|
HC MICROGUIDEWIRE
|
Facility
|
OP
|
$594.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081801
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$118.80 |
| Max. Negotiated Rate |
$534.60 |
| Rate for Payer: Adventist Health Commercial |
$118.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$396.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$504.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$326.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$445.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$287.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$345.53
|
| Rate for Payer: Blue Shield of California Commercial |
$376.60
|
| Rate for Payer: Blue Shield of California EPN |
$237.01
|
| Rate for Payer: Cash Price |
$267.30
|
| Rate for Payer: Cash Price |
$267.30
|
| Rate for Payer: Central Health Plan Commercial |
$475.20
|
| Rate for Payer: Cigna of CA HMO |
$380.16
|
| Rate for Payer: Cigna of CA PPO |
$439.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$504.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$504.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$504.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$415.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$237.60
|
| Rate for Payer: EPIC Health Plan Senior |
$237.60
|
| Rate for Payer: Galaxy Health WC |
$504.90
|
| Rate for Payer: Global Benefits Group Commercial |
$356.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$534.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$377.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$215.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$350.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$415.80
|
| Rate for Payer: Multiplan Commercial |
$445.50
|
| Rate for Payer: Networks By Design Commercial |
$386.10
|
| Rate for Payer: Prime Health Services Commercial |
$504.90
|
| Rate for Payer: Riverside University Health System MISP |
$237.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$356.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$356.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$297.00
|
| Rate for Payer: United Healthcare All Other HMO |
$297.00
|
| Rate for Payer: United Healthcare HMO Rider |
$297.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$297.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$504.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$504.90
|
| Rate for Payer: Vantage Medical Group Senior |
$504.90
|
|
|
HC MICROHEMATOCRIT SPUN
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT 85013
|
| Hospital Charge Code |
900910790
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$23.90 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$7.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$7.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.90
|
| Rate for Payer: Blue Shield of California Commercial |
$69.30
|
| Rate for Payer: Blue Shield of California Commercial |
$6.30
|
| Rate for Payer: Blue Shield of California EPN |
$43.67
|
| Rate for Payer: Blue Shield of California EPN |
$3.97
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Central Health Plan Commercial |
$8.00
|
| Rate for Payer: Central Health Plan Commercial |
$88.00
|
| Rate for Payer: Cigna of CA HMO |
$70.40
|
| Rate for Payer: Cigna of CA HMO |
$6.40
|
| Rate for Payer: Cigna of CA PPO |
$81.40
|
| Rate for Payer: Cigna of CA PPO |
$7.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$77.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.55
|
| Rate for Payer: EPIC Health Plan Senior |
$7.70
|
| Rate for Payer: EPIC Health Plan Senior |
$7.70
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Galaxy Health WC |
$8.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11.48
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$69.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.38
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
| Rate for Payer: Multiplan Commercial |
$7.50
|
| Rate for Payer: Networks By Design Commercial |
$6.50
|
| Rate for Payer: Networks By Design Commercial |
$71.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7.00
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
| Rate for Payer: Prime Health Services Commercial |
$8.50
|
| Rate for Payer: Prime Health Services Medicare |
$7.42
|
| Rate for Payer: Prime Health Services Medicare |
$7.42
|
| Rate for Payer: Riverside University Health System MISP |
$7.70
|
| Rate for Payer: Riverside University Health System MISP |
$7.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$66.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.67
|
| Rate for Payer: United Healthcare All Other HMO |
$5.67
|
| Rate for Payer: United Healthcare All Other HMO |
$5.67
|
| Rate for Payer: United Healthcare HMO Rider |
$5.67
|
| Rate for Payer: United Healthcare HMO Rider |
$5.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.67
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.70
|
| Rate for Payer: Vantage Medical Group Senior |
$7.00
|
| Rate for Payer: Vantage Medical Group Senior |
$7.00
|
|
|
HC MICROHEMATOCRIT SPUN
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT 85013
|
| Hospital Charge Code |
900910790
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Central Health Plan Commercial |
$88.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$77.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.00
|
| Rate for Payer: EPIC Health Plan Senior |
$44.00
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$69.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$64.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.00
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
| Rate for Payer: Networks By Design Commercial |
$71.50
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
|
|
HC MICROHEMATOCRIT SPUN BODY FLUID
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
CPT 85013
|
| Hospital Charge Code |
900910159
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.49 |
| Max. Negotiated Rate |
$119.70 |
| Rate for Payer: Adventist Health Commercial |
$26.60
|
| Rate for Payer: Adventist Health Commercial |
$2.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$7.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$7.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.90
|
| Rate for Payer: Blue Shield of California Commercial |
$8.82
|
| Rate for Payer: Blue Shield of California Commercial |
$83.79
|
| Rate for Payer: Blue Shield of California EPN |
$5.56
|
| Rate for Payer: Blue Shield of California EPN |
$52.80
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cash Price |
$59.85
|
| Rate for Payer: Cash Price |
$59.85
|
| Rate for Payer: Central Health Plan Commercial |
$106.40
|
| Rate for Payer: Central Health Plan Commercial |
$11.20
|
| Rate for Payer: Cigna of CA HMO |
$8.96
|
| Rate for Payer: Cigna of CA HMO |
$85.12
|
| Rate for Payer: Cigna of CA PPO |
$10.36
|
| Rate for Payer: Cigna of CA PPO |
$98.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$93.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.55
|
| Rate for Payer: EPIC Health Plan Senior |
$7.70
|
| Rate for Payer: EPIC Health Plan Senior |
$7.70
|
| Rate for Payer: Galaxy Health WC |
$11.90
|
| Rate for Payer: Galaxy Health WC |
$113.05
|
| Rate for Payer: Global Benefits Group Commercial |
$8.40
|
| Rate for Payer: Global Benefits Group Commercial |
$79.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$119.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11.48
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$84.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.38
|
| Rate for Payer: Multiplan Commercial |
$10.50
|
| Rate for Payer: Multiplan Commercial |
$99.75
|
| Rate for Payer: Networks By Design Commercial |
$86.45
|
| Rate for Payer: Networks By Design Commercial |
$9.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7.00
|
| Rate for Payer: Prime Health Services Commercial |
$11.90
|
| Rate for Payer: Prime Health Services Commercial |
$113.05
|
| Rate for Payer: Prime Health Services Medicare |
$7.42
|
| Rate for Payer: Prime Health Services Medicare |
$7.42
|
| Rate for Payer: Riverside University Health System MISP |
$7.70
|
| Rate for Payer: Riverside University Health System MISP |
$7.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$79.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$79.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.67
|
| Rate for Payer: United Healthcare All Other HMO |
$5.67
|
| Rate for Payer: United Healthcare All Other HMO |
$5.67
|
| Rate for Payer: United Healthcare HMO Rider |
$5.67
|
| Rate for Payer: United Healthcare HMO Rider |
$5.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.67
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.70
|
| Rate for Payer: Vantage Medical Group Senior |
$7.00
|
| Rate for Payer: Vantage Medical Group Senior |
$7.00
|
|
|
HC MICROHEMATOCRIT SPUN BODY FLUID
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
CPT 85013
|
| Hospital Charge Code |
900910159
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$26.60 |
| Max. Negotiated Rate |
$119.70 |
| Rate for Payer: Adventist Health Commercial |
$26.60
|
| Rate for Payer: Cash Price |
$59.85
|
| Rate for Payer: Central Health Plan Commercial |
$106.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$93.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.20
|
| Rate for Payer: EPIC Health Plan Senior |
$53.20
|
| Rate for Payer: Galaxy Health WC |
$113.05
|
| Rate for Payer: Global Benefits Group Commercial |
$79.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$119.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$84.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$78.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.60
|
| Rate for Payer: Multiplan Commercial |
$99.75
|
| Rate for Payer: Networks By Design Commercial |
$86.45
|
| Rate for Payer: Prime Health Services Commercial |
$113.05
|
|
|
HC MICROPRO CNTRL FEATURE ADDN UE
|
Facility
|
IP
|
$5,230.00
|
|
|
Service Code
|
CPT L6882
|
| Hospital Charge Code |
915356882
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,046.00 |
| Max. Negotiated Rate |
$4,707.00 |
| Rate for Payer: Adventist Health Commercial |
$1,046.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,194.46
|
| Rate for Payer: Blue Shield of California EPN |
$2,635.92
|
| Rate for Payer: Cash Price |
$2,353.50
|
| Rate for Payer: Central Health Plan Commercial |
$4,184.00
|
| Rate for Payer: Cigna of CA HMO |
$3,661.00
|
| Rate for Payer: Cigna of CA PPO |
$3,661.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,661.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,092.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,092.00
|
| Rate for Payer: Galaxy Health WC |
$4,445.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,138.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,707.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,321.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,085.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,046.00
|
| Rate for Payer: Multiplan Commercial |
$3,922.50
|
| Rate for Payer: Networks By Design Commercial |
$3,399.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,445.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,962.82
|
| Rate for Payer: United Healthcare All Other HMO |
$1,910.52
|
| Rate for Payer: United Healthcare HMO Rider |
$1,869.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,712.83
|
|
|
HC MICROPRO CNTRL FEATURE ADDN UE
|
Facility
|
OP
|
$5,230.00
|
|
|
Service Code
|
CPT L6882
|
| Hospital Charge Code |
915356882
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,712.83 |
| Max. Negotiated Rate |
$4,707.00 |
| Rate for Payer: Adventist Health Commercial |
$2,144.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,445.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,876.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,922.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,042.29
|
| Rate for Payer: Blue Shield of California Commercial |
$4,194.46
|
| Rate for Payer: Blue Shield of California EPN |
$2,635.92
|
| Rate for Payer: Cash Price |
$2,353.50
|
| Rate for Payer: Central Health Plan Commercial |
$4,184.00
|
| Rate for Payer: Cigna of CA HMO |
$3,661.00
|
| Rate for Payer: Cigna of CA PPO |
$3,661.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,445.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,445.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,445.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,661.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,092.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,092.00
|
| Rate for Payer: Galaxy Health WC |
$4,445.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,138.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,707.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,321.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,085.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,144.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,661.00
|
| Rate for Payer: Multiplan Commercial |
$3,922.50
|
| Rate for Payer: Networks By Design Commercial |
$2,615.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,445.50
|
| Rate for Payer: Riverside University Health System MISP |
$2,092.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,138.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,138.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,962.82
|
| Rate for Payer: United Healthcare All Other HMO |
$1,910.52
|
| Rate for Payer: United Healthcare HMO Rider |
$1,869.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,712.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,445.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,445.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,445.50
|
|
|
HC MICROPRO CNTRL FEATURE ADDN UE
|
Facility
|
OP
|
$5,230.00
|
|
|
Service Code
|
CPT L6882
|
| Hospital Charge Code |
905356882
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,712.83 |
| Max. Negotiated Rate |
$4,707.00 |
| Rate for Payer: Adventist Health Commercial |
$2,144.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,445.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,876.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,922.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,042.29
|
| Rate for Payer: Blue Shield of California Commercial |
$4,194.46
|
| Rate for Payer: Blue Shield of California EPN |
$2,635.92
|
| Rate for Payer: Cash Price |
$2,353.50
|
| Rate for Payer: Central Health Plan Commercial |
$4,184.00
|
| Rate for Payer: Cigna of CA HMO |
$3,661.00
|
| Rate for Payer: Cigna of CA PPO |
$3,661.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,445.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,445.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,445.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,661.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,092.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,092.00
|
| Rate for Payer: Galaxy Health WC |
$4,445.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,138.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,707.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,321.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,085.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,144.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,661.00
|
| Rate for Payer: Multiplan Commercial |
$3,922.50
|
| Rate for Payer: Networks By Design Commercial |
$2,615.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,445.50
|
| Rate for Payer: Riverside University Health System MISP |
$2,092.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,138.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,138.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,962.82
|
| Rate for Payer: United Healthcare All Other HMO |
$1,910.52
|
| Rate for Payer: United Healthcare HMO Rider |
$1,869.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,712.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,445.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,445.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,445.50
|
|
|
HC MICROPRO CNTRL FEATURE ADDN UE
|
Facility
|
IP
|
$5,230.00
|
|
|
Service Code
|
CPT L6882
|
| Hospital Charge Code |
905356882
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,046.00 |
| Max. Negotiated Rate |
$4,707.00 |
| Rate for Payer: Adventist Health Commercial |
$1,046.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,194.46
|
| Rate for Payer: Blue Shield of California EPN |
$2,635.92
|
| Rate for Payer: Cash Price |
$2,353.50
|
| Rate for Payer: Central Health Plan Commercial |
$4,184.00
|
| Rate for Payer: Cigna of CA HMO |
$3,661.00
|
| Rate for Payer: Cigna of CA PPO |
$3,661.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,661.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,092.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,092.00
|
| Rate for Payer: Galaxy Health WC |
$4,445.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,138.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,707.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,321.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,085.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,046.00
|
| Rate for Payer: Multiplan Commercial |
$3,922.50
|
| Rate for Payer: Networks By Design Commercial |
$3,399.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,445.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,962.82
|
| Rate for Payer: United Healthcare All Other HMO |
$1,910.52
|
| Rate for Payer: United Healthcare HMO Rider |
$1,869.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,712.83
|
|
|
HC MICROSPHERES EMBOSPHERES
|
Facility
|
OP
|
$3,900.00
|
|
| Hospital Charge Code |
909000024
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,780.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,138.76
|
| Rate for Payer: Blue Shield of California Commercial |
$3,127.80
|
| Rate for Payer: Blue Shield of California EPN |
$1,965.60
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: Cigna of CA HMO |
$2,730.00
|
| Rate for Payer: Cigna of CA PPO |
$2,730.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,315.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,730.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,476.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,415.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,301.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$1,950.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,560.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,340.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,463.67
|
| Rate for Payer: United Healthcare All Other HMO |
$1,424.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1,393.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,277.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC MICROSPHERES EMBOSPHERES
|
Facility
|
IP
|
$3,900.00
|
|
| Hospital Charge Code |
909000024
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,127.80
|
| Rate for Payer: Blue Shield of California EPN |
$1,965.60
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: Cigna of CA HMO |
$2,730.00
|
| Rate for Payer: Cigna of CA PPO |
$2,730.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,730.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,476.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,301.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$1,950.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,463.67
|
| Rate for Payer: United Healthcare All Other HMO |
$1,424.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1,393.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,277.25
|
|
|
HC MICROWIRE MIRAGE
|
Facility
|
IP
|
$2,254.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909000025
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$450.80 |
| Max. Negotiated Rate |
$2,028.60 |
| Rate for Payer: Adventist Health Commercial |
$450.80
|
| Rate for Payer: Cash Price |
$1,014.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,803.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,577.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$901.60
|
| Rate for Payer: EPIC Health Plan Senior |
$901.60
|
| Rate for Payer: Galaxy Health WC |
$1,915.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,352.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,028.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,431.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,329.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$450.80
|
| Rate for Payer: Multiplan Commercial |
$1,690.50
|
| Rate for Payer: Networks By Design Commercial |
$1,465.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,915.90
|
|
|
HC MICROWIRE MIRAGE
|
Facility
|
OP
|
$2,254.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909000025
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$396.30 |
| Max. Negotiated Rate |
$2,028.60 |
| Rate for Payer: Adventist Health Commercial |
$450.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$396.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,915.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,239.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,690.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,091.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,311.15
|
| Rate for Payer: Blue Shield of California Commercial |
$1,429.04
|
| Rate for Payer: Blue Shield of California EPN |
$899.35
|
| Rate for Payer: Cash Price |
$1,014.30
|
| Rate for Payer: Cash Price |
$1,014.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,803.20
|
| Rate for Payer: Cigna of CA HMO |
$1,442.56
|
| Rate for Payer: Cigna of CA PPO |
$1,667.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,915.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,915.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,915.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,577.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$901.60
|
| Rate for Payer: EPIC Health Plan Senior |
$901.60
|
| Rate for Payer: Galaxy Health WC |
$1,915.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,352.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,028.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,431.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$818.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,329.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$450.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,577.80
|
| Rate for Payer: Multiplan Commercial |
$1,690.50
|
| Rate for Payer: Networks By Design Commercial |
$1,465.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,915.90
|
| Rate for Payer: Riverside University Health System MISP |
$901.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,352.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,352.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,127.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,127.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,127.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,127.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,915.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,915.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,915.90
|
|
|
HC MILD KIT
|
Facility
|
OP
|
$8,608.00
|
|
|
Service Code
|
CPT C1889
|
| Hospital Charge Code |
906811880
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,721.60 |
| Max. Negotiated Rate |
$7,747.20 |
| Rate for Payer: Adventist Health Commercial |
$1,721.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5,227.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,316.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,734.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,456.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,167.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,007.27
|
| Rate for Payer: Blue Shield of California Commercial |
$5,457.47
|
| Rate for Payer: Blue Shield of California EPN |
$3,434.59
|
| Rate for Payer: Cash Price |
$3,873.60
|
| Rate for Payer: Central Health Plan Commercial |
$6,886.40
|
| Rate for Payer: Cigna of CA HMO |
$5,509.12
|
| Rate for Payer: Cigna of CA PPO |
$6,369.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,316.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,316.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,316.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,025.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,443.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,443.20
|
| Rate for Payer: Galaxy Health WC |
$7,316.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,164.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,747.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,466.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,124.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,078.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,721.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,025.60
|
| Rate for Payer: Multiplan Commercial |
$6,456.00
|
| Rate for Payer: Networks By Design Commercial |
$5,595.20
|
| Rate for Payer: Prime Health Services Commercial |
$7,316.80
|
| Rate for Payer: Riverside University Health System MISP |
$3,443.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,164.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,164.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,304.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,304.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,304.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,304.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,316.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,316.80
|
| Rate for Payer: Vantage Medical Group Senior |
$7,316.80
|
|
|
HC MILD KIT
|
Facility
|
IP
|
$8,608.00
|
|
|
Service Code
|
CPT C1889
|
| Hospital Charge Code |
906811880
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,721.60 |
| Max. Negotiated Rate |
$7,747.20 |
| Rate for Payer: Adventist Health Commercial |
$1,721.60
|
| Rate for Payer: Cash Price |
$3,873.60
|
| Rate for Payer: Central Health Plan Commercial |
$6,886.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,025.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,443.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,443.20
|
| Rate for Payer: Galaxy Health WC |
$7,316.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,164.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,747.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,466.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,078.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,721.60
|
| Rate for Payer: Multiplan Commercial |
$6,456.00
|
| Rate for Payer: Networks By Design Commercial |
$5,595.20
|
| Rate for Payer: Prime Health Services Commercial |
$7,316.80
|
|
|
HC MISC CD FLOW MARKER (EA)
|
Facility
|
OP
|
$344.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
903901917
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$68.80 |
| Max. Negotiated Rate |
$760.68 |
| Rate for Payer: Adventist Health Commercial |
$68.80
|
| Rate for Payer: Adventist Health Commercial |
$83.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$461.02
|
| Rate for Payer: Adventist Health Medi-Cal |
$461.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$533.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$533.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$691.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$691.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$507.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$507.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$461.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$461.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$283.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$283.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$394.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$394.51
|
| Rate for Payer: Blue Shield of California Commercial |
$262.71
|
| Rate for Payer: Blue Shield of California Commercial |
$216.72
|
| Rate for Payer: Blue Shield of California EPN |
$165.55
|
| Rate for Payer: Blue Shield of California EPN |
$136.57
|
| Rate for Payer: Cash Price |
$187.65
|
| Rate for Payer: Cash Price |
$187.65
|
| Rate for Payer: Cash Price |
$154.80
|
| Rate for Payer: Cash Price |
$154.80
|
| Rate for Payer: Central Health Plan Commercial |
$275.20
|
| Rate for Payer: Central Health Plan Commercial |
$333.60
|
| Rate for Payer: Cigna of CA HMO |
$266.88
|
| Rate for Payer: Cigna of CA HMO |
$220.16
|
| Rate for Payer: Cigna of CA PPO |
$308.58
|
| Rate for Payer: Cigna of CA PPO |
$254.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$691.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$691.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$507.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$507.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$461.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$461.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$240.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$291.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$760.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$760.68
|
| Rate for Payer: EPIC Health Plan Senior |
$507.12
|
| Rate for Payer: EPIC Health Plan Senior |
$507.12
|
| Rate for Payer: Galaxy Health WC |
$354.45
|
| Rate for Payer: Galaxy Health WC |
$292.40
|
| Rate for Payer: Global Benefits Group Commercial |
$250.20
|
| Rate for Payer: Global Benefits Group Commercial |
$206.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$375.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$309.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$756.07
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$756.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$72.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$72.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$461.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$461.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$218.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$264.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$80.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$80.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$645.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$645.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$617.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$617.77
|
| Rate for Payer: Multiplan Commercial |
$312.75
|
| Rate for Payer: Multiplan Commercial |
$258.00
|
| Rate for Payer: Networks By Design Commercial |
$223.60
|
| Rate for Payer: Networks By Design Commercial |
$271.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$461.02
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$461.02
|
| Rate for Payer: Prime Health Services Commercial |
$354.45
|
| Rate for Payer: Prime Health Services Commercial |
$292.40
|
| Rate for Payer: Prime Health Services Medicare |
$488.68
|
| Rate for Payer: Prime Health Services Medicare |
$488.68
|
| Rate for Payer: Riverside University Health System MISP |
$507.12
|
| Rate for Payer: Riverside University Health System MISP |
$507.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$206.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$250.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$250.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$206.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$240.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$240.94
|
| Rate for Payer: United Healthcare All Other HMO |
$240.94
|
| Rate for Payer: United Healthcare All Other HMO |
$240.94
|
| Rate for Payer: United Healthcare HMO Rider |
$240.94
|
| Rate for Payer: United Healthcare HMO Rider |
$240.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$240.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$240.94
|
| Rate for Payer: Upland Medical Group Pediatric |
$461.02
|
| Rate for Payer: Upland Medical Group Pediatric |
$461.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$691.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$691.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$507.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$507.12
|
| Rate for Payer: Vantage Medical Group Senior |
$461.02
|
| Rate for Payer: Vantage Medical Group Senior |
$461.02
|
|
|
HC MISC CD FLOW MARKER (EA)
|
Facility
|
IP
|
$417.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
903901917
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$83.40 |
| Max. Negotiated Rate |
$375.30 |
| Rate for Payer: Adventist Health Commercial |
$83.40
|
| Rate for Payer: Cash Price |
$187.65
|
| Rate for Payer: Central Health Plan Commercial |
$333.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$291.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$166.80
|
| Rate for Payer: EPIC Health Plan Senior |
$166.80
|
| Rate for Payer: Galaxy Health WC |
$354.45
|
| Rate for Payer: Global Benefits Group Commercial |
$250.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$375.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$264.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$246.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.40
|
| Rate for Payer: Multiplan Commercial |
$312.75
|
| Rate for Payer: Networks By Design Commercial |
$271.05
|
| Rate for Payer: Prime Health Services Commercial |
$354.45
|
|
|
HC MISC CYTOPLAMIC FLOW MARKER EA
|
Facility
|
OP
|
$248.00
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
903901998
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.95 |
| Max. Negotiated Rate |
$319.06 |
| Rate for Payer: Adventist Health Commercial |
$49.60
|
| Rate for Payer: Adventist Health Commercial |
$25.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$319.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$319.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$210.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$106.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$136.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$93.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$186.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$139.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$139.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$193.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$193.85
|
| Rate for Payer: Blue Shield of California Commercial |
$78.75
|
| Rate for Payer: Blue Shield of California Commercial |
$156.24
|
| Rate for Payer: Blue Shield of California EPN |
$49.62
|
| Rate for Payer: Blue Shield of California EPN |
$98.46
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Cash Price |
$111.60
|
| Rate for Payer: Cash Price |
$111.60
|
| Rate for Payer: Central Health Plan Commercial |
$198.40
|
| Rate for Payer: Central Health Plan Commercial |
$100.00
|
| Rate for Payer: Cigna of CA HMO |
$80.00
|
| Rate for Payer: Cigna of CA HMO |
$158.72
|
| Rate for Payer: Cigna of CA PPO |
$92.50
|
| Rate for Payer: Cigna of CA PPO |
$183.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$106.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$210.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$210.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$106.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$106.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$210.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$87.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$173.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.00
|
| Rate for Payer: EPIC Health Plan Senior |
$99.20
|
| Rate for Payer: EPIC Health Plan Senior |
$50.00
|
| Rate for Payer: Galaxy Health WC |
$106.25
|
| Rate for Payer: Galaxy Health WC |
$210.80
|
| Rate for Payer: Global Benefits Group Commercial |
$148.80
|
| Rate for Payer: Global Benefits Group Commercial |
$75.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$112.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$223.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$35.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$35.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$79.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$157.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$73.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$146.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$173.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$87.50
|
| Rate for Payer: Multiplan Commercial |
$186.00
|
| Rate for Payer: Multiplan Commercial |
$93.75
|
| Rate for Payer: Networks By Design Commercial |
$161.20
|
| Rate for Payer: Networks By Design Commercial |
$81.25
|
| Rate for Payer: Prime Health Services Commercial |
$106.25
|
| Rate for Payer: Prime Health Services Commercial |
$210.80
|
| Rate for Payer: Riverside University Health System MISP |
$99.20
|
| Rate for Payer: Riverside University Health System MISP |
$50.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$148.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$148.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.95
|
| Rate for Payer: United Healthcare All Other HMO |
$17.95
|
| Rate for Payer: United Healthcare All Other HMO |
$17.95
|
| Rate for Payer: United Healthcare HMO Rider |
$17.95
|
| Rate for Payer: United Healthcare HMO Rider |
$17.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$106.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$210.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$210.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$106.25
|
| Rate for Payer: Vantage Medical Group Senior |
$106.25
|
| Rate for Payer: Vantage Medical Group Senior |
$210.80
|
|
|
HC MISC CYTOPLAMIC FLOW MARKER EA
|
Facility
|
IP
|
$248.00
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
903901998
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$49.60 |
| Max. Negotiated Rate |
$223.20 |
| Rate for Payer: Adventist Health Commercial |
$49.60
|
| Rate for Payer: Cash Price |
$111.60
|
| Rate for Payer: Central Health Plan Commercial |
$198.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$173.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.20
|
| Rate for Payer: EPIC Health Plan Senior |
$99.20
|
| Rate for Payer: Galaxy Health WC |
$210.80
|
| Rate for Payer: Global Benefits Group Commercial |
$148.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$223.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$157.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$146.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.60
|
| Rate for Payer: Multiplan Commercial |
$186.00
|
| Rate for Payer: Networks By Design Commercial |
$161.20
|
| Rate for Payer: Prime Health Services Commercial |
$210.80
|
|
|
HC MMR ADMINISTRATION
|
Facility
|
OP
|
$24.00
|
|
| Hospital Charge Code |
902890244
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$1,833.00 |
| Rate for Payer: Adventist Health Commercial |
$9.84
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.96
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Central Health Plan Commercial |
$19.20
|
| Rate for Payer: Cigna of CA HMO |
$15.36
|
| Rate for Payer: Cigna of CA PPO |
$17.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.80
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: Riverside University Health System MISP |
$9.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.40
|
| Rate for Payer: Vantage Medical Group Senior |
$20.40
|
|
|
HC MMR ADMINISTRATION
|
Facility
|
IP
|
$24.00
|
|
| Hospital Charge Code |
902890244
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Central Health Plan Commercial |
$19.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
|
|
HC MNT RA SUB 2ND RFRL GROUP EA 30 MIN
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
CPT G0271
|
| Hospital Charge Code |
902000271
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$824.00 |
| Rate for Payer: Adventist Health Commercial |
$19.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$100.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$23.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.92
|
| Rate for Payer: Blue Shield of California Commercial |
$30.43
|
| Rate for Payer: Blue Shield of California EPN |
$19.15
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Central Health Plan Commercial |
$38.40
|
| Rate for Payer: Cigna of CA HMO |
$30.72
|
| Rate for Payer: Cigna of CA PPO |
$35.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$40.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$33.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.20
|
| Rate for Payer: EPIC Health Plan Senior |
$19.20
|
| Rate for Payer: Galaxy Health WC |
$40.80
|
| Rate for Payer: Global Benefits Group Commercial |
$28.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$43.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$33.60
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: Networks By Design Commercial |
$31.20
|
| Rate for Payer: Prime Health Services Commercial |
$40.80
|
| Rate for Payer: Riverside University Health System MISP |
$19.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$634.00
|
| Rate for Payer: United Healthcare All Other HMO |
$824.00
|
| Rate for Payer: United Healthcare HMO Rider |
$623.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$570.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.80
|
| Rate for Payer: Vantage Medical Group Senior |
$40.80
|
|
|
HC MNT RA SUB 2ND RFRL GROUP EA 30 MIN
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
CPT G0271
|
| Hospital Charge Code |
902000271
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$43.20 |
| Rate for Payer: Adventist Health Commercial |
$9.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Central Health Plan Commercial |
$38.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$33.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.20
|
| Rate for Payer: EPIC Health Plan Senior |
$19.20
|
| Rate for Payer: Galaxy Health WC |
$40.80
|
| Rate for Payer: Global Benefits Group Commercial |
$28.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$43.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.60
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: Networks By Design Commercial |
$31.20
|
| Rate for Payer: Prime Health Services Commercial |
$40.80
|
|
|
HC MNT RA SUB 2ND RFRL INDIV W PT EA 15 MIN
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
CPT G0270
|
| Hospital Charge Code |
902000270
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$75.60 |
| Rate for Payer: Adventist Health Commercial |
$16.80
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Central Health Plan Commercial |
$67.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$58.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.60
|
| Rate for Payer: EPIC Health Plan Senior |
$33.60
|
| Rate for Payer: Galaxy Health WC |
$71.40
|
| Rate for Payer: Global Benefits Group Commercial |
$50.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$75.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$53.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.80
|
| Rate for Payer: Multiplan Commercial |
$63.00
|
| Rate for Payer: Networks By Design Commercial |
$54.60
|
| Rate for Payer: Prime Health Services Commercial |
$71.40
|
|
|
HC MNT RA SUB 2ND RFRL INDIV W PT EA 15 MIN
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
CPT G0270
|
| Hospital Charge Code |
902000270
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$824.00 |
| Rate for Payer: Adventist Health Commercial |
$34.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$184.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$71.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$46.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$63.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$40.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.86
|
| Rate for Payer: Blue Shield of California Commercial |
$53.26
|
| Rate for Payer: Blue Shield of California EPN |
$33.52
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Central Health Plan Commercial |
$67.20
|
| Rate for Payer: Cigna of CA HMO |
$53.76
|
| Rate for Payer: Cigna of CA PPO |
$62.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$71.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$71.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$71.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$58.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.60
|
| Rate for Payer: EPIC Health Plan Senior |
$33.60
|
| Rate for Payer: Galaxy Health WC |
$71.40
|
| Rate for Payer: Global Benefits Group Commercial |
$50.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$75.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$53.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$58.80
|
| Rate for Payer: Multiplan Commercial |
$63.00
|
| Rate for Payer: Networks By Design Commercial |
$54.60
|
| Rate for Payer: Prime Health Services Commercial |
$71.40
|
| Rate for Payer: Riverside University Health System MISP |
$33.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$50.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$50.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$634.00
|
| Rate for Payer: United Healthcare All Other HMO |
$824.00
|
| Rate for Payer: United Healthcare HMO Rider |
$623.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$570.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$71.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$71.40
|
| Rate for Payer: Vantage Medical Group Senior |
$71.40
|
|
