|
HC HLA SERUM PROCESSING
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
CPT 86849
|
| Hospital Charge Code |
903901964
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Central Health Plan Commercial |
$72.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$63.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.00
|
| Rate for Payer: EPIC Health Plan Senior |
$36.00
|
| Rate for Payer: Galaxy Health WC |
$76.50
|
| Rate for Payer: Global Benefits Group Commercial |
$54.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$81.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$57.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$53.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
| Rate for Payer: Networks By Design Commercial |
$58.50
|
| Rate for Payer: Prime Health Services Commercial |
$76.50
|
|
|
HC HLA SERUM PROCESSING
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
CPT 86849
|
| Hospital Charge Code |
903901964
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Adventist Health Commercial |
$6.80
|
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$20.65
|
| Rate for Payer: Aetna of CA HMO/PPO |
$54.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$49.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.50
|
| Rate for Payer: Blue Shield of California Commercial |
$21.42
|
| Rate for Payer: Blue Shield of California Commercial |
$56.70
|
| Rate for Payer: Blue Shield of California EPN |
$13.50
|
| Rate for Payer: Blue Shield of California EPN |
$35.73
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Central Health Plan Commercial |
$27.20
|
| Rate for Payer: Central Health Plan Commercial |
$72.00
|
| Rate for Payer: Cigna of CA HMO |
$57.60
|
| Rate for Payer: Cigna of CA HMO |
$21.76
|
| Rate for Payer: Cigna of CA PPO |
$66.60
|
| Rate for Payer: Cigna of CA PPO |
$25.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$76.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$28.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$76.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$63.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.00
|
| Rate for Payer: EPIC Health Plan Senior |
$13.60
|
| Rate for Payer: EPIC Health Plan Senior |
$36.00
|
| Rate for Payer: Galaxy Health WC |
$76.50
|
| Rate for Payer: Galaxy Health WC |
$28.90
|
| Rate for Payer: Global Benefits Group Commercial |
$54.00
|
| Rate for Payer: Global Benefits Group Commercial |
$20.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$81.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$57.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$53.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$63.00
|
| Rate for Payer: Multiplan Commercial |
$25.50
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
| Rate for Payer: Networks By Design Commercial |
$58.50
|
| Rate for Payer: Networks By Design Commercial |
$22.10
|
| Rate for Payer: Prime Health Services Commercial |
$28.90
|
| Rate for Payer: Prime Health Services Commercial |
$76.50
|
| Rate for Payer: Riverside University Health System MISP |
$36.00
|
| Rate for Payer: Riverside University Health System MISP |
$13.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$54.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$54.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.00
|
| Rate for Payer: United Healthcare All Other HMO |
$17.00
|
| Rate for Payer: United Healthcare All Other HMO |
$45.00
|
| Rate for Payer: United Healthcare HMO Rider |
$45.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$45.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$76.50
|
| Rate for Payer: Vantage Medical Group Senior |
$28.90
|
| Rate for Payer: Vantage Medical Group Senior |
$76.50
|
|
|
HC HLA X MATCH AUTO
|
Facility
|
IP
|
$814.00
|
|
|
Service Code
|
CPT 86825
|
| Hospital Charge Code |
903901926
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$162.80 |
| Max. Negotiated Rate |
$732.60 |
| Rate for Payer: Adventist Health Commercial |
$162.80
|
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: Central Health Plan Commercial |
$651.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$569.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$325.60
|
| Rate for Payer: EPIC Health Plan Senior |
$325.60
|
| Rate for Payer: Galaxy Health WC |
$691.90
|
| Rate for Payer: Global Benefits Group Commercial |
$488.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$732.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$516.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$480.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.80
|
| Rate for Payer: Multiplan Commercial |
$610.50
|
| Rate for Payer: Networks By Design Commercial |
$529.10
|
| Rate for Payer: Prime Health Services Commercial |
$691.90
|
|
|
HC HLA X MATCH AUTO
|
Facility
|
OP
|
$524.00
|
|
|
Service Code
|
CPT 86825
|
| Hospital Charge Code |
903901926
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$88.69 |
| Max. Negotiated Rate |
$717.46 |
| Rate for Payer: Adventist Health Commercial |
$104.80
|
| Rate for Payer: Adventist Health Commercial |
$162.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$109.49
|
| Rate for Payer: Adventist Health Medi-Cal |
$109.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$589.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$589.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$164.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$164.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$120.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$120.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$109.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$109.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$516.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$516.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$717.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$717.46
|
| Rate for Payer: Blue Shield of California Commercial |
$512.82
|
| Rate for Payer: Blue Shield of California Commercial |
$330.12
|
| Rate for Payer: Blue Shield of California EPN |
$323.16
|
| Rate for Payer: Blue Shield of California EPN |
$208.03
|
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: Cash Price |
$235.80
|
| Rate for Payer: Cash Price |
$235.80
|
| Rate for Payer: Central Health Plan Commercial |
$419.20
|
| Rate for Payer: Central Health Plan Commercial |
$651.20
|
| Rate for Payer: Cigna of CA HMO |
$520.96
|
| Rate for Payer: Cigna of CA HMO |
$335.36
|
| Rate for Payer: Cigna of CA PPO |
$602.36
|
| Rate for Payer: Cigna of CA PPO |
$387.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$164.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$164.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$120.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$120.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$109.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$109.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$366.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$569.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$180.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$180.66
|
| Rate for Payer: EPIC Health Plan Senior |
$120.44
|
| Rate for Payer: EPIC Health Plan Senior |
$120.44
|
| Rate for Payer: Galaxy Health WC |
$691.90
|
| Rate for Payer: Galaxy Health WC |
$445.40
|
| Rate for Payer: Global Benefits Group Commercial |
$488.40
|
| Rate for Payer: Global Benefits Group Commercial |
$314.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$732.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$471.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$179.56
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$179.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$150.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$150.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$109.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$109.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$332.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$516.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$166.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$166.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$153.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$153.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$146.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$146.72
|
| Rate for Payer: Multiplan Commercial |
$610.50
|
| Rate for Payer: Multiplan Commercial |
$393.00
|
| Rate for Payer: Networks By Design Commercial |
$340.60
|
| Rate for Payer: Networks By Design Commercial |
$529.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$109.49
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$109.49
|
| Rate for Payer: Prime Health Services Commercial |
$691.90
|
| Rate for Payer: Prime Health Services Commercial |
$445.40
|
| Rate for Payer: Prime Health Services Medicare |
$116.06
|
| Rate for Payer: Prime Health Services Medicare |
$116.06
|
| Rate for Payer: Riverside University Health System MISP |
$120.44
|
| Rate for Payer: Riverside University Health System MISP |
$120.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$314.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$488.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$488.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$314.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$88.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$88.69
|
| Rate for Payer: United Healthcare All Other HMO |
$88.69
|
| Rate for Payer: United Healthcare All Other HMO |
$88.69
|
| Rate for Payer: United Healthcare HMO Rider |
$88.69
|
| Rate for Payer: United Healthcare HMO Rider |
$88.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$88.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$88.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$109.49
|
| Rate for Payer: Upland Medical Group Pediatric |
$109.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$164.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$164.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$120.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$120.44
|
| Rate for Payer: Vantage Medical Group Senior |
$109.49
|
| Rate for Payer: Vantage Medical Group Senior |
$109.49
|
|
|
HC HLA X MATCH B FLOW
|
Facility
|
IP
|
$730.00
|
|
|
Service Code
|
CPT 86356
|
| Hospital Charge Code |
903901936
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$146.00 |
| Max. Negotiated Rate |
$657.00 |
| Rate for Payer: Adventist Health Commercial |
$146.00
|
| Rate for Payer: Cash Price |
$328.50
|
| Rate for Payer: Central Health Plan Commercial |
$584.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$511.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$292.00
|
| Rate for Payer: EPIC Health Plan Senior |
$292.00
|
| Rate for Payer: Galaxy Health WC |
$620.50
|
| Rate for Payer: Global Benefits Group Commercial |
$438.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$657.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$463.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$430.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$146.00
|
| Rate for Payer: Multiplan Commercial |
$547.50
|
| Rate for Payer: Networks By Design Commercial |
$474.50
|
| Rate for Payer: Prime Health Services Commercial |
$620.50
|
|
|
HC HLA X MATCH B FLOW
|
Facility
|
OP
|
$355.00
|
|
|
Service Code
|
CPT 86356
|
| Hospital Charge Code |
903901936
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.69 |
| Max. Negotiated Rate |
$319.50 |
| Rate for Payer: Adventist Health Commercial |
$71.00
|
| Rate for Payer: Adventist Health Commercial |
$146.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$26.78
|
| Rate for Payer: Adventist Health Medi-Cal |
$26.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$196.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$196.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$194.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$194.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$270.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$270.79
|
| Rate for Payer: Blue Shield of California Commercial |
$459.90
|
| Rate for Payer: Blue Shield of California Commercial |
$223.65
|
| Rate for Payer: Blue Shield of California EPN |
$289.81
|
| Rate for Payer: Blue Shield of California EPN |
$140.94
|
| Rate for Payer: Cash Price |
$328.50
|
| Rate for Payer: Cash Price |
$328.50
|
| Rate for Payer: Cash Price |
$159.75
|
| Rate for Payer: Cash Price |
$159.75
|
| Rate for Payer: Central Health Plan Commercial |
$284.00
|
| Rate for Payer: Central Health Plan Commercial |
$584.00
|
| Rate for Payer: Cigna of CA HMO |
$467.20
|
| Rate for Payer: Cigna of CA HMO |
$227.20
|
| Rate for Payer: Cigna of CA PPO |
$540.20
|
| Rate for Payer: Cigna of CA PPO |
$262.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$248.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$511.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.19
|
| Rate for Payer: EPIC Health Plan Senior |
$29.46
|
| Rate for Payer: EPIC Health Plan Senior |
$29.46
|
| Rate for Payer: Galaxy Health WC |
$620.50
|
| Rate for Payer: Galaxy Health WC |
$301.75
|
| Rate for Payer: Global Benefits Group Commercial |
$438.00
|
| Rate for Payer: Global Benefits Group Commercial |
$213.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$657.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$319.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$43.92
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$43.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$40.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$40.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$26.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$26.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$225.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$463.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$45.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$45.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$37.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$37.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$146.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$35.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$35.89
|
| Rate for Payer: Multiplan Commercial |
$547.50
|
| Rate for Payer: Multiplan Commercial |
$266.25
|
| Rate for Payer: Networks By Design Commercial |
$230.75
|
| Rate for Payer: Networks By Design Commercial |
$474.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$26.78
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$26.78
|
| Rate for Payer: Prime Health Services Commercial |
$620.50
|
| Rate for Payer: Prime Health Services Commercial |
$301.75
|
| Rate for Payer: Prime Health Services Medicare |
$28.39
|
| Rate for Payer: Prime Health Services Medicare |
$28.39
|
| Rate for Payer: Riverside University Health System MISP |
$29.46
|
| Rate for Payer: Riverside University Health System MISP |
$29.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$213.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$438.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$438.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$213.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.69
|
| Rate for Payer: United Healthcare All Other HMO |
$21.69
|
| Rate for Payer: United Healthcare All Other HMO |
$21.69
|
| Rate for Payer: United Healthcare HMO Rider |
$21.69
|
| Rate for Payer: United Healthcare HMO Rider |
$21.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$26.78
|
| Rate for Payer: Upland Medical Group Pediatric |
$26.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.46
|
| Rate for Payer: Vantage Medical Group Senior |
$26.78
|
| Rate for Payer: Vantage Medical Group Senior |
$26.78
|
|
|
HC HLA X MATCH B SEROLOGY
|
Facility
|
IP
|
$770.00
|
|
|
Service Code
|
CPT 86805
|
| Hospital Charge Code |
903901925
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$154.00 |
| Max. Negotiated Rate |
$693.00 |
| Rate for Payer: Adventist Health Commercial |
$154.00
|
| Rate for Payer: Cash Price |
$346.50
|
| Rate for Payer: Central Health Plan Commercial |
$616.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$539.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$308.00
|
| Rate for Payer: EPIC Health Plan Senior |
$308.00
|
| Rate for Payer: Galaxy Health WC |
$654.50
|
| Rate for Payer: Global Benefits Group Commercial |
$462.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$693.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$488.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$454.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.00
|
| Rate for Payer: Multiplan Commercial |
$577.50
|
| Rate for Payer: Networks By Design Commercial |
$500.50
|
| Rate for Payer: Prime Health Services Commercial |
$654.50
|
|
|
HC HLA X MATCH B SEROLOGY
|
Facility
|
OP
|
$263.00
|
|
|
Service Code
|
CPT 86805
|
| Hospital Charge Code |
903901925
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$52.60 |
| Max. Negotiated Rate |
$364.01 |
| Rate for Payer: Adventist Health Commercial |
$52.60
|
| Rate for Payer: Adventist Health Commercial |
$154.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$189.51
|
| Rate for Payer: Adventist Health Medi-Cal |
$189.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$317.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$317.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$284.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$284.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$208.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$208.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$189.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$189.51
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$261.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$261.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$364.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$364.01
|
| Rate for Payer: Blue Shield of California Commercial |
$485.10
|
| Rate for Payer: Blue Shield of California Commercial |
$165.69
|
| Rate for Payer: Blue Shield of California EPN |
$305.69
|
| Rate for Payer: Blue Shield of California EPN |
$104.41
|
| Rate for Payer: Cash Price |
$346.50
|
| Rate for Payer: Cash Price |
$346.50
|
| Rate for Payer: Cash Price |
$118.35
|
| Rate for Payer: Cash Price |
$118.35
|
| Rate for Payer: Central Health Plan Commercial |
$210.40
|
| Rate for Payer: Central Health Plan Commercial |
$616.00
|
| Rate for Payer: Cigna of CA HMO |
$492.80
|
| Rate for Payer: Cigna of CA HMO |
$168.32
|
| Rate for Payer: Cigna of CA PPO |
$569.80
|
| Rate for Payer: Cigna of CA PPO |
$194.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$284.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$284.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$208.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$208.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$189.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$189.51
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$184.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$539.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$312.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$312.69
|
| Rate for Payer: EPIC Health Plan Senior |
$208.46
|
| Rate for Payer: EPIC Health Plan Senior |
$208.46
|
| Rate for Payer: Galaxy Health WC |
$654.50
|
| Rate for Payer: Galaxy Health WC |
$223.55
|
| Rate for Payer: Global Benefits Group Commercial |
$462.00
|
| Rate for Payer: Global Benefits Group Commercial |
$157.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$693.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$236.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$310.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$310.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$83.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$83.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$189.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$189.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$167.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$488.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$92.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$92.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$265.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$265.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$253.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$253.94
|
| Rate for Payer: Multiplan Commercial |
$577.50
|
| Rate for Payer: Multiplan Commercial |
$197.25
|
| Rate for Payer: Networks By Design Commercial |
$170.95
|
| Rate for Payer: Networks By Design Commercial |
$500.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$189.51
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$189.51
|
| Rate for Payer: Prime Health Services Commercial |
$654.50
|
| Rate for Payer: Prime Health Services Commercial |
$223.55
|
| Rate for Payer: Prime Health Services Medicare |
$200.88
|
| Rate for Payer: Prime Health Services Medicare |
$200.88
|
| Rate for Payer: Riverside University Health System MISP |
$208.46
|
| Rate for Payer: Riverside University Health System MISP |
$208.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$157.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$462.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$462.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$157.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$153.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$153.50
|
| Rate for Payer: United Healthcare All Other HMO |
$153.50
|
| Rate for Payer: United Healthcare All Other HMO |
$153.50
|
| Rate for Payer: United Healthcare HMO Rider |
$153.50
|
| Rate for Payer: United Healthcare HMO Rider |
$153.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$153.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$153.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$189.51
|
| Rate for Payer: Upland Medical Group Pediatric |
$189.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$284.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$284.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$208.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$208.46
|
| Rate for Payer: Vantage Medical Group Senior |
$189.51
|
| Rate for Payer: Vantage Medical Group Senior |
$189.51
|
|
|
HC HLA X MATCH FLOW
|
Facility
|
OP
|
$1,118.00
|
|
|
Service Code
|
CPT 86825
|
| Hospital Charge Code |
903901914
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$88.69 |
| Max. Negotiated Rate |
$1,006.20 |
| Rate for Payer: Adventist Health Commercial |
$223.60
|
| Rate for Payer: Adventist Health Commercial |
$126.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$109.49
|
| Rate for Payer: Adventist Health Medi-Cal |
$109.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$589.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$589.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$164.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$164.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$120.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$120.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$109.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$109.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$516.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$516.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$717.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$717.46
|
| Rate for Payer: Blue Shield of California Commercial |
$396.90
|
| Rate for Payer: Blue Shield of California Commercial |
$704.34
|
| Rate for Payer: Blue Shield of California EPN |
$250.11
|
| Rate for Payer: Blue Shield of California EPN |
$443.85
|
| Rate for Payer: Cash Price |
$283.50
|
| Rate for Payer: Cash Price |
$283.50
|
| Rate for Payer: Cash Price |
$503.10
|
| Rate for Payer: Cash Price |
$503.10
|
| Rate for Payer: Central Health Plan Commercial |
$894.40
|
| Rate for Payer: Central Health Plan Commercial |
$504.00
|
| Rate for Payer: Cigna of CA HMO |
$403.20
|
| Rate for Payer: Cigna of CA HMO |
$715.52
|
| Rate for Payer: Cigna of CA PPO |
$466.20
|
| Rate for Payer: Cigna of CA PPO |
$827.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$164.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$164.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$120.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$120.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$109.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$109.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$782.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$441.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$180.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$180.66
|
| Rate for Payer: EPIC Health Plan Senior |
$120.44
|
| Rate for Payer: EPIC Health Plan Senior |
$120.44
|
| Rate for Payer: Galaxy Health WC |
$535.50
|
| Rate for Payer: Galaxy Health WC |
$950.30
|
| Rate for Payer: Global Benefits Group Commercial |
$378.00
|
| Rate for Payer: Global Benefits Group Commercial |
$670.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$567.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,006.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$179.56
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$179.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$150.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$150.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$109.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$109.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$709.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$400.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$166.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$166.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$153.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$153.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$146.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$146.72
|
| Rate for Payer: Multiplan Commercial |
$472.50
|
| Rate for Payer: Multiplan Commercial |
$838.50
|
| Rate for Payer: Networks By Design Commercial |
$726.70
|
| Rate for Payer: Networks By Design Commercial |
$409.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$109.49
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$109.49
|
| Rate for Payer: Prime Health Services Commercial |
$535.50
|
| Rate for Payer: Prime Health Services Commercial |
$950.30
|
| Rate for Payer: Prime Health Services Medicare |
$116.06
|
| Rate for Payer: Prime Health Services Medicare |
$116.06
|
| Rate for Payer: Riverside University Health System MISP |
$120.44
|
| Rate for Payer: Riverside University Health System MISP |
$120.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$670.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$378.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$378.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$670.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$88.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$88.69
|
| Rate for Payer: United Healthcare All Other HMO |
$88.69
|
| Rate for Payer: United Healthcare All Other HMO |
$88.69
|
| Rate for Payer: United Healthcare HMO Rider |
$88.69
|
| Rate for Payer: United Healthcare HMO Rider |
$88.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$88.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$88.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$109.49
|
| Rate for Payer: Upland Medical Group Pediatric |
$109.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$164.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$164.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$120.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$120.44
|
| Rate for Payer: Vantage Medical Group Senior |
$109.49
|
| Rate for Payer: Vantage Medical Group Senior |
$109.49
|
|
|
HC HLA X MATCH FLOW
|
Facility
|
IP
|
$1,118.00
|
|
|
Service Code
|
CPT 86825
|
| Hospital Charge Code |
903901914
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$223.60 |
| Max. Negotiated Rate |
$1,006.20 |
| Rate for Payer: Adventist Health Commercial |
$223.60
|
| Rate for Payer: Cash Price |
$503.10
|
| Rate for Payer: Central Health Plan Commercial |
$894.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$782.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$447.20
|
| Rate for Payer: EPIC Health Plan Senior |
$447.20
|
| Rate for Payer: Galaxy Health WC |
$950.30
|
| Rate for Payer: Global Benefits Group Commercial |
$670.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,006.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$709.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$659.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.60
|
| Rate for Payer: Multiplan Commercial |
$838.50
|
| Rate for Payer: Networks By Design Commercial |
$726.70
|
| Rate for Payer: Prime Health Services Commercial |
$950.30
|
|
|
HC HLA X MATCH T SEROLOGY
|
Facility
|
IP
|
$867.00
|
|
|
Service Code
|
CPT 86805
|
| Hospital Charge Code |
903901924
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$173.40 |
| Max. Negotiated Rate |
$780.30 |
| Rate for Payer: Adventist Health Commercial |
$173.40
|
| Rate for Payer: Cash Price |
$390.15
|
| Rate for Payer: Central Health Plan Commercial |
$693.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$606.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$346.80
|
| Rate for Payer: EPIC Health Plan Senior |
$346.80
|
| Rate for Payer: Galaxy Health WC |
$736.95
|
| Rate for Payer: Global Benefits Group Commercial |
$520.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$780.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$550.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$511.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$173.40
|
| Rate for Payer: Multiplan Commercial |
$650.25
|
| Rate for Payer: Networks By Design Commercial |
$563.55
|
| Rate for Payer: Prime Health Services Commercial |
$736.95
|
|
|
HC HLA X MATCH T SEROLOGY
|
Facility
|
OP
|
$263.00
|
|
|
Service Code
|
CPT 86805
|
| Hospital Charge Code |
903901924
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$52.60 |
| Max. Negotiated Rate |
$364.01 |
| Rate for Payer: Adventist Health Commercial |
$52.60
|
| Rate for Payer: Adventist Health Commercial |
$173.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$189.51
|
| Rate for Payer: Adventist Health Medi-Cal |
$189.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$317.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$317.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$284.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$284.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$208.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$208.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$189.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$189.51
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$261.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$261.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$364.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$364.01
|
| Rate for Payer: Blue Shield of California Commercial |
$546.21
|
| Rate for Payer: Blue Shield of California Commercial |
$165.69
|
| Rate for Payer: Blue Shield of California EPN |
$344.20
|
| Rate for Payer: Blue Shield of California EPN |
$104.41
|
| Rate for Payer: Cash Price |
$390.15
|
| Rate for Payer: Cash Price |
$390.15
|
| Rate for Payer: Cash Price |
$118.35
|
| Rate for Payer: Cash Price |
$118.35
|
| Rate for Payer: Central Health Plan Commercial |
$210.40
|
| Rate for Payer: Central Health Plan Commercial |
$693.60
|
| Rate for Payer: Cigna of CA HMO |
$554.88
|
| Rate for Payer: Cigna of CA HMO |
$168.32
|
| Rate for Payer: Cigna of CA PPO |
$641.58
|
| Rate for Payer: Cigna of CA PPO |
$194.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$284.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$284.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$208.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$208.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$189.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$189.51
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$184.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$606.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$312.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$312.69
|
| Rate for Payer: EPIC Health Plan Senior |
$208.46
|
| Rate for Payer: EPIC Health Plan Senior |
$208.46
|
| Rate for Payer: Galaxy Health WC |
$736.95
|
| Rate for Payer: Galaxy Health WC |
$223.55
|
| Rate for Payer: Global Benefits Group Commercial |
$520.20
|
| Rate for Payer: Global Benefits Group Commercial |
$157.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$780.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$236.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$310.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$310.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$83.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$83.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$189.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$189.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$167.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$550.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$92.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$92.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$265.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$265.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$173.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$253.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$253.94
|
| Rate for Payer: Multiplan Commercial |
$650.25
|
| Rate for Payer: Multiplan Commercial |
$197.25
|
| Rate for Payer: Networks By Design Commercial |
$170.95
|
| Rate for Payer: Networks By Design Commercial |
$563.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$189.51
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$189.51
|
| Rate for Payer: Prime Health Services Commercial |
$736.95
|
| Rate for Payer: Prime Health Services Commercial |
$223.55
|
| Rate for Payer: Prime Health Services Medicare |
$200.88
|
| Rate for Payer: Prime Health Services Medicare |
$200.88
|
| Rate for Payer: Riverside University Health System MISP |
$208.46
|
| Rate for Payer: Riverside University Health System MISP |
$208.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$157.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$520.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$520.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$157.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$153.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$153.50
|
| Rate for Payer: United Healthcare All Other HMO |
$153.50
|
| Rate for Payer: United Healthcare All Other HMO |
$153.50
|
| Rate for Payer: United Healthcare HMO Rider |
$153.50
|
| Rate for Payer: United Healthcare HMO Rider |
$153.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$153.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$153.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$189.51
|
| Rate for Payer: Upland Medical Group Pediatric |
$189.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$284.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$284.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$208.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$208.46
|
| Rate for Payer: Vantage Medical Group Senior |
$189.51
|
| Rate for Payer: Vantage Medical Group Senior |
$189.51
|
|
|
HC HLA XM T FLOW, ADDL SERUM
|
Facility
|
IP
|
$323.00
|
|
|
Service Code
|
CPT 86826
|
| Hospital Charge Code |
903902015
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$64.60 |
| Max. Negotiated Rate |
$290.70 |
| Rate for Payer: Adventist Health Commercial |
$64.60
|
| Rate for Payer: Cash Price |
$145.35
|
| Rate for Payer: Central Health Plan Commercial |
$258.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$226.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$129.20
|
| Rate for Payer: EPIC Health Plan Senior |
$129.20
|
| Rate for Payer: Galaxy Health WC |
$274.55
|
| Rate for Payer: Global Benefits Group Commercial |
$193.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$290.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$205.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$190.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.60
|
| Rate for Payer: Multiplan Commercial |
$242.25
|
| Rate for Payer: Networks By Design Commercial |
$209.95
|
| Rate for Payer: Prime Health Services Commercial |
$274.55
|
|
|
HC HLA XM T FLOW, ADDL SERUM
|
Facility
|
OP
|
$323.00
|
|
|
Service Code
|
CPT 86826
|
| Hospital Charge Code |
903902015
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$29.59 |
| Max. Negotiated Rate |
$290.70 |
| Rate for Payer: Adventist Health Commercial |
$64.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$36.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$196.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$54.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$172.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$239.20
|
| Rate for Payer: Blue Shield of California Commercial |
$203.49
|
| Rate for Payer: Blue Shield of California EPN |
$128.23
|
| Rate for Payer: Cash Price |
$145.35
|
| Rate for Payer: Cash Price |
$145.35
|
| Rate for Payer: Central Health Plan Commercial |
$258.40
|
| Rate for Payer: Cigna of CA HMO |
$206.72
|
| Rate for Payer: Cigna of CA PPO |
$239.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$54.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$36.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$226.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.27
|
| Rate for Payer: EPIC Health Plan Senior |
$40.18
|
| Rate for Payer: Galaxy Health WC |
$274.55
|
| Rate for Payer: Global Benefits Group Commercial |
$193.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$290.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$59.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$50.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$36.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$205.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$55.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$51.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$48.95
|
| Rate for Payer: Multiplan Commercial |
$242.25
|
| Rate for Payer: Networks By Design Commercial |
$209.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$36.53
|
| Rate for Payer: Prime Health Services Commercial |
$274.55
|
| Rate for Payer: Prime Health Services Medicare |
$38.72
|
| Rate for Payer: Riverside University Health System MISP |
$40.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$193.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$193.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$29.59
|
| Rate for Payer: United Healthcare All Other HMO |
$29.59
|
| Rate for Payer: United Healthcare HMO Rider |
$29.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.59
|
| Rate for Payer: Upland Medical Group Pediatric |
$36.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$54.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.18
|
| Rate for Payer: Vantage Medical Group Senior |
$36.53
|
|
|
HC HLTH BHV ASSMT/REASSMT
|
Facility
|
OP
|
$592.00
|
|
|
Service Code
|
CPT 96156
|
| Hospital Charge Code |
902506156
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$118.40 |
| Max. Negotiated Rate |
$1,570.00 |
| Rate for Payer: Adventist Health Commercial |
$118.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$130.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$508.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$195.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$143.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$130.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$286.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$344.37
|
| Rate for Payer: Blue Shield of California Commercial |
$375.33
|
| Rate for Payer: Blue Shield of California EPN |
$236.21
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Central Health Plan Commercial |
$473.60
|
| Rate for Payer: Cigna of CA HMO |
$378.88
|
| Rate for Payer: Cigna of CA PPO |
$438.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$195.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$143.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$130.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$414.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.59
|
| Rate for Payer: EPIC Health Plan Senior |
$143.73
|
| Rate for Payer: Galaxy Health WC |
$503.20
|
| Rate for Payer: Global Benefits Group Commercial |
$355.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$532.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$214.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$146.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$130.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$375.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$162.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$182.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$175.08
|
| Rate for Payer: Multiplan Commercial |
$444.00
|
| Rate for Payer: Networks By Design Commercial |
$384.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$130.66
|
| Rate for Payer: Prime Health Services Commercial |
$503.20
|
| Rate for Payer: Prime Health Services Medicare |
$138.50
|
| Rate for Payer: Riverside University Health System MISP |
$143.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$355.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$355.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,570.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,496.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,129.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,035.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$130.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$195.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$143.73
|
| Rate for Payer: Vantage Medical Group Senior |
$130.66
|
|
|
HC HLTH BHV ASSMT/REASSMT
|
Facility
|
IP
|
$592.00
|
|
|
Service Code
|
CPT 96156
|
| Hospital Charge Code |
902506156
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$118.40 |
| Max. Negotiated Rate |
$532.80 |
| Rate for Payer: Adventist Health Commercial |
$118.40
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Central Health Plan Commercial |
$473.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$414.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$236.80
|
| Rate for Payer: EPIC Health Plan Senior |
$236.80
|
| Rate for Payer: Galaxy Health WC |
$503.20
|
| Rate for Payer: Global Benefits Group Commercial |
$355.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$532.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$375.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$349.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.40
|
| Rate for Payer: Multiplan Commercial |
$444.00
|
| Rate for Payer: Networks By Design Commercial |
$384.80
|
| Rate for Payer: Prime Health Services Commercial |
$503.20
|
|
|
HC HLTH BHV INTV FMLY W/PT 30 MIN
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
CPT 96167
|
| Hospital Charge Code |
902506167
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$370.78 |
| Rate for Payer: Adventist Health Commercial |
$20.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$48.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$370.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$48.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$50.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$60.50
|
| Rate for Payer: Blue Shield of California Commercial |
$65.94
|
| Rate for Payer: Blue Shield of California EPN |
$41.50
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Central Health Plan Commercial |
$83.20
|
| Rate for Payer: Cigna of CA HMO |
$66.56
|
| Rate for Payer: Cigna of CA PPO |
$76.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$53.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$72.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.51
|
| Rate for Payer: EPIC Health Plan Senior |
$53.01
|
| Rate for Payer: Galaxy Health WC |
$88.40
|
| Rate for Payer: Global Benefits Group Commercial |
$62.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$93.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$79.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$106.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$48.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$66.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$117.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$64.57
|
| Rate for Payer: Multiplan Commercial |
$78.00
|
| Rate for Payer: Networks By Design Commercial |
$67.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$48.19
|
| Rate for Payer: Prime Health Services Commercial |
$88.40
|
| Rate for Payer: Prime Health Services Medicare |
$51.08
|
| Rate for Payer: Riverside University Health System MISP |
$53.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$62.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$62.40
|
| Rate for Payer: Upland Medical Group Pediatric |
$48.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$53.01
|
| Rate for Payer: Vantage Medical Group Senior |
$48.19
|
|
|
HC HLTH BHV INTV FMLY W/PT 30 MIN
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
CPT 96167
|
| Hospital Charge Code |
902506167
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: Adventist Health Commercial |
$20.80
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Central Health Plan Commercial |
$83.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$72.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.60
|
| Rate for Payer: EPIC Health Plan Senior |
$41.60
|
| Rate for Payer: Galaxy Health WC |
$88.40
|
| Rate for Payer: Global Benefits Group Commercial |
$62.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$93.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$66.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$61.36
|
| Rate for Payer: Multiplan Commercial |
$78.00
|
| Rate for Payer: Networks By Design Commercial |
$67.60
|
| Rate for Payer: Prime Health Services Commercial |
$88.40
|
|
|
HC HLTH BHV INTV IND EA ADD 15MIN
|
Facility
|
OP
|
$455.00
|
|
|
Service Code
|
CPT 96159
|
| Hospital Charge Code |
902506159
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$34.59 |
| Max. Negotiated Rate |
$409.50 |
| Rate for Payer: Adventist Health Commercial |
$91.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$119.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$386.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$250.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$341.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$220.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$264.67
|
| Rate for Payer: Blue Shield of California Commercial |
$288.47
|
| Rate for Payer: Blue Shield of California EPN |
$181.54
|
| Rate for Payer: Cash Price |
$204.75
|
| Rate for Payer: Cash Price |
$204.75
|
| Rate for Payer: Central Health Plan Commercial |
$364.00
|
| Rate for Payer: Cigna of CA HMO |
$291.20
|
| Rate for Payer: Cigna of CA PPO |
$336.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$386.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$386.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$386.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$318.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.00
|
| Rate for Payer: EPIC Health Plan Senior |
$182.00
|
| Rate for Payer: Galaxy Health WC |
$386.75
|
| Rate for Payer: Global Benefits Group Commercial |
$273.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$409.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$34.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$288.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$268.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$318.50
|
| Rate for Payer: Multiplan Commercial |
$341.25
|
| Rate for Payer: Networks By Design Commercial |
$295.75
|
| Rate for Payer: Prime Health Services Commercial |
$386.75
|
| Rate for Payer: Riverside University Health System MISP |
$182.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$273.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$386.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$386.75
|
| Rate for Payer: Vantage Medical Group Senior |
$386.75
|
|
|
HC HLTH BHV INTV IND EA ADD 15MIN
|
Facility
|
IP
|
$455.00
|
|
|
Service Code
|
CPT 96159
|
| Hospital Charge Code |
902506159
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$409.50 |
| Rate for Payer: Adventist Health Commercial |
$91.00
|
| Rate for Payer: Cash Price |
$204.75
|
| Rate for Payer: Central Health Plan Commercial |
$364.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$318.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.00
|
| Rate for Payer: EPIC Health Plan Senior |
$182.00
|
| Rate for Payer: Galaxy Health WC |
$386.75
|
| Rate for Payer: Global Benefits Group Commercial |
$273.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$409.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$288.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$268.45
|
| Rate for Payer: Multiplan Commercial |
$341.25
|
| Rate for Payer: Networks By Design Commercial |
$295.75
|
| Rate for Payer: Prime Health Services Commercial |
$386.75
|
|
|
HC HLTH BHV INTVN GR EA ADD 15MIN
|
Facility
|
OP
|
$455.00
|
|
|
Service Code
|
CPT 96165
|
| Hospital Charge Code |
902506165
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$3.72 |
| Max. Negotiated Rate |
$409.50 |
| Rate for Payer: Adventist Health Commercial |
$91.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$386.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$250.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$341.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$220.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$264.67
|
| Rate for Payer: Blue Shield of California Commercial |
$288.47
|
| Rate for Payer: Blue Shield of California EPN |
$181.54
|
| Rate for Payer: Cash Price |
$204.75
|
| Rate for Payer: Cash Price |
$204.75
|
| Rate for Payer: Central Health Plan Commercial |
$364.00
|
| Rate for Payer: Cigna of CA HMO |
$291.20
|
| Rate for Payer: Cigna of CA PPO |
$336.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$386.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$386.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$386.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$318.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.00
|
| Rate for Payer: EPIC Health Plan Senior |
$182.00
|
| Rate for Payer: Galaxy Health WC |
$386.75
|
| Rate for Payer: Global Benefits Group Commercial |
$273.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$409.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$288.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$268.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$318.50
|
| Rate for Payer: Multiplan Commercial |
$341.25
|
| Rate for Payer: Networks By Design Commercial |
$295.75
|
| Rate for Payer: Prime Health Services Commercial |
$386.75
|
| Rate for Payer: Riverside University Health System MISP |
$182.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$273.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$386.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$386.75
|
| Rate for Payer: Vantage Medical Group Senior |
$386.75
|
|
|
HC HLTH BHV INTVN GR EA ADD 15MIN
|
Facility
|
IP
|
$455.00
|
|
|
Service Code
|
CPT 96165
|
| Hospital Charge Code |
902506165
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$409.50 |
| Rate for Payer: Adventist Health Commercial |
$91.00
|
| Rate for Payer: Cash Price |
$204.75
|
| Rate for Payer: Central Health Plan Commercial |
$364.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$318.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.00
|
| Rate for Payer: EPIC Health Plan Senior |
$182.00
|
| Rate for Payer: Galaxy Health WC |
$386.75
|
| Rate for Payer: Global Benefits Group Commercial |
$273.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$409.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$288.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$268.45
|
| Rate for Payer: Multiplan Commercial |
$341.25
|
| Rate for Payer: Networks By Design Commercial |
$295.75
|
| Rate for Payer: Prime Health Services Commercial |
$386.75
|
|
|
HC HLTH BHV INTVN GRP 1ST 30 MIN
|
Facility
|
IP
|
$908.00
|
|
|
Service Code
|
CPT 96164
|
| Hospital Charge Code |
902506164
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$181.60 |
| Max. Negotiated Rate |
$817.20 |
| Rate for Payer: Adventist Health Commercial |
$181.60
|
| Rate for Payer: Cash Price |
$408.60
|
| Rate for Payer: Central Health Plan Commercial |
$726.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$635.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$363.20
|
| Rate for Payer: EPIC Health Plan Senior |
$363.20
|
| Rate for Payer: Galaxy Health WC |
$771.80
|
| Rate for Payer: Global Benefits Group Commercial |
$544.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$817.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$576.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$535.72
|
| Rate for Payer: Multiplan Commercial |
$681.00
|
| Rate for Payer: Networks By Design Commercial |
$590.20
|
| Rate for Payer: Prime Health Services Commercial |
$771.80
|
|
|
HC HLTH BHV INTVN GRP 1ST 30 MIN
|
Facility
|
OP
|
$908.00
|
|
|
Service Code
|
CPT 96164
|
| Hospital Charge Code |
902506164
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$14.65 |
| Max. Negotiated Rate |
$817.20 |
| Rate for Payer: Adventist Health Commercial |
$181.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$48.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$50.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$48.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$439.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$528.18
|
| Rate for Payer: Blue Shield of California Commercial |
$575.67
|
| Rate for Payer: Blue Shield of California EPN |
$362.29
|
| Rate for Payer: Cash Price |
$408.60
|
| Rate for Payer: Cash Price |
$408.60
|
| Rate for Payer: Central Health Plan Commercial |
$726.40
|
| Rate for Payer: Cigna of CA HMO |
$581.12
|
| Rate for Payer: Cigna of CA PPO |
$671.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$53.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$635.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.51
|
| Rate for Payer: EPIC Health Plan Senior |
$53.01
|
| Rate for Payer: Galaxy Health WC |
$771.80
|
| Rate for Payer: Global Benefits Group Commercial |
$544.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$817.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$79.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$48.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$576.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$64.57
|
| Rate for Payer: Multiplan Commercial |
$681.00
|
| Rate for Payer: Networks By Design Commercial |
$590.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$48.19
|
| Rate for Payer: Prime Health Services Commercial |
$771.80
|
| Rate for Payer: Prime Health Services Medicare |
$51.08
|
| Rate for Payer: Riverside University Health System MISP |
$53.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$544.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$544.80
|
| Rate for Payer: Upland Medical Group Pediatric |
$48.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$53.01
|
| Rate for Payer: Vantage Medical Group Senior |
$48.19
|
|
|
HC HLTH BHV INTVN INDIV 1ST 30MIN
|
Facility
|
IP
|
$908.00
|
|
|
Service Code
|
CPT 96158
|
| Hospital Charge Code |
902506158
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$181.60 |
| Max. Negotiated Rate |
$817.20 |
| Rate for Payer: Adventist Health Commercial |
$181.60
|
| Rate for Payer: Cash Price |
$408.60
|
| Rate for Payer: Central Health Plan Commercial |
$726.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$635.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$363.20
|
| Rate for Payer: EPIC Health Plan Senior |
$363.20
|
| Rate for Payer: Galaxy Health WC |
$771.80
|
| Rate for Payer: Global Benefits Group Commercial |
$544.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$817.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$576.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$535.72
|
| Rate for Payer: Multiplan Commercial |
$681.00
|
| Rate for Payer: Networks By Design Commercial |
$590.20
|
| Rate for Payer: Prime Health Services Commercial |
$771.80
|
|
