|
HC LYMPHOCYTE SUBSET, EA CELL MAR
|
Facility
|
IP
|
$527.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
903901952
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$105.40 |
| Max. Negotiated Rate |
$474.30 |
| Rate for Payer: Adventist Health Commercial |
$105.40
|
| Rate for Payer: Cash Price |
$289.85
|
| Rate for Payer: Central Health Plan Commercial |
$421.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$210.80
|
| Rate for Payer: EPIC Health Plan Senior |
$210.80
|
| Rate for Payer: Galaxy Health WC |
$447.95
|
| Rate for Payer: Global Benefits Group Commercial |
$316.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$474.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$351.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$200.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$326.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.40
|
| Rate for Payer: Multiplan Commercial |
$395.25
|
| Rate for Payer: Networks By Design Commercial |
$342.55
|
| Rate for Payer: Prime Health Services Commercial |
$447.95
|
|
|
HC LYSIS OF LABIAL ADHESIONS
|
Facility
|
IP
|
$10,498.00
|
|
|
Service Code
|
CPT 56441
|
| Hospital Charge Code |
902400744
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$2,099.60 |
| Max. Negotiated Rate |
$9,448.20 |
| Rate for Payer: Adventist Health Commercial |
$2,099.60
|
| Rate for Payer: Cash Price |
$5,773.90
|
| Rate for Payer: Central Health Plan Commercial |
$8,398.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,199.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,199.20
|
| Rate for Payer: Galaxy Health WC |
$8,923.30
|
| Rate for Payer: Global Benefits Group Commercial |
$6,298.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,448.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,002.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,999.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,498.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,099.60
|
| Rate for Payer: Multiplan Commercial |
$7,873.50
|
| Rate for Payer: Networks By Design Commercial |
$6,823.70
|
| Rate for Payer: Prime Health Services Commercial |
$8,923.30
|
|
|
HC LYSIS OF LABIAL ADHESIONS
|
Facility
|
OP
|
$10,498.00
|
|
|
Service Code
|
CPT 56441
|
| Hospital Charge Code |
902400744
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$290.68 |
| Max. Negotiated Rate |
$9,448.20 |
| Rate for Payer: Adventist Health Commercial |
$2,099.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,039.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,039.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,414.28
|
| Rate for Payer: Blue Shield of California EPN |
$4,188.70
|
| Rate for Payer: Cash Price |
$5,773.90
|
| Rate for Payer: Cash Price |
$5,773.90
|
| Rate for Payer: Cash Price |
$5,773.90
|
| Rate for Payer: Central Health Plan Commercial |
$8,398.40
|
| Rate for Payer: Cigna of CA HMO |
$6,718.72
|
| Rate for Payer: Cigna of CA PPO |
$7,768.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,443.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,039.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,453.88
|
| Rate for Payer: EPIC Health Plan Senior |
$4,039.91
|
| Rate for Payer: Galaxy Health WC |
$8,923.30
|
| Rate for Payer: Global Benefits Group Commercial |
$6,298.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,448.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,625.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$290.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,039.91
|
| Rate for Payer: InnovAge PACE Commercial |
$6,059.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,002.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$321.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,039.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,099.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,413.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,413.48
|
| Rate for Payer: Multiplan Commercial |
$7,873.50
|
| Rate for Payer: Networks By Design Commercial |
$6,823.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,039.91
|
| Rate for Payer: Prime Health Services Commercial |
$8,923.30
|
| Rate for Payer: Prime Health Services Medicare |
$4,282.30
|
| Rate for Payer: Riverside University Health System MISP |
$4,443.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,298.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,298.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,091.00
|
| Rate for Payer: United Healthcare All Other HMO |
$839.00
|
| Rate for Payer: United Healthcare HMO Rider |
$635.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$581.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,039.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Vantage Medical Group Senior |
$4,039.91
|
|
|
HC LYSIS OF LABIAL ADHESIONS
|
Facility
|
IP
|
$10,498.00
|
|
|
Service Code
|
CPT 56441
|
| Hospital Charge Code |
902400744
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,099.60 |
| Max. Negotiated Rate |
$9,448.20 |
| Rate for Payer: Adventist Health Commercial |
$2,099.60
|
| Rate for Payer: Cash Price |
$5,773.90
|
| Rate for Payer: Central Health Plan Commercial |
$8,398.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,199.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,199.20
|
| Rate for Payer: Galaxy Health WC |
$8,923.30
|
| Rate for Payer: Global Benefits Group Commercial |
$6,298.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,448.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,002.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,999.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,498.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,099.60
|
| Rate for Payer: Multiplan Commercial |
$7,873.50
|
| Rate for Payer: Networks By Design Commercial |
$6,823.70
|
| Rate for Payer: Prime Health Services Commercial |
$8,923.30
|
|
|
HC LYSIS OF LABIAL ADHESIONS
|
Facility
|
OP
|
$10,498.00
|
|
|
Service Code
|
CPT 56441
|
| Hospital Charge Code |
902400744
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$321.10 |
| Max. Negotiated Rate |
$9,448.20 |
| Rate for Payer: Adventist Health Commercial |
$2,099.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,039.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,436.87
|
| Rate for Payer: Cash Price |
$5,773.90
|
| Rate for Payer: Cash Price |
$5,773.90
|
| Rate for Payer: Cash Price |
$5,773.90
|
| Rate for Payer: Cash Price |
$5,773.90
|
| Rate for Payer: Central Health Plan Commercial |
$8,398.40
|
| Rate for Payer: Cigna of CA HMO |
$6,718.72
|
| Rate for Payer: Cigna of CA PPO |
$7,768.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,443.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,039.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,453.88
|
| Rate for Payer: EPIC Health Plan Senior |
$4,039.91
|
| Rate for Payer: Galaxy Health WC |
$8,923.30
|
| Rate for Payer: Global Benefits Group Commercial |
$6,298.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,448.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,625.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,039.91
|
| Rate for Payer: InnovAge PACE Commercial |
$6,059.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,002.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$321.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,039.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,099.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,413.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,413.48
|
| Rate for Payer: Multiplan Commercial |
$7,873.50
|
| Rate for Payer: Multiplan WC |
$6,436.87
|
| Rate for Payer: Networks By Design Commercial |
$6,823.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,039.91
|
| Rate for Payer: Preferred Health Network WC |
$6,568.23
|
| Rate for Payer: Prime Health Services Commercial |
$8,923.30
|
| Rate for Payer: Prime Health Services Medicare |
$4,282.30
|
| Rate for Payer: Prime Health Services WC |
$6,371.18
|
| Rate for Payer: Riverside University Health System MISP |
$4,443.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,298.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,249.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5,249.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,249.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,249.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,039.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Vantage Medical Group Senior |
$4,039.91
|
|
|
HC MAGNESIUM
|
Facility
|
IP
|
$39.66
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
900910230
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.93 |
| Max. Negotiated Rate |
$35.69 |
| Rate for Payer: Adventist Health Commercial |
$7.93
|
| Rate for Payer: Cash Price |
$21.81
|
| Rate for Payer: Central Health Plan Commercial |
$31.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.86
|
| Rate for Payer: EPIC Health Plan Senior |
$15.86
|
| Rate for Payer: Galaxy Health WC |
$33.71
|
| Rate for Payer: Global Benefits Group Commercial |
$23.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.93
|
| Rate for Payer: Multiplan Commercial |
$29.75
|
| Rate for Payer: Networks By Design Commercial |
$25.78
|
| Rate for Payer: Prime Health Services Commercial |
$33.71
|
|
|
HC MAGNESIUM
|
Facility
|
OP
|
$39.66
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
900910230
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$48.44 |
| Rate for Payer: Adventist Health Commercial |
$7.93
|
| Rate for Payer: Adventist Health Medi-Cal |
$6.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$48.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.83
|
| Rate for Payer: Blue Shield of California Commercial |
$24.07
|
| Rate for Payer: Blue Shield of California EPN |
$15.75
|
| Rate for Payer: Cash Price |
$21.81
|
| Rate for Payer: Cash Price |
$21.81
|
| Rate for Payer: Central Health Plan Commercial |
$31.73
|
| Rate for Payer: Cigna of CA HMO |
$25.38
|
| Rate for Payer: Cigna of CA PPO |
$29.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.04
|
| Rate for Payer: EPIC Health Plan Senior |
$6.70
|
| Rate for Payer: Galaxy Health WC |
$33.71
|
| Rate for Payer: Global Benefits Group Commercial |
$23.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.69
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.70
|
| Rate for Payer: InnovAge PACE Commercial |
$10.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.98
|
| Rate for Payer: Multiplan Commercial |
$29.75
|
| Rate for Payer: Networks By Design Commercial |
$25.78
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6.70
|
| Rate for Payer: Prime Health Services Commercial |
$33.71
|
| Rate for Payer: Prime Health Services Medicare |
$7.10
|
| Rate for Payer: Riverside University Health System MISP |
$7.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.43
|
| Rate for Payer: United Healthcare All Other HMO |
$5.43
|
| Rate for Payer: United Healthcare HMO Rider |
$5.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.43
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.37
|
| Rate for Payer: Vantage Medical Group Senior |
$6.70
|
|
|
HC MAGNETIC RESONANCE ELSTGRPHY
|
Facility
|
OP
|
$2,440.00
|
|
|
Service Code
|
CPT 76391
|
| Hospital Charge Code |
908876391
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$2,196.00 |
| Rate for Payer: Adventist Health Commercial |
$488.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$307.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,481.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,447.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,433.01
|
| Rate for Payer: Blue Shield of California Commercial |
$1,481.08
|
| Rate for Payer: Blue Shield of California EPN |
$968.68
|
| Rate for Payer: Cash Price |
$1,342.00
|
| Rate for Payer: Cash Price |
$1,342.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,952.00
|
| Rate for Payer: Cigna of CA HMO |
$1,561.60
|
| Rate for Payer: Cigna of CA PPO |
$1,805.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.63
|
| Rate for Payer: EPIC Health Plan Senior |
$307.13
|
| Rate for Payer: Galaxy Health WC |
$2,074.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,464.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,196.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$342.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: InnovAge PACE Commercial |
$460.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,627.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$378.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$488.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$411.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.55
|
| Rate for Payer: Multiplan Commercial |
$1,830.00
|
| Rate for Payer: Networks By Design Commercial |
$1,586.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$307.13
|
| Rate for Payer: Prime Health Services Commercial |
$2,074.00
|
| Rate for Payer: Prime Health Services Medicare |
$325.56
|
| Rate for Payer: Riverside University Health System MISP |
$337.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,464.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,464.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$590.24
|
| Rate for Payer: United Healthcare All Other HMO |
$590.24
|
| Rate for Payer: United Healthcare HMO Rider |
$590.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$590.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$307.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC MAGNETIC RESONANCE ELSTGRPHY
|
Facility
|
IP
|
$2,440.00
|
|
|
Service Code
|
CPT 76391
|
| Hospital Charge Code |
908876391
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$488.00 |
| Max. Negotiated Rate |
$2,196.00 |
| Rate for Payer: Adventist Health Commercial |
$488.00
|
| Rate for Payer: Cash Price |
$1,342.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,952.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$976.00
|
| Rate for Payer: EPIC Health Plan Senior |
$976.00
|
| Rate for Payer: Galaxy Health WC |
$2,074.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,464.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,196.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,627.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$929.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,510.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$488.00
|
| Rate for Payer: Multiplan Commercial |
$1,830.00
|
| Rate for Payer: Networks By Design Commercial |
$1,586.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,074.00
|
|
|
HC MALARIA QUANTITAT
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
900911640
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.85 |
| Max. Negotiated Rate |
$43.59 |
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$25.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.99
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$43.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.85
|
| Rate for Payer: Blue Shield of California Commercial |
$25.49
|
| Rate for Payer: Blue Shield of California EPN |
$16.67
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Central Health Plan Commercial |
$33.60
|
| Rate for Payer: Cigna of CA HMO |
$26.88
|
| Rate for Payer: Cigna of CA PPO |
$31.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.09
|
| Rate for Payer: EPIC Health Plan Senior |
$5.99
|
| Rate for Payer: Galaxy Health WC |
$35.70
|
| Rate for Payer: Global Benefits Group Commercial |
$25.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$37.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.99
|
| Rate for Payer: InnovAge PACE Commercial |
$8.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.03
|
| Rate for Payer: Multiplan Commercial |
$31.50
|
| Rate for Payer: Networks By Design Commercial |
$27.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.99
|
| Rate for Payer: Prime Health Services Commercial |
$35.70
|
| Rate for Payer: Prime Health Services Medicare |
$6.35
|
| Rate for Payer: Riverside University Health System MISP |
$6.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.85
|
| Rate for Payer: United Healthcare All Other HMO |
$4.85
|
| Rate for Payer: United Healthcare HMO Rider |
$4.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.85
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.59
|
| Rate for Payer: Vantage Medical Group Senior |
$5.99
|
|
|
HC MALARIA QUANTITAT
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
900911640
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$37.80 |
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Central Health Plan Commercial |
$33.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.80
|
| Rate for Payer: EPIC Health Plan Senior |
$16.80
|
| Rate for Payer: Galaxy Health WC |
$35.70
|
| Rate for Payer: Global Benefits Group Commercial |
$25.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$37.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.40
|
| Rate for Payer: Multiplan Commercial |
$31.50
|
| Rate for Payer: Networks By Design Commercial |
$27.30
|
| Rate for Payer: Prime Health Services Commercial |
$35.70
|
|
|
HC MALARIA SCREEN AG TEST
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
CPT 87899
|
| Hospital Charge Code |
900912441
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$65.38 |
| Rate for Payer: Adventist Health Commercial |
$7.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$16.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$65.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.27
|
| Rate for Payer: Blue Shield of California Commercial |
$23.07
|
| Rate for Payer: Blue Shield of California EPN |
$15.09
|
| Rate for Payer: Cash Price |
$20.90
|
| Rate for Payer: Cash Price |
$20.90
|
| Rate for Payer: Central Health Plan Commercial |
$30.40
|
| Rate for Payer: Cigna of CA HMO |
$24.32
|
| Rate for Payer: Cigna of CA PPO |
$28.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.69
|
| Rate for Payer: EPIC Health Plan Senior |
$16.07
|
| Rate for Payer: Galaxy Health WC |
$32.30
|
| Rate for Payer: Global Benefits Group Commercial |
$22.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$26.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.07
|
| Rate for Payer: InnovAge PACE Commercial |
$24.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.53
|
| Rate for Payer: Multiplan Commercial |
$28.50
|
| Rate for Payer: Networks By Design Commercial |
$24.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16.07
|
| Rate for Payer: Prime Health Services Commercial |
$32.30
|
| Rate for Payer: Prime Health Services Medicare |
$17.03
|
| Rate for Payer: Riverside University Health System MISP |
$17.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.01
|
| Rate for Payer: United Healthcare All Other HMO |
$13.01
|
| Rate for Payer: United Healthcare HMO Rider |
$13.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.01
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.68
|
| Rate for Payer: Vantage Medical Group Senior |
$16.07
|
|
|
HC MALARIA SCREEN AG TEST
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
CPT 87899
|
| Hospital Charge Code |
900912441
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$34.20 |
| Rate for Payer: Adventist Health Commercial |
$7.60
|
| Rate for Payer: Cash Price |
$20.90
|
| Rate for Payer: Central Health Plan Commercial |
$30.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.20
|
| Rate for Payer: EPIC Health Plan Senior |
$15.20
|
| Rate for Payer: Galaxy Health WC |
$32.30
|
| Rate for Payer: Global Benefits Group Commercial |
$22.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.60
|
| Rate for Payer: Multiplan Commercial |
$28.50
|
| Rate for Payer: Networks By Design Commercial |
$24.70
|
| Rate for Payer: Prime Health Services Commercial |
$32.30
|
|
|
HC MALARIA SMEARS
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
900911686
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.85 |
| Max. Negotiated Rate |
$43.59 |
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$25.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.99
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$43.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.85
|
| Rate for Payer: Blue Shield of California Commercial |
$25.49
|
| Rate for Payer: Blue Shield of California EPN |
$16.67
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Central Health Plan Commercial |
$33.60
|
| Rate for Payer: Cigna of CA HMO |
$26.88
|
| Rate for Payer: Cigna of CA PPO |
$31.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.09
|
| Rate for Payer: EPIC Health Plan Senior |
$5.99
|
| Rate for Payer: Galaxy Health WC |
$35.70
|
| Rate for Payer: Global Benefits Group Commercial |
$25.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$37.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.99
|
| Rate for Payer: InnovAge PACE Commercial |
$8.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.03
|
| Rate for Payer: Multiplan Commercial |
$31.50
|
| Rate for Payer: Networks By Design Commercial |
$27.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.99
|
| Rate for Payer: Prime Health Services Commercial |
$35.70
|
| Rate for Payer: Prime Health Services Medicare |
$6.35
|
| Rate for Payer: Riverside University Health System MISP |
$6.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.85
|
| Rate for Payer: United Healthcare All Other HMO |
$4.85
|
| Rate for Payer: United Healthcare HMO Rider |
$4.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.85
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.59
|
| Rate for Payer: Vantage Medical Group Senior |
$5.99
|
|
|
HC MALARIA SMEARS
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
900911686
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$37.80 |
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Central Health Plan Commercial |
$33.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.80
|
| Rate for Payer: EPIC Health Plan Senior |
$16.80
|
| Rate for Payer: Galaxy Health WC |
$35.70
|
| Rate for Payer: Global Benefits Group Commercial |
$25.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$37.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.40
|
| Rate for Payer: Multiplan Commercial |
$31.50
|
| Rate for Payer: Networks By Design Commercial |
$27.30
|
| Rate for Payer: Prime Health Services Commercial |
$35.70
|
|
|
HC MAMMARY DUCTOGRAM
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
CPT 19030
|
| Hospital Charge Code |
909000103
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$150.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$637.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$412.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$562.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$363.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$440.48
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Central Health Plan Commercial |
$600.00
|
| Rate for Payer: Cigna of CA HMO |
$480.00
|
| Rate for Payer: Cigna of CA PPO |
$555.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$637.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$637.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$637.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$300.00
|
| Rate for Payer: EPIC Health Plan Senior |
$300.00
|
| Rate for Payer: Galaxy Health WC |
$637.50
|
| Rate for Payer: Global Benefits Group Commercial |
$450.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$675.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$332.99
|
| Rate for Payer: InnovAge PACE Commercial |
$375.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$500.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$367.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$464.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$150.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$525.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$525.00
|
| Rate for Payer: Multiplan Commercial |
$562.50
|
| Rate for Payer: Networks By Design Commercial |
$487.50
|
| Rate for Payer: Prime Health Services Commercial |
$637.50
|
| Rate for Payer: Riverside University Health System MISP |
$300.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$450.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$637.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$637.50
|
| Rate for Payer: Vantage Medical Group Senior |
$637.50
|
|
|
HC MAMMARY DUCTOGRAM
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
CPT 19030
|
| Hospital Charge Code |
909000103
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$675.00 |
| Rate for Payer: Adventist Health Commercial |
$150.00
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Central Health Plan Commercial |
$600.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$300.00
|
| Rate for Payer: EPIC Health Plan Senior |
$300.00
|
| Rate for Payer: Galaxy Health WC |
$637.50
|
| Rate for Payer: Global Benefits Group Commercial |
$450.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$675.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$500.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$285.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$464.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$150.00
|
| Rate for Payer: Multiplan Commercial |
$562.50
|
| Rate for Payer: Networks By Design Commercial |
$487.50
|
| Rate for Payer: Prime Health Services Commercial |
$637.50
|
|
|
HC MAMMOGRAPHY DIGITAL BILAT
|
Facility
|
IP
|
$1,050.00
|
|
|
Service Code
|
CPT 77066
|
| Hospital Charge Code |
909002011
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$945.00 |
| Rate for Payer: Adventist Health Commercial |
$210.00
|
| Rate for Payer: Cash Price |
$577.50
|
| Rate for Payer: Central Health Plan Commercial |
$840.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$420.00
|
| Rate for Payer: EPIC Health Plan Senior |
$420.00
|
| Rate for Payer: Galaxy Health WC |
$892.50
|
| Rate for Payer: Global Benefits Group Commercial |
$630.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$945.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$700.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$400.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$649.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.00
|
| Rate for Payer: Multiplan Commercial |
$787.50
|
| Rate for Payer: Networks By Design Commercial |
$682.50
|
| Rate for Payer: Prime Health Services Commercial |
$892.50
|
|
|
HC MAMMOGRAPHY DIGITAL BILAT
|
Facility
|
OP
|
$1,050.00
|
|
|
Service Code
|
CPT 77066
|
| Hospital Charge Code |
909002011
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$945.00 |
| Rate for Payer: Adventist Health Commercial |
$210.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$637.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$892.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$577.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$787.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$714.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$616.66
|
| Rate for Payer: Blue Shield of California Commercial |
$637.35
|
| Rate for Payer: Blue Shield of California EPN |
$416.85
|
| Rate for Payer: Cash Price |
$577.50
|
| Rate for Payer: Cash Price |
$577.50
|
| Rate for Payer: Central Health Plan Commercial |
$840.00
|
| Rate for Payer: Cigna of CA HMO |
$672.00
|
| Rate for Payer: Cigna of CA PPO |
$777.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$892.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$892.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$892.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$420.00
|
| Rate for Payer: EPIC Health Plan Senior |
$420.00
|
| Rate for Payer: Galaxy Health WC |
$892.50
|
| Rate for Payer: Global Benefits Group Commercial |
$630.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$945.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$254.61
|
| Rate for Payer: InnovAge PACE Commercial |
$525.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$700.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$281.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$649.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$735.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$735.00
|
| Rate for Payer: Multiplan Commercial |
$787.50
|
| Rate for Payer: Networks By Design Commercial |
$682.50
|
| Rate for Payer: Prime Health Services Commercial |
$892.50
|
| Rate for Payer: Riverside University Health System MISP |
$420.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$630.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$630.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$321.54
|
| Rate for Payer: United Healthcare All Other HMO |
$321.54
|
| Rate for Payer: United Healthcare HMO Rider |
$321.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$321.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$892.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$892.50
|
| Rate for Payer: Vantage Medical Group Senior |
$892.50
|
|
|
HC MAMMOGRAPHY DIGITAL UNILAT ALL VIEWS
|
Facility
|
IP
|
$854.00
|
|
|
Service Code
|
CPT 77065
|
| Hospital Charge Code |
909002012
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$170.80 |
| Max. Negotiated Rate |
$768.60 |
| Rate for Payer: Adventist Health Commercial |
$170.80
|
| Rate for Payer: Cash Price |
$469.70
|
| Rate for Payer: Central Health Plan Commercial |
$683.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$341.60
|
| Rate for Payer: EPIC Health Plan Senior |
$341.60
|
| Rate for Payer: Galaxy Health WC |
$725.90
|
| Rate for Payer: Global Benefits Group Commercial |
$512.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$768.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$569.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$325.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$528.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.80
|
| Rate for Payer: Multiplan Commercial |
$640.50
|
| Rate for Payer: Networks By Design Commercial |
$555.10
|
| Rate for Payer: Prime Health Services Commercial |
$725.90
|
|
|
HC MAMMOGRAPHY DIGITAL UNILAT ALL VIEWS
|
Facility
|
OP
|
$854.00
|
|
|
Service Code
|
CPT 77065
|
| Hospital Charge Code |
909002012
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$170.80 |
| Max. Negotiated Rate |
$768.60 |
| Rate for Payer: Adventist Health Commercial |
$170.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$518.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$725.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$469.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$640.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$558.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$501.55
|
| Rate for Payer: Blue Shield of California Commercial |
$518.38
|
| Rate for Payer: Blue Shield of California EPN |
$339.04
|
| Rate for Payer: Cash Price |
$469.70
|
| Rate for Payer: Cash Price |
$469.70
|
| Rate for Payer: Central Health Plan Commercial |
$683.20
|
| Rate for Payer: Cigna of CA HMO |
$546.56
|
| Rate for Payer: Cigna of CA PPO |
$631.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$725.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$725.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$725.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$341.60
|
| Rate for Payer: EPIC Health Plan Senior |
$341.60
|
| Rate for Payer: Galaxy Health WC |
$725.90
|
| Rate for Payer: Global Benefits Group Commercial |
$512.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$768.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$201.38
|
| Rate for Payer: InnovAge PACE Commercial |
$427.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$569.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$222.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$528.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$597.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$597.80
|
| Rate for Payer: Multiplan Commercial |
$640.50
|
| Rate for Payer: Networks By Design Commercial |
$555.10
|
| Rate for Payer: Prime Health Services Commercial |
$725.90
|
| Rate for Payer: Riverside University Health System MISP |
$341.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$512.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$512.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$252.70
|
| Rate for Payer: United Healthcare All Other HMO |
$252.70
|
| Rate for Payer: United Healthcare HMO Rider |
$252.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$252.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$725.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$725.90
|
| Rate for Payer: Vantage Medical Group Senior |
$725.90
|
|
|
HC MAMOTOME PROBE 11 GA
|
Facility
|
OP
|
$833.00
|
|
| Hospital Charge Code |
906601882
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$166.60 |
| Max. Negotiated Rate |
$749.70 |
| Rate for Payer: Adventist Health Commercial |
$166.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$505.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$708.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$458.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$624.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$403.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$489.22
|
| Rate for Payer: Blue Shield of California Commercial |
$508.96
|
| Rate for Payer: Blue Shield of California EPN |
$332.37
|
| Rate for Payer: Cash Price |
$458.15
|
| Rate for Payer: Central Health Plan Commercial |
$666.40
|
| Rate for Payer: Cigna of CA HMO |
$533.12
|
| Rate for Payer: Cigna of CA PPO |
$616.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$708.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$708.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$708.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$333.20
|
| Rate for Payer: EPIC Health Plan Senior |
$333.20
|
| Rate for Payer: Galaxy Health WC |
$708.05
|
| Rate for Payer: Global Benefits Group Commercial |
$499.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$749.70
|
| Rate for Payer: InnovAge PACE Commercial |
$416.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$555.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$317.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$515.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$583.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$583.10
|
| Rate for Payer: Multiplan Commercial |
$624.75
|
| Rate for Payer: Networks By Design Commercial |
$541.45
|
| Rate for Payer: Prime Health Services Commercial |
$708.05
|
| Rate for Payer: Riverside University Health System MISP |
$333.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$499.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$499.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$416.50
|
| Rate for Payer: United Healthcare All Other HMO |
$416.50
|
| Rate for Payer: United Healthcare HMO Rider |
$416.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$416.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$708.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$708.05
|
| Rate for Payer: Vantage Medical Group Senior |
$708.05
|
|
|
HC MAMOTOME PROBE 11 GA
|
Facility
|
IP
|
$833.00
|
|
| Hospital Charge Code |
906601882
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$166.60 |
| Max. Negotiated Rate |
$749.70 |
| Rate for Payer: Adventist Health Commercial |
$166.60
|
| Rate for Payer: Cash Price |
$458.15
|
| Rate for Payer: Central Health Plan Commercial |
$666.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$333.20
|
| Rate for Payer: EPIC Health Plan Senior |
$333.20
|
| Rate for Payer: Galaxy Health WC |
$708.05
|
| Rate for Payer: Global Benefits Group Commercial |
$499.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$749.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$555.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$317.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$515.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.60
|
| Rate for Payer: Multiplan Commercial |
$624.75
|
| Rate for Payer: Networks By Design Commercial |
$541.45
|
| Rate for Payer: Prime Health Services Commercial |
$708.05
|
|
|
HC MANDIBLE-COMPLETE
|
Facility
|
IP
|
$1,790.00
|
|
|
Service Code
|
CPT 70110
|
| Hospital Charge Code |
909001122
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$358.00 |
| Max. Negotiated Rate |
$1,611.00 |
| Rate for Payer: Adventist Health Commercial |
$358.00
|
| Rate for Payer: Cash Price |
$984.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,432.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$716.00
|
| Rate for Payer: EPIC Health Plan Senior |
$716.00
|
| Rate for Payer: Galaxy Health WC |
$1,521.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,074.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,611.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,193.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$681.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,108.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$358.00
|
| Rate for Payer: Multiplan Commercial |
$1,342.50
|
| Rate for Payer: Networks By Design Commercial |
$1,163.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,521.50
|
|
|
HC MANDIBLE-COMPLETE
|
Facility
|
OP
|
$1,790.00
|
|
|
Service Code
|
CPT 70110
|
| Hospital Charge Code |
909001122
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$26.26 |
| Max. Negotiated Rate |
$1,611.00 |
| Rate for Payer: Adventist Health Commercial |
$358.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$135.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,087.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$129.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.26
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.53
|
| Rate for Payer: Blue Shield of California EPN |
$710.63
|
| Rate for Payer: Cash Price |
$984.50
|
| Rate for Payer: Cash Price |
$984.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,432.00
|
| Rate for Payer: Cigna of CA HMO |
$1,145.60
|
| Rate for Payer: Cigna of CA PPO |
$1,324.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$1,521.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,074.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,611.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$58.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: InnovAge PACE Commercial |
$202.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,193.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$358.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$181.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$1,342.50
|
| Rate for Payer: Networks By Design Commercial |
$1,163.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$135.12
|
| Rate for Payer: Prime Health Services Commercial |
$1,521.50
|
| Rate for Payer: Prime Health Services Medicare |
$143.23
|
| Rate for Payer: Riverside University Health System MISP |
$148.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,074.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,074.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
