charge Code |
900501960
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$18.80 |
| Max. Negotiated Rate |
$84.60 |
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Central Health Plan Commercial |
$75.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.60
|
| Rate for Payer: Galaxy Health WC |
$79.90
|
| Rate for Payer: Global Benefits Group Commercial |
$56.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$84.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$62.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.80
|
| Rate for Payer: Multiplan Commercial |
$70.50
|
| Rate for Payer: Networks By Design Commercial |
$61.10
|
| Rate for Payer: Prime Health Services Commercial |
$79.90
|
|
|
HC CHW EDU TRAINING PT SELF MGMT EA 30MN
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
CPT 98960
|
| Hospital Charge Code |
900501960
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$18.80 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$79.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$51.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$56.40
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Central Health Plan Commercial |
$75.20
|
| Rate for Payer: Cigna of CA PPO |
$69.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$79.90
|
| Rate for Payer: Dignity Health Media |
$79.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$79.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$37.60
|
| Rate for Payer: Galaxy Health WC |
$79.90
|
| Rate for Payer: Global Benefits Group Commercial |
$56.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$84.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$70.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$62.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.80
|
| Rate for Payer: Multiplan Commercial |
$70.50
|
| Rate for Payer: Networks By Design Commercial |
$61.10
|
| Rate for Payer: Prime Health Services Commercial |
$79.90
|
| Rate for Payer: Riverside University Health System MISP |
$37.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$56.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$47.00
|
| Rate for Payer: United Healthcare All Other HMO |
$47.00
|
| Rate for Payer: United Healthcare HMO Rider |
$47.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$47.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$79.90
|
| Rate for Payer: Vantage Medical Group Senior |
$79.90
|
|
|
HC CILIARY TRANSSLERAL THERAPY
|
Facility
|
OP
|
$7,182.00
|
|
|
Service Code
|
CPT 66710
|
| Hospital Charge Code |
900566710
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$6,463.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,919.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,309.20
|
| Rate for Payer: Caremore Medicare Advantage |
$2,919.67
|
| Rate for Payer: Cash Price |
$3,231.90
|
| Rate for Payer: Cash Price |
$3,231.90
|
| Rate for Payer: Cash Price |
$3,231.90
|
| Rate for Payer: Cash Price |
$3,231.90
|
| Rate for Payer: Central Health Plan Commercial |
$5,745.60
|
| Rate for Payer: Cigna of CA PPO |
$5,314.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Dignity Health Media |
$2,919.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,211.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,941.55
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,919.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,919.67
|
| Rate for Payer: Galaxy Health WC |
$6,104.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4,309.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,463.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,386.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,788.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,919.67
|
| Rate for Payer: InnovAge PACE Commercial |
$4,379.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,790.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$472.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,919.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,436.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,912.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,912.36
|
| Rate for Payer: Multiplan Commercial |
$5,386.50
|
| Rate for Payer: Networks By Design Commercial |
$4,668.30
|
| Rate for Payer: Prime Health Services Commercial |
$6,104.70
|
| Rate for Payer: Prime Health Services Medicare |
$3,094.85
|
| Rate for Payer: Riverside University Health System MISP |
$3,211.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,309.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,591.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,591.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,591.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,919.67
|
|
|
HC CILIARY TRANSSLERAL THERAPY
|
Facility
|
IP
|
$7,182.00
|
|
|
Service Code
|
CPT 66710
|
| Hospital Charge Code |
900566710
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,436.40 |
| Max. Negotiated Rate |
$6,463.80 |
| Rate for Payer: Cash Price |
$3,231.90
|
| Rate for Payer: Central Health Plan Commercial |
$5,745.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,872.80
|
| Rate for Payer: Galaxy Health WC |
$6,104.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4,309.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,463.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,790.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,736.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,436.40
|
| Rate for Payer: Multiplan Commercial |
$5,386.50
|
| Rate for Payer: Networks By Design Commercial |
$4,668.30
|
| Rate for Payer: Prime Health Services Commercial |
$6,104.70
|
|
|
HC CIPROFLOXACIN E TEST
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
900912443
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$17.40 |
| Max. Negotiated Rate |
$78.30 |
| Rate for Payer: Cash Price |
$39.15
|
| Rate for Payer: Central Health Plan Commercial |
$69.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.80
|
| Rate for Payer: Galaxy Health WC |
$73.95
|
| Rate for Payer: Global Benefits Group Commercial |
$52.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$78.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.40
|
| Rate for Payer: Multiplan Commercial |
$65.25
|
| Rate for Payer: Networks By Design Commercial |
$56.55
|
| Rate for Payer: Prime Health Services Commercial |
$73.95
|
|
|
HC CIPROFLOXACIN E TEST
|
Facility
|
OP
|
$11.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
900912443
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$20.01 |
| Rate for Payer: Adventist Health Medi-Cal |
$4.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$16.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.01
|
| Rate for Payer: Blue Distinction Transplant |
$6.60
|
| Rate for Payer: Blue Shield of California Commercial |
$6.80
|
| Rate for Payer: Blue Shield of California EPN |
$5.35
|
| Rate for Payer: Caremore Medicare Advantage |
$4.75
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Central Health Plan Commercial |
$8.80
|
| Rate for Payer: Cigna of CA HMO |
$7.04
|
| Rate for Payer: Cigna of CA PPO |
$8.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.12
|
| Rate for Payer: Dignity Health Media |
$4.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.41
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4.75
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.75
|
| Rate for Payer: Galaxy Health WC |
$9.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.75
|
| Rate for Payer: InnovAge PACE Commercial |
$7.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.36
|
| Rate for Payer: Multiplan Commercial |
$8.25
|
| Rate for Payer: Networks By Design Commercial |
$7.15
|
| Rate for Payer: Prime Health Services Commercial |
$9.35
|
| Rate for Payer: Prime Health Services Medicare |
$5.04
|
| Rate for Payer: Riverside University Health System MISP |
$5.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.85
|
| Rate for Payer: United Healthcare All Other HMO |
$3.85
|
| Rate for Payer: United Healthcare HMO Rider |
$3.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Vantage Medical Group Senior |
$4.75
|
|
|
HC CIRC ANTICOAG SCRN
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 85732
|
| Hospital Charge Code |
900910015
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$57.41 |
| Rate for Payer: Adventist Health Medi-Cal |
$6.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$47.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$47.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.41
|
| Rate for Payer: Blue Distinction Transplant |
$15.00
|
| Rate for Payer: Blue Shield of California Commercial |
$15.45
|
| Rate for Payer: Blue Shield of California EPN |
$12.15
|
| Rate for Payer: Caremore Medicare Advantage |
$6.47
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: Cigna of CA HMO |
$16.00
|
| Rate for Payer: Cigna of CA PPO |
$18.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.70
|
| Rate for Payer: Dignity Health Media |
$6.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.73
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6.47
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.47
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$18.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.47
|
| Rate for Payer: InnovAge PACE Commercial |
$9.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.67
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Prime Health Services Medicare |
$6.86
|
| Rate for Payer: Riverside University Health System MISP |
$7.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.24
|
| Rate for Payer: United Healthcare All Other HMO |
$5.24
|
| Rate for Payer: United Healthcare HMO Rider |
$5.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Vantage Medical Group Senior |
$6.47
|
|
|
HC CIRC ANTICOAG SCRN
|
Facility
|
IP
|
$351.00
|
|
|
Service Code
|
CPT 85732
|
| Hospital Charge Code |
900910015
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$70.20 |
| Max. Negotiated Rate |
$315.90 |
| Rate for Payer: Cash Price |
$157.95
|
| Rate for Payer: Central Health Plan Commercial |
$280.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.40
|
| Rate for Payer: Galaxy Health WC |
$298.35
|
| Rate for Payer: Global Benefits Group Commercial |
$210.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$234.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.20
|
| Rate for Payer: Multiplan Commercial |
$263.25
|
| Rate for Payer: Networks By Design Commercial |
$228.15
|
| Rate for Payer: Prime Health Services Commercial |
$298.35
|
|
|
HC CISTERNOGRAM
|
Facility
|
OP
|
$3,221.00
|
|
|
Service Code
|
CPT 78630
|
| Hospital Charge Code |
909301413
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$321.46 |
| Max. Negotiated Rate |
$2,898.90 |
| Rate for Payer: Adventist Health Medi-Cal |
$675.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,699.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$742.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$675.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,037.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,902.97
|
| Rate for Payer: Blue Distinction Transplant |
$1,932.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,990.58
|
| Rate for Payer: Blue Shield of California EPN |
$1,565.41
|
| Rate for Payer: Caremore Medicare Advantage |
$675.33
|
| Rate for Payer: Cash Price |
$1,449.45
|
| Rate for Payer: Cash Price |
$1,449.45
|
| Rate for Payer: Central Health Plan Commercial |
$2,576.80
|
| Rate for Payer: Cigna of CA HMO |
$2,061.44
|
| Rate for Payer: Cigna of CA PPO |
$2,383.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Dignity Health Media |
$675.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$742.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$911.70
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$675.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$675.33
|
| Rate for Payer: Galaxy Health WC |
$2,737.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,932.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,898.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,415.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,107.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,114.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$675.33
|
| Rate for Payer: InnovAge PACE Commercial |
$1,013.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,148.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$321.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$675.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$644.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$904.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$904.94
|
| Rate for Payer: Multiplan Commercial |
$2,415.75
|
| Rate for Payer: Networks By Design Commercial |
$2,093.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,737.85
|
| Rate for Payer: Prime Health Services Medicare |
$715.85
|
| Rate for Payer: Riverside University Health System MISP |
$742.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,932.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,932.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,570.86
|
| Rate for Payer: United Healthcare All Other HMO |
$1,570.86
|
| Rate for Payer: United Healthcare HMO Rider |
$1,570.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,570.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$742.86
|
| Rate for Payer: Vantage Medical Group Senior |
$675.33
|
|
|
HC CISTERNOGRAM
|
Facility
|
IP
|
$3,221.00
|
|
|
Service Code
|
CPT 78630
|
| Hospital Charge Code |
909301413
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$644.20 |
| Max. Negotiated Rate |
$2,898.90 |
| Rate for Payer: Cash Price |
$1,449.45
|
| Rate for Payer: Central Health Plan Commercial |
$2,576.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,288.40
|
| Rate for Payer: Galaxy Health WC |
$2,737.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,932.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,898.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,148.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,227.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$644.20
|
| Rate for Payer: Multiplan Commercial |
$2,415.75
|
| Rate for Payer: Networks By Design Commercial |
$2,093.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,737.85
|
|
|
HC CITRULLINATED PEPTIDE AB
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
CPT 86200
|
| Hospital Charge Code |
900913554
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$145.80 |
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Central Health Plan Commercial |
$129.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.80
|
| Rate for Payer: Galaxy Health WC |
$137.70
|
| Rate for Payer: Global Benefits Group Commercial |
$97.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$145.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$108.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.40
|
| Rate for Payer: Multiplan Commercial |
$121.50
|
| Rate for Payer: Networks By Design Commercial |
$105.30
|
| Rate for Payer: Prime Health Services Commercial |
$137.70
|
|
|
HC CITRULLINATED PEPTIDE AB
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
CPT 86200
|
| Hospital Charge Code |
900913554
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$112.37 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$95.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$92.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$112.37
|
| Rate for Payer: Blue Distinction Transplant |
$29.40
|
| Rate for Payer: Blue Shield of California Commercial |
$30.28
|
| Rate for Payer: Blue Shield of California EPN |
$23.81
|
| Rate for Payer: Caremore Medicare Advantage |
$12.95
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Central Health Plan Commercial |
$39.20
|
| Rate for Payer: Cigna of CA HMO |
$31.36
|
| Rate for Payer: Cigna of CA PPO |
$36.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.42
|
| Rate for Payer: Dignity Health Media |
$12.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.48
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.95
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.95
|
| Rate for Payer: Galaxy Health WC |
$41.65
|
| Rate for Payer: Global Benefits Group Commercial |
$29.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$36.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.95
|
| Rate for Payer: InnovAge PACE Commercial |
$19.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.35
|
| Rate for Payer: Multiplan Commercial |
$36.75
|
| Rate for Payer: Networks By Design Commercial |
$31.85
|
| Rate for Payer: Prime Health Services Commercial |
$41.65
|
| Rate for Payer: Prime Health Services Medicare |
$13.73
|
| Rate for Payer: Riverside University Health System MISP |
$14.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.49
|
| Rate for Payer: United Healthcare All Other HMO |
$10.49
|
| Rate for Payer: United Healthcare HMO Rider |
$10.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.24
|
| Rate for Payer: Vantage Medical Group Senior |
$12.95
|
|
|
HC CK-MB
|
Facility
|
IP
|
$269.00
|
|
|
Service Code
|
CPT 82553
|
| Hospital Charge Code |
900910805
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$53.80 |
| Max. Negotiated Rate |
$242.10 |
| Rate for Payer: Cash Price |
$121.05
|
| Rate for Payer: Central Health Plan Commercial |
$215.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.60
|
| Rate for Payer: Galaxy Health WC |
$228.65
|
| Rate for Payer: Global Benefits Group Commercial |
$161.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$242.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$179.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.80
|
| Rate for Payer: Multiplan Commercial |
$201.75
|
| Rate for Payer: Networks By Design Commercial |
$174.85
|
| Rate for Payer: Prime Health Services Commercial |
$228.65
|
|
|
HC CK-MB
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
CPT 82553
|
| Hospital Charge Code |
900910805
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.40 |
| Max. Negotiated Rate |
$102.45 |
| Rate for Payer: Adventist Health Medi-Cal |
$11.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$84.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$84.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$102.45
|
| Rate for Payer: Blue Distinction Transplant |
$19.20
|
| Rate for Payer: Blue Shield of California Commercial |
$19.78
|
| Rate for Payer: Blue Shield of California EPN |
$15.55
|
| Rate for Payer: Caremore Medicare Advantage |
$11.55
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Central Health Plan Commercial |
$25.60
|
| Rate for Payer: Cigna of CA HMO |
$20.48
|
| Rate for Payer: Cigna of CA PPO |
$23.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.32
|
| Rate for Payer: Dignity Health Media |
$11.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.59
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$11.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.55
|
| Rate for Payer: Galaxy Health WC |
$27.20
|
| Rate for Payer: Global Benefits Group Commercial |
$19.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$24.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.55
|
| Rate for Payer: InnovAge PACE Commercial |
$17.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.48
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: Networks By Design Commercial |
$20.80
|
| Rate for Payer: Prime Health Services Commercial |
$27.20
|
| Rate for Payer: Prime Health Services Medicare |
$12.24
|
| Rate for Payer: Riverside University Health System MISP |
$12.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.36
|
| Rate for Payer: United Healthcare All Other HMO |
$9.36
|
| Rate for Payer: United Healthcare HMO Rider |
$9.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.70
|
| Rate for Payer: Vantage Medical Group Senior |
$11.55
|
|
|
HC CLAVICLE
|
Facility
|
OP
|
$846.00
|
|
|
Service Code
|
CPT 73000
|
| Hospital Charge Code |
909001478
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$39.48 |
| Max. Negotiated Rate |
$761.40 |
| Rate for Payer: Adventist Health Medi-Cal |
$113.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$115.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$108.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.50
|
| Rate for Payer: Blue Distinction Transplant |
$507.60
|
| Rate for Payer: Blue Shield of California Commercial |
$522.83
|
| Rate for Payer: Blue Shield of California EPN |
$411.16
|
| Rate for Payer: Caremore Medicare Advantage |
$113.54
|
| Rate for Payer: Cash Price |
$380.70
|
| Rate for Payer: Cash Price |
$380.70
|
| Rate for Payer: Central Health Plan Commercial |
$676.80
|
| Rate for Payer: Cigna of CA HMO |
$541.44
|
| Rate for Payer: Cigna of CA PPO |
$626.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Media |
$113.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.54
|
| Rate for Payer: Galaxy Health WC |
$719.10
|
| Rate for Payer: Global Benefits Group Commercial |
$507.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$761.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$634.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$186.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$187.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$113.54
|
| Rate for Payer: InnovAge PACE Commercial |
$170.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$564.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$152.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$634.50
|
| Rate for Payer: Networks By Design Commercial |
$549.90
|
| Rate for Payer: Prime Health Services Commercial |
$719.10
|
| Rate for Payer: Prime Health Services Medicare |
$120.35
|
| Rate for Payer: Riverside University Health System MISP |
$124.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$507.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$507.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC CLAVICLE
|
Facility
|
IP
|
$846.00
|
|
|
Service Code
|
CPT 73000
|
| Hospital Charge Code |
909001478
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$169.20 |
| Max. Negotiated Rate |
$761.40 |
| Rate for Payer: Cash Price |
$380.70
|
| Rate for Payer: Central Health Plan Commercial |
$676.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$338.40
|
| Rate for Payer: Galaxy Health WC |
$719.10
|
| Rate for Payer: Global Benefits Group Commercial |
$507.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$761.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$564.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$322.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.20
|
| Rate for Payer: Multiplan Commercial |
$634.50
|
| Rate for Payer: Networks By Design Commercial |
$549.90
|
| Rate for Payer: Prime Health Services Commercial |
$719.10
|
|
