|
HC HLA X MATCH T SEROLOGY
|
Facility
|
OP
|
$199.00
|
|
|
Service Code
|
CPT 86805
|
| Hospital Charge Code |
903901924
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$39.80 |
| Max. Negotiated Rate |
$319.37 |
| Rate for Payer: Adventist Health Medi-Cal |
$189.51
|
| 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 Medi-Cal |
$208.46
|
| 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 HMO/PPO |
$319.37
|
| Rate for Payer: Blue Distinction Transplant |
$119.40
|
| Rate for Payer: Blue Shield of California Commercial |
$122.98
|
| Rate for Payer: Blue Shield of California EPN |
$96.71
|
| Rate for Payer: Caremore Medicare Advantage |
$189.51
|
| Rate for Payer: Cash Price |
$89.55
|
| Rate for Payer: Cash Price |
$89.55
|
| Rate for Payer: Central Health Plan Commercial |
$159.20
|
| Rate for Payer: Cigna of CA HMO |
$127.36
|
| Rate for Payer: Cigna of CA PPO |
$147.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$284.26
|
| Rate for Payer: Dignity Health Media |
$189.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$208.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$255.84
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$189.51
|
| Rate for Payer: EPIC Health Plan Transplant |
$189.51
|
| Rate for Payer: Galaxy Health WC |
$169.15
|
| Rate for Payer: Global Benefits Group Commercial |
$119.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$179.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$149.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$310.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$312.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$189.51
|
| Rate for Payer: InnovAge PACE Commercial |
$284.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$132.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$189.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$253.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$253.94
|
| Rate for Payer: Multiplan Commercial |
$149.25
|
| Rate for Payer: Networks By Design Commercial |
$129.35
|
| Rate for Payer: Prime Health Services Commercial |
$169.15
|
| Rate for Payer: Prime Health Services Medicare |
$200.88
|
| Rate for Payer: Riverside University Health System MISP |
$208.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$119.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$119.40
|
| 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 HMO Rider |
$153.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$153.50
|
| 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 Senior |
$189.51
|
|
|
HC HLA X MATCH T SEROLOGY
|
Facility
|
IP
|
$656.00
|
|
|
Service Code
|
CPT 86805
|
| Hospital Charge Code |
903901924
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$131.20 |
| Max. Negotiated Rate |
$590.40 |
| Rate for Payer: Cash Price |
$295.20
|
| Rate for Payer: Central Health Plan Commercial |
$524.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$262.40
|
| Rate for Payer: Galaxy Health WC |
$557.60
|
| Rate for Payer: Global Benefits Group Commercial |
$393.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$590.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$437.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$249.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.20
|
| Rate for Payer: Multiplan Commercial |
$492.00
|
| Rate for Payer: Networks By Design Commercial |
$426.40
|
| Rate for Payer: Prime Health Services Commercial |
$557.60
|
|
|
HC HLA XM T FLOW, ADDL SERUM
|
Facility
|
OP
|
$244.00
|
|
|
Service Code
|
CPT 86826
|
| Hospital Charge Code |
903902015
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$29.59 |
| Max. Negotiated Rate |
$219.60 |
| 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 |
$209.87
|
| Rate for Payer: Blue Distinction Transplant |
$146.40
|
| Rate for Payer: Blue Shield of California Commercial |
$150.79
|
| Rate for Payer: Blue Shield of California EPN |
$118.58
|
| Rate for Payer: Caremore Medicare Advantage |
$36.53
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Central Health Plan Commercial |
$195.20
|
| Rate for Payer: Cigna of CA HMO |
$156.16
|
| Rate for Payer: Cigna of CA PPO |
$180.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$54.80
|
| Rate for Payer: Dignity Health Media |
$36.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$36.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$36.53
|
| Rate for Payer: Galaxy Health WC |
$207.40
|
| Rate for Payer: Global Benefits Group Commercial |
$146.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$219.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$183.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$59.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$60.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$36.53
|
| Rate for Payer: InnovAge PACE Commercial |
$54.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$162.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$48.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$48.95
|
| Rate for Payer: Multiplan Commercial |
$183.00
|
| Rate for Payer: Networks By Design Commercial |
$158.60
|
| Rate for Payer: Prime Health Services Commercial |
$207.40
|
| 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 |
$146.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$146.40
|
| 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: 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 HLA XM T FLOW, ADDL SERUM
|
Facility
|
IP
|
$244.00
|
|
|
Service Code
|
CPT 86826
|
| Hospital Charge Code |
903902015
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$48.80 |
| Max. Negotiated Rate |
$219.60 |
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Central Health Plan Commercial |
$195.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.60
|
| Rate for Payer: Galaxy Health WC |
$207.40
|
| Rate for Payer: Global Benefits Group Commercial |
$146.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$219.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$162.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.80
|
| Rate for Payer: Multiplan Commercial |
$183.00
|
| Rate for Payer: Networks By Design Commercial |
$158.60
|
| Rate for Payer: Prime Health Services Commercial |
$207.40
|
|
|
HC HLTH BHV ASSMT/REASSMT
|
Facility
|
IP
|
$755.00
|
|
|
Service Code
|
CPT 96156
|
| Hospital Charge Code |
902506156
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$151.00 |
| Max. Negotiated Rate |
$679.50 |
| Rate for Payer: Cash Price |
$339.75
|
| Rate for Payer: Central Health Plan Commercial |
$604.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$302.00
|
| Rate for Payer: Galaxy Health WC |
$641.75
|
| Rate for Payer: Global Benefits Group Commercial |
$453.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$679.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$503.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$287.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.00
|
| Rate for Payer: Multiplan Commercial |
$566.25
|
| Rate for Payer: Networks By Design Commercial |
$490.75
|
| Rate for Payer: Prime Health Services Commercial |
$641.75
|
|
|
HC HLTH BHV ASSMT/REASSMT
|
Facility
|
OP
|
$755.00
|
|
|
Service Code
|
CPT 96156
|
| Hospital Charge Code |
902506156
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$111.37 |
| Max. Negotiated Rate |
$1,510.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$111.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$525.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$122.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$365.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$446.05
|
| Rate for Payer: Blue Distinction Transplant |
$453.00
|
| Rate for Payer: Blue Shield of California Commercial |
$474.90
|
| Rate for Payer: Blue Shield of California EPN |
$369.20
|
| Rate for Payer: Caremore Medicare Advantage |
$111.37
|
| Rate for Payer: Cash Price |
$339.75
|
| Rate for Payer: Cash Price |
$339.75
|
| Rate for Payer: Cash Price |
$339.75
|
| Rate for Payer: Central Health Plan Commercial |
$604.00
|
| Rate for Payer: Cigna of CA HMO |
$483.20
|
| Rate for Payer: Cigna of CA PPO |
$558.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.06
|
| Rate for Payer: Dignity Health Media |
$111.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$122.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$150.35
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$111.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$111.37
|
| Rate for Payer: Galaxy Health WC |
$641.75
|
| Rate for Payer: Global Benefits Group Commercial |
$453.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$679.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$566.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$182.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$183.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.37
|
| Rate for Payer: InnovAge PACE Commercial |
$167.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$503.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$162.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$149.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.24
|
| Rate for Payer: Multiplan Commercial |
$566.25
|
| Rate for Payer: Networks By Design Commercial |
$490.75
|
| Rate for Payer: Prime Health Services Commercial |
$641.75
|
| Rate for Payer: Prime Health Services Medicare |
$118.05
|
| Rate for Payer: Riverside University Health System MISP |
$122.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$453.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$453.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,510.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,425.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$122.51
|
| Rate for Payer: Vantage Medical Group Senior |
$111.37
|
|
|
HC HLTH BHV INTV FMLY W/PT 30 MIN
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
CPT 96167
|
| Hospital Charge Code |
902506167
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$77.40 |
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Central Health Plan Commercial |
$68.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.40
|
| Rate for Payer: Galaxy Health WC |
$73.10
|
| Rate for Payer: Global Benefits Group Commercial |
$51.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$77.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.20
|
| Rate for Payer: Multiplan Commercial |
$64.50
|
| Rate for Payer: Networks By Design Commercial |
$55.90
|
| Rate for Payer: Prime Health Services Commercial |
$73.10
|
|
|
HC HLTH BHV INTV FMLY W/PT 30 MIN
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
CPT 96167
|
| Hospital Charge Code |
902506167
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$382.93 |
| Rate for Payer: Adventist Health Medi-Cal |
$35.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$382.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$53.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$41.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.81
|
| Rate for Payer: Blue Distinction Transplant |
$51.60
|
| Rate for Payer: Blue Shield of California Commercial |
$54.09
|
| Rate for Payer: Blue Shield of California EPN |
$42.05
|
| Rate for Payer: Caremore Medicare Advantage |
$35.85
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Central Health Plan Commercial |
$68.80
|
| Rate for Payer: Cigna of CA HMO |
$55.04
|
| Rate for Payer: Cigna of CA PPO |
$63.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$53.78
|
| Rate for Payer: Dignity Health Media |
$35.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$39.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.40
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$35.85
|
| Rate for Payer: EPIC Health Plan Transplant |
$35.85
|
| Rate for Payer: Galaxy Health WC |
$73.10
|
| Rate for Payer: Global Benefits Group Commercial |
$51.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$77.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$64.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$58.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$59.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.85
|
| Rate for Payer: InnovAge PACE Commercial |
$53.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$117.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$48.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$48.04
|
| Rate for Payer: Multiplan Commercial |
$64.50
|
| Rate for Payer: Networks By Design Commercial |
$55.90
|
| Rate for Payer: Prime Health Services Commercial |
$73.10
|
| Rate for Payer: Prime Health Services Medicare |
$38.00
|
| Rate for Payer: Riverside University Health System MISP |
$39.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$43.00
|
| Rate for Payer: United Healthcare All Other HMO |
$43.00
|
| Rate for Payer: United Healthcare HMO Rider |
$43.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$53.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39.44
|
| Rate for Payer: Vantage Medical Group Senior |
$35.85
|
|
|
HC HLTH BHV INTV IND EA ADD 15MIN
|
Facility
|
OP
|
$378.00
|
|
|
Service Code
|
CPT 96159
|
| Hospital Charge Code |
902506159
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$38.21 |
| Max. Negotiated Rate |
$340.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$123.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$321.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$207.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$207.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$183.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$223.32
|
| Rate for Payer: Blue Distinction Transplant |
$226.80
|
| Rate for Payer: Blue Shield of California Commercial |
$237.76
|
| Rate for Payer: Blue Shield of California EPN |
$184.84
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Central Health Plan Commercial |
$302.40
|
| Rate for Payer: Cigna of CA HMO |
$241.92
|
| Rate for Payer: Cigna of CA PPO |
$279.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$321.30
|
| Rate for Payer: Dignity Health Media |
$321.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$321.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$151.20
|
| Rate for Payer: Galaxy Health WC |
$321.30
|
| Rate for Payer: Global Benefits Group Commercial |
$226.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$340.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$283.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$132.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$252.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.60
|
| Rate for Payer: Multiplan Commercial |
$283.50
|
| Rate for Payer: Networks By Design Commercial |
$245.70
|
| Rate for Payer: Prime Health Services Commercial |
$321.30
|
| Rate for Payer: Riverside University Health System MISP |
$151.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$226.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$226.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$189.00
|
| Rate for Payer: United Healthcare All Other HMO |
$189.00
|
| Rate for Payer: United Healthcare HMO Rider |
$189.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$189.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$321.30
|
| Rate for Payer: Vantage Medical Group Senior |
$321.30
|
|
|
HC HLTH BHV INTV IND EA ADD 15MIN
|
Facility
|
IP
|
$378.00
|
|
|
Service Code
|
CPT 96159
|
| Hospital Charge Code |
902506159
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$75.60 |
| Max. Negotiated Rate |
$340.20 |
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Central Health Plan Commercial |
$302.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.20
|
| Rate for Payer: Galaxy Health WC |
$321.30
|
| Rate for Payer: Global Benefits Group Commercial |
$226.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$340.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$252.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.60
|
| Rate for Payer: Multiplan Commercial |
$283.50
|
| Rate for Payer: Networks By Design Commercial |
$245.70
|
| Rate for Payer: Prime Health Services Commercial |
$321.30
|
|
|
HC HLTH BHV INTVN GR EA ADD 15MIN
|
Facility
|
OP
|
$378.00
|
|
|
Service Code
|
CPT 96165
|
| Hospital Charge Code |
902506165
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$7.62 |
| Max. Negotiated Rate |
$340.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$23.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$321.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$207.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$207.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$183.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$223.32
|
| Rate for Payer: Blue Distinction Transplant |
$226.80
|
| Rate for Payer: Blue Shield of California Commercial |
$237.76
|
| Rate for Payer: Blue Shield of California EPN |
$184.84
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Central Health Plan Commercial |
$302.40
|
| Rate for Payer: Cigna of CA HMO |
$241.92
|
| Rate for Payer: Cigna of CA PPO |
$279.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$321.30
|
| Rate for Payer: Dignity Health Media |
$321.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$321.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$151.20
|
| Rate for Payer: Galaxy Health WC |
$321.30
|
| Rate for Payer: Global Benefits Group Commercial |
$226.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$340.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$283.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$132.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$252.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.60
|
| Rate for Payer: Multiplan Commercial |
$283.50
|
| Rate for Payer: Networks By Design Commercial |
$245.70
|
| Rate for Payer: Prime Health Services Commercial |
$321.30
|
| Rate for Payer: Riverside University Health System MISP |
$151.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$226.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$226.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$189.00
|
| Rate for Payer: United Healthcare All Other HMO |
$189.00
|
| Rate for Payer: United Healthcare HMO Rider |
$189.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$189.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$321.30
|
| Rate for Payer: Vantage Medical Group Senior |
$321.30
|
|
|
HC HLTH BHV INTVN GR EA ADD 15MIN
|
Facility
|
IP
|
$378.00
|
|
|
Service Code
|
CPT 96165
|
| Hospital Charge Code |
902506165
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$75.60 |
| Max. Negotiated Rate |
$340.20 |
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Central Health Plan Commercial |
$302.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.20
|
| Rate for Payer: Galaxy Health WC |
$321.30
|
| Rate for Payer: Global Benefits Group Commercial |
$226.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$340.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$252.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.60
|
| Rate for Payer: Multiplan Commercial |
$283.50
|
| Rate for Payer: Networks By Design Commercial |
$245.70
|
| Rate for Payer: Prime Health Services Commercial |
$321.30
|
|
|
HC HLTH BHV INTVN GRP 1ST 30 MIN
|
Facility
|
IP
|
$755.00
|
|
|
Service Code
|
CPT 96164
|
| Hospital Charge Code |
902506164
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$151.00 |
| Max. Negotiated Rate |
$679.50 |
| Rate for Payer: Cash Price |
$339.75
|
| Rate for Payer: Central Health Plan Commercial |
$604.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$302.00
|
| Rate for Payer: Galaxy Health WC |
$641.75
|
| Rate for Payer: Global Benefits Group Commercial |
$453.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$679.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$503.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$287.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.00
|
| Rate for Payer: Multiplan Commercial |
$566.25
|
| Rate for Payer: Networks By Design Commercial |
$490.75
|
| Rate for Payer: Prime Health Services Commercial |
$641.75
|
|
|
HC HLTH BHV INTVN GRP 1ST 30 MIN
|
Facility
|
OP
|
$755.00
|
|
|
Service Code
|
CPT 96164
|
| Hospital Charge Code |
902506164
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$16.19 |
| Max. Negotiated Rate |
$679.50 |
| Rate for Payer: Adventist Health Medi-Cal |
$35.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$52.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$53.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$365.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$446.05
|
| Rate for Payer: Blue Distinction Transplant |
$453.00
|
| Rate for Payer: Blue Shield of California Commercial |
$474.90
|
| Rate for Payer: Blue Shield of California EPN |
$369.20
|
| Rate for Payer: Caremore Medicare Advantage |
$35.85
|
| Rate for Payer: Cash Price |
$339.75
|
| Rate for Payer: Cash Price |
$339.75
|
| Rate for Payer: Central Health Plan Commercial |
$604.00
|
| Rate for Payer: Cigna of CA HMO |
$483.20
|
| Rate for Payer: Cigna of CA PPO |
$558.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$53.78
|
| Rate for Payer: Dignity Health Media |
$35.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$39.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.40
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$35.85
|
| Rate for Payer: EPIC Health Plan Transplant |
$35.85
|
| Rate for Payer: Galaxy Health WC |
$641.75
|
| Rate for Payer: Global Benefits Group Commercial |
$453.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$679.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$566.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$58.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$59.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.85
|
| Rate for Payer: InnovAge PACE Commercial |
$53.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$503.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$48.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$48.04
|
| Rate for Payer: Multiplan Commercial |
$566.25
|
| Rate for Payer: Networks By Design Commercial |
$490.75
|
| Rate for Payer: Prime Health Services Commercial |
$641.75
|
| Rate for Payer: Prime Health Services Medicare |
$38.00
|
| Rate for Payer: Riverside University Health System MISP |
$39.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$453.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$453.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$377.50
|
| Rate for Payer: United Healthcare All Other HMO |
$377.50
|
| Rate for Payer: United Healthcare HMO Rider |
$377.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$377.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$53.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39.44
|
| Rate for Payer: Vantage Medical Group Senior |
$35.85
|
|
|
HC HLTH BHV INTVN INDIV 1ST 30MIN
|
Facility
|
OP
|
$755.00
|
|
|
Service Code
|
CPT 96158
|
| Hospital Charge Code |
902506158
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$109.50 |
| Max. Negotiated Rate |
$679.50 |
| Rate for Payer: Adventist Health Medi-Cal |
$199.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$358.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$219.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$199.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$365.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$446.05
|
| Rate for Payer: Blue Distinction Transplant |
$453.00
|
| Rate for Payer: Blue Shield of California Commercial |
$474.90
|
| Rate for Payer: Blue Shield of California EPN |
$369.20
|
| Rate for Payer: Caremore Medicare Advantage |
$199.21
|
| Rate for Payer: Cash Price |
$339.75
|
| Rate for Payer: Cash Price |
$339.75
|
| Rate for Payer: Central Health Plan Commercial |
$604.00
|
| Rate for Payer: Cigna of CA HMO |
$483.20
|
| Rate for Payer: Cigna of CA PPO |
$558.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.82
|
| Rate for Payer: Dignity Health Media |
$199.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$219.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.93
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$199.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$199.21
|
| Rate for Payer: Galaxy Health WC |
$641.75
|
| Rate for Payer: Global Benefits Group Commercial |
$453.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$679.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$566.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$326.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$328.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$199.21
|
| Rate for Payer: InnovAge PACE Commercial |
$298.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$503.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$199.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$266.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$266.94
|
| Rate for Payer: Multiplan Commercial |
$566.25
|
| Rate for Payer: Networks By Design Commercial |
$490.75
|
| Rate for Payer: Prime Health Services Commercial |
$641.75
|
| Rate for Payer: Prime Health Services Medicare |
$211.16
|
| Rate for Payer: Riverside University Health System MISP |
$219.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$453.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$453.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$377.50
|
| Rate for Payer: United Healthcare All Other HMO |
$377.50
|
| Rate for Payer: United Healthcare HMO Rider |
$377.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$377.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$219.13
|
| Rate for Payer: Vantage Medical Group Senior |
$199.21
|
|
|
HC HLTH BHV INTVN INDIV 1ST 30MIN
|
Facility
|
IP
|
$755.00
|
|
|
Service Code
|
CPT 96158
|
| Hospital Charge Code |
902506158
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$151.00 |
| Max. Negotiated Rate |
$679.50 |
| Rate for Payer: Cash Price |
$339.75
|
| Rate for Payer: Central Health Plan Commercial |
$604.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$302.00
|
| Rate for Payer: Galaxy Health WC |
$641.75
|
| Rate for Payer: Global Benefits Group Commercial |
$453.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$679.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$503.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$287.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.00
|
| Rate for Payer: Multiplan Commercial |
$566.25
|
| Rate for Payer: Networks By Design Commercial |
$490.75
|
| Rate for Payer: Prime Health Services Commercial |
$641.75
|
|
|
HC HLTH BV INT FMY W/PT ADD 15 MN
|
Facility
|
IP
|
$44.00
|
|
|
Service Code
|
CPT 96168
|
| Hospital Charge Code |
902506168
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$8.80 |
| Max. Negotiated Rate |
$39.60 |
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Central Health Plan Commercial |
$35.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.60
|
| Rate for Payer: Galaxy Health WC |
$37.40
|
| Rate for Payer: Global Benefits Group Commercial |
$26.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.80
|
| Rate for Payer: Multiplan Commercial |
$33.00
|
| Rate for Payer: Networks By Design Commercial |
$28.60
|
| Rate for Payer: Prime Health Services Commercial |
$37.40
|
|
|
HC HLTH BV INT FMY W/PT ADD 15 MN
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
CPT 96168
|
| Hospital Charge Code |
902506168
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$8.80 |
| Max. Negotiated Rate |
$136.09 |
| Rate for Payer: Aetna of CA HMO/PPO |
$136.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.00
|
| Rate for Payer: Blue Distinction Transplant |
$26.40
|
| Rate for Payer: Blue Shield of California Commercial |
$27.68
|
| Rate for Payer: Blue Shield of California EPN |
$21.52
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Central Health Plan Commercial |
$35.20
|
| Rate for Payer: Cigna of CA HMO |
$28.16
|
| Rate for Payer: Cigna of CA PPO |
$32.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.40
|
| Rate for Payer: Dignity Health Media |
$37.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$37.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.60
|
| Rate for Payer: Galaxy Health WC |
$37.40
|
| Rate for Payer: Global Benefits Group Commercial |
$26.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$33.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$15.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.80
|
| Rate for Payer: Multiplan Commercial |
$33.00
|
| Rate for Payer: Networks By Design Commercial |
$28.60
|
| Rate for Payer: Prime Health Services Commercial |
$37.40
|
| Rate for Payer: Riverside University Health System MISP |
$17.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.00
|
| Rate for Payer: United Healthcare All Other HMO |
$22.00
|
| Rate for Payer: United Healthcare HMO Rider |
$22.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$37.40
|
| Rate for Payer: Vantage Medical Group Senior |
$37.40
|
|
|
HC HO ABDUCTION FREJKA COVER
|
Facility
|
OP
|
$177.00
|
|
|
Service Code
|
CPT L1610
|
| Hospital Charge Code |
905351610
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.40 |
| Max. Negotiated Rate |
$159.30 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$150.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$97.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$97.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$85.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$104.57
|
| Rate for Payer: Blue Distinction Transplant |
$106.20
|
| Rate for Payer: Blue Shield of California Commercial |
$132.75
|
| Rate for Payer: Blue Shield of California EPN |
$96.29
|
| Rate for Payer: Cash Price |
$79.65
|
| Rate for Payer: Cash Price |
$79.65
|
| Rate for Payer: Central Health Plan Commercial |
$141.60
|
| Rate for Payer: Cigna of CA HMO |
$123.90
|
| Rate for Payer: Cigna of CA PPO |
$123.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$150.45
|
| Rate for Payer: Dignity Health Media |
$150.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$150.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$70.80
|
| Rate for Payer: Galaxy Health WC |
$150.45
|
| Rate for Payer: Global Benefits Group Commercial |
$106.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$159.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$132.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$61.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$118.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.57
|
| Rate for Payer: Multiplan Commercial |
$132.75
|
| Rate for Payer: Networks By Design Commercial |
$88.50
|
| Rate for Payer: Prime Health Services Commercial |
$150.45
|
| Rate for Payer: Riverside University Health System MISP |
$70.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$106.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$106.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$88.50
|
| Rate for Payer: United Healthcare All Other HMO |
$88.50
|
| Rate for Payer: United Healthcare HMO Rider |
$88.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$88.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$150.45
|
| Rate for Payer: Vantage Medical Group Senior |
$150.45
|
|
|
HC HO ABDUCTION FREJKA COVER
|
Facility
|
IP
|
$177.00
|
|
|
Service Code
|
CPT L1610
|
| Hospital Charge Code |
905351610
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.40 |
| Max. Negotiated Rate |
$159.30 |
| Rate for Payer: Blue Shield of California EPN |
$94.52
|
| Rate for Payer: Cash Price |
$79.65
|
| Rate for Payer: Central Health Plan Commercial |
$141.60
|
| Rate for Payer: Cigna of CA HMO |
$123.90
|
| Rate for Payer: Cigna of CA PPO |
$123.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$70.80
|
| Rate for Payer: Galaxy Health WC |
$150.45
|
| Rate for Payer: Global Benefits Group Commercial |
$106.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$159.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$118.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.40
|
| Rate for Payer: Multiplan Commercial |
$132.75
|
| Rate for Payer: Networks By Design Commercial |
$88.50
|
| Rate for Payer: Prime Health Services Commercial |
$150.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$66.84
|
| Rate for Payer: United Healthcare All Other HMO |
$65.28
|
| Rate for Payer: United Healthcare HMO Rider |
$63.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$58.41
|
|
|
HC HO ABDUCTION FREJKA TYPE
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
CPT L1600
|
| Hospital Charge Code |
905351600
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Blue Shield of California EPN |
$72.09
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Central Health Plan Commercial |
$108.00
|
| Rate for Payer: Cigna of CA HMO |
$94.50
|
| Rate for Payer: Cigna of CA PPO |
$94.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$54.00
|
| Rate for Payer: Galaxy Health WC |
$114.75
|
| Rate for Payer: Global Benefits Group Commercial |
$81.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$121.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$90.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.00
|
| Rate for Payer: Multiplan Commercial |
$101.25
|
| Rate for Payer: Networks By Design Commercial |
$67.50
|
| Rate for Payer: Prime Health Services Commercial |
$114.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.98
|
| Rate for Payer: United Healthcare All Other HMO |
$49.79
|
| Rate for Payer: United Healthcare HMO Rider |
$48.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$44.55
|
|
|
HC HO ABDUCTION FREJKA TYPE
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
CPT L1600
|
| Hospital Charge Code |
905351600
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$47.25 |
| Max. Negotiated Rate |
$141.49 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$114.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$74.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$65.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.76
|
| Rate for Payer: Blue Distinction Transplant |
$81.00
|
| Rate for Payer: Blue Shield of California Commercial |
$101.25
|
| Rate for Payer: Blue Shield of California EPN |
$73.44
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Central Health Plan Commercial |
$108.00
|
| Rate for Payer: Cigna of CA HMO |
$94.50
|
| Rate for Payer: Cigna of CA PPO |
$94.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.75
|
| Rate for Payer: Dignity Health Media |
$114.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$114.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$54.00
|
| Rate for Payer: Galaxy Health WC |
$114.75
|
| Rate for Payer: Global Benefits Group Commercial |
$81.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$121.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$101.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$47.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$90.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$141.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.35
|
| Rate for Payer: Multiplan Commercial |
$101.25
|
| Rate for Payer: Networks By Design Commercial |
$67.50
|
| Rate for Payer: Prime Health Services Commercial |
$114.75
|
| Rate for Payer: Riverside University Health System MISP |
$54.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$67.50
|
| Rate for Payer: United Healthcare All Other HMO |
$67.50
|
| Rate for Payer: United Healthcare HMO Rider |
$67.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$67.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$114.75
|
| Rate for Payer: Vantage Medical Group Senior |
$114.75
|
|
|
HC HO ABDUCTION LLFIELD
|
Facility
|
OP
|
$449.00
|
|
|
Service Code
|
CPT L1650
|
| Hospital Charge Code |
905351650
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$157.15 |
| Max. Negotiated Rate |
$404.10 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$381.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$246.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$246.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$217.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$265.27
|
| Rate for Payer: Blue Distinction Transplant |
$269.40
|
| Rate for Payer: Blue Shield of California Commercial |
$336.75
|
| Rate for Payer: Blue Shield of California EPN |
$244.26
|
| Rate for Payer: Cash Price |
$202.05
|
| Rate for Payer: Cash Price |
$202.05
|
| Rate for Payer: Central Health Plan Commercial |
$359.20
|
| Rate for Payer: Cigna of CA HMO |
$314.30
|
| Rate for Payer: Cigna of CA PPO |
$314.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$381.65
|
| Rate for Payer: Dignity Health Media |
$381.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$381.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$179.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$179.60
|
| Rate for Payer: Galaxy Health WC |
$381.65
|
| Rate for Payer: Global Benefits Group Commercial |
$269.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$404.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$336.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$157.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$299.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$293.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.09
|
| Rate for Payer: Multiplan Commercial |
$336.75
|
| Rate for Payer: Networks By Design Commercial |
$224.50
|
| Rate for Payer: Prime Health Services Commercial |
$381.65
|
| Rate for Payer: Riverside University Health System MISP |
$179.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$269.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$269.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$224.50
|
| Rate for Payer: United Healthcare All Other HMO |
$224.50
|
| Rate for Payer: United Healthcare HMO Rider |
$224.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$224.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$381.65
|
| Rate for Payer: Vantage Medical Group Senior |
$381.65
|
|
|
HC HO ABDUCTION LLFIELD
|
Facility
|
IP
|
$449.00
|
|
|
Service Code
|
CPT L1650
|
| Hospital Charge Code |
905351650
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$89.80 |
| Max. Negotiated Rate |
$404.10 |
| Rate for Payer: Blue Shield of California EPN |
$239.77
|
| Rate for Payer: Cash Price |
$202.05
|
| Rate for Payer: Central Health Plan Commercial |
$359.20
|
| Rate for Payer: Cigna of CA HMO |
$314.30
|
| Rate for Payer: Cigna of CA PPO |
$314.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$179.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$179.60
|
| Rate for Payer: Galaxy Health WC |
$381.65
|
| Rate for Payer: Global Benefits Group Commercial |
$269.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$404.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$299.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$171.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.80
|
| Rate for Payer: Multiplan Commercial |
$336.75
|
| Rate for Payer: Networks By Design Commercial |
$224.50
|
| Rate for Payer: Prime Health Services Commercial |
$381.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$169.54
|
| Rate for Payer: United Healthcare All Other HMO |
$165.59
|
| Rate for Payer: United Healthcare HMO Rider |
$162.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$148.17
|
|
|
HC HO ABDUCTION PAVLIK HARNESS
|
Facility
|
OP
|
$265.00
|
|
|
Service Code
|
CPT L1620
|
| Hospital Charge Code |
905351620
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$92.75 |
| Max. Negotiated Rate |
$238.50 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$225.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$145.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$145.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$128.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.56
|
| Rate for Payer: Blue Distinction Transplant |
$159.00
|
| Rate for Payer: Blue Shield of California Commercial |
$198.75
|
| Rate for Payer: Blue Shield of California EPN |
$144.16
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Central Health Plan Commercial |
$212.00
|
| Rate for Payer: Cigna of CA HMO |
$185.50
|
| Rate for Payer: Cigna of CA PPO |
$185.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.25
|
| Rate for Payer: Dignity Health Media |
$225.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$225.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$106.00
|
| Rate for Payer: Galaxy Health WC |
$225.25
|
| Rate for Payer: Global Benefits Group Commercial |
$159.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$238.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$198.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$92.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$190.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.65
|
| Rate for Payer: Multiplan Commercial |
$198.75
|
| Rate for Payer: Networks By Design Commercial |
$132.50
|
| Rate for Payer: Prime Health Services Commercial |
$225.25
|
| Rate for Payer: Riverside University Health System MISP |
$106.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$159.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$159.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$132.50
|
| Rate for Payer: United Healthcare All Other HMO |
$132.50
|
| Rate for Payer: United Healthcare HMO Rider |
$132.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$225.25
|
| Rate for Payer: Vantage Medical Group Senior |
$225.25
|
|
