|
HC MYLOPEROXIDASE AB
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900913678
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Adventist Health Commercial |
$14.00
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: Central Health Plan Commercial |
$56.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.00
|
| Rate for Payer: EPIC Health Plan Senior |
$28.00
|
| Rate for Payer: Galaxy Health WC |
$59.50
|
| Rate for Payer: Global Benefits Group Commercial |
$42.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.00
|
| Rate for Payer: Multiplan Commercial |
$52.50
|
| Rate for Payer: Networks By Design Commercial |
$45.50
|
| Rate for Payer: Prime Health Services Commercial |
$59.50
|
|
|
HC MYLOPEROXIDASE AB
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900913678
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.34 |
| Max. Negotiated Rate |
$170.20 |
| Rate for Payer: Adventist Health Commercial |
$14.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$11.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$42.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$170.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.54
|
| Rate for Payer: Blue Shield of California Commercial |
$42.49
|
| Rate for Payer: Blue Shield of California EPN |
$27.79
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: Central Health Plan Commercial |
$56.00
|
| Rate for Payer: Cigna of CA HMO |
$44.80
|
| Rate for Payer: Cigna of CA PPO |
$51.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.57
|
| Rate for Payer: EPIC Health Plan Senior |
$11.53
|
| Rate for Payer: Galaxy Health WC |
$59.50
|
| Rate for Payer: Global Benefits Group Commercial |
$42.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: InnovAge PACE Commercial |
$17.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.45
|
| Rate for Payer: Multiplan Commercial |
$52.50
|
| Rate for Payer: Networks By Design Commercial |
$45.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11.53
|
| Rate for Payer: Prime Health Services Commercial |
$59.50
|
| Rate for Payer: Prime Health Services Medicare |
$12.22
|
| Rate for Payer: Riverside University Health System MISP |
$12.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.34
|
| Rate for Payer: United Healthcare All Other HMO |
$9.34
|
| Rate for Payer: United Healthcare HMO Rider |
$9.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
|
HC MYOCARDIAL PERFUSION MULTIPLE TEST
|
Facility
|
OP
|
$2,260.00
|
|
|
Service Code
|
CPT 78454
|
| Hospital Charge Code |
909301383
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$289.49 |
| Max. Negotiated Rate |
$2,720.33 |
| Rate for Payer: Adventist Health Commercial |
$452.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,658.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,372.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,488.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,824.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,658.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$682.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,327.30
|
| Rate for Payer: Blue Shield of California Commercial |
$1,371.82
|
| Rate for Payer: Blue Shield of California EPN |
$897.22
|
| Rate for Payer: Cash Price |
$1,243.00
|
| Rate for Payer: Cash Price |
$1,243.00
|
| Rate for Payer: Center for Health Promotion Commercial |
$1,325.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,808.00
|
| Rate for Payer: Cigna of CA HMO |
$1,446.40
|
| Rate for Payer: Cigna of CA PPO |
$1,672.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,488.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,824.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,658.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,239.30
|
| Rate for Payer: EPIC Health Plan Senior |
$1,658.74
|
| Rate for Payer: Galaxy Health WC |
$1,921.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,356.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,034.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,720.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$289.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,658.74
|
| Rate for Payer: InnovAge PACE Commercial |
$2,488.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,507.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$319.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,658.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$452.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,222.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,222.71
|
| Rate for Payer: Multiplan Commercial |
$1,695.00
|
| Rate for Payer: Networks By Design Commercial |
$1,469.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,658.74
|
| Rate for Payer: Prime Health Services Commercial |
$1,921.00
|
| Rate for Payer: Prime Health Services Medicare |
$1,758.26
|
| Rate for Payer: Riverside University Health System MISP |
$1,824.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,356.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,356.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,721.55
|
| Rate for Payer: United Healthcare All Other HMO |
$1,721.55
|
| Rate for Payer: United Healthcare HMO Rider |
$1,721.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,721.55
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,658.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,488.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,824.61
|
| Rate for Payer: Vantage Medical Group Senior |
$1,658.74
|
|
|
HC MYOCARDIAL PERFUSION MULTIPLE TEST
|
Facility
|
IP
|
$2,260.00
|
|
|
Service Code
|
CPT 78454
|
| Hospital Charge Code |
909301383
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$452.00 |
| Max. Negotiated Rate |
$2,034.00 |
| Rate for Payer: Adventist Health Commercial |
$452.00
|
| Rate for Payer: Cash Price |
$1,243.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,808.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$904.00
|
| Rate for Payer: EPIC Health Plan Senior |
$904.00
|
| Rate for Payer: Galaxy Health WC |
$1,921.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,356.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,034.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,507.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$861.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,398.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$452.00
|
| Rate for Payer: Multiplan Commercial |
$1,695.00
|
| Rate for Payer: Networks By Design Commercial |
$1,469.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,921.00
|
|
|
HC MYOCARDIAL PERFUSION SINGLE
|
Facility
|
IP
|
$2,853.00
|
|
|
Service Code
|
CPT 78453
|
| Hospital Charge Code |
909301385
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$570.60 |
| Max. Negotiated Rate |
$2,567.70 |
| Rate for Payer: Adventist Health Commercial |
$570.60
|
| Rate for Payer: Cash Price |
$1,569.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,282.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,141.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,141.20
|
| Rate for Payer: Galaxy Health WC |
$2,425.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,711.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,567.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,902.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,086.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,766.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$570.60
|
| Rate for Payer: Multiplan Commercial |
$2,139.75
|
| Rate for Payer: Networks By Design Commercial |
$1,854.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,425.05
|
|
|
HC MYOCARDIAL PERFUSION SINGLE
|
Facility
|
OP
|
$2,853.00
|
|
|
Service Code
|
CPT 78453
|
| Hospital Charge Code |
909301385
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$303.75 |
| Max. Negotiated Rate |
$2,720.33 |
| Rate for Payer: Adventist Health Commercial |
$570.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,658.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,732.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,488.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,824.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,658.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$812.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,675.57
|
| Rate for Payer: Blue Shield of California Commercial |
$1,731.77
|
| Rate for Payer: Blue Shield of California EPN |
$1,132.64
|
| Rate for Payer: Cash Price |
$1,569.15
|
| Rate for Payer: Cash Price |
$1,569.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,282.40
|
| Rate for Payer: Cigna of CA HMO |
$1,825.92
|
| Rate for Payer: Cigna of CA PPO |
$2,111.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,488.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,824.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,658.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,239.30
|
| Rate for Payer: EPIC Health Plan Senior |
$1,658.74
|
| Rate for Payer: Galaxy Health WC |
$2,425.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,711.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,567.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,720.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$303.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,658.74
|
| Rate for Payer: InnovAge PACE Commercial |
$2,488.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,902.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$335.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,658.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$570.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,222.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,222.71
|
| Rate for Payer: Multiplan Commercial |
$2,139.75
|
| Rate for Payer: Networks By Design Commercial |
$1,854.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,658.74
|
| Rate for Payer: Prime Health Services Commercial |
$2,425.05
|
| Rate for Payer: Prime Health Services Medicare |
$1,758.26
|
| Rate for Payer: Riverside University Health System MISP |
$1,824.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,711.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,711.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,721.55
|
| Rate for Payer: United Healthcare All Other HMO |
$1,721.55
|
| Rate for Payer: United Healthcare HMO Rider |
$1,721.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,721.55
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,658.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,488.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,824.61
|
| Rate for Payer: Vantage Medical Group Senior |
$1,658.74
|
|
|
HC MYOCARDIAL STRAIN IMAGING
|
Facility
|
IP
|
$1,965.00
|
|
|
Service Code
|
CPT 93356
|
| Hospital Charge Code |
900200356
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$393.00 |
| Max. Negotiated Rate |
$1,768.50 |
| Rate for Payer: Adventist Health Commercial |
$393.00
|
| Rate for Payer: Cash Price |
$1,080.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,572.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$786.00
|
| Rate for Payer: EPIC Health Plan Senior |
$786.00
|
| Rate for Payer: Galaxy Health WC |
$1,670.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,179.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,768.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,310.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$748.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,216.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$393.00
|
| Rate for Payer: Multiplan Commercial |
$1,473.75
|
| Rate for Payer: Networks By Design Commercial |
$1,277.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,670.25
|
|
|
HC MYOCARDIAL STRAIN IMAGING
|
Facility
|
OP
|
$1,965.00
|
|
|
Service Code
|
CPT 93356
|
| Hospital Charge Code |
900200356
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$63.11 |
| Max. Negotiated Rate |
$1,768.50 |
| Rate for Payer: Adventist Health Commercial |
$393.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,193.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,670.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,080.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,473.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$282.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,154.04
|
| Rate for Payer: Blue Shield of California Commercial |
$1,192.76
|
| Rate for Payer: Blue Shield of California EPN |
$780.11
|
| Rate for Payer: Cash Price |
$1,080.75
|
| Rate for Payer: Cash Price |
$1,080.75
|
| Rate for Payer: Cash Price |
$1,080.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,572.00
|
| Rate for Payer: Cigna of CA HMO |
$1,257.60
|
| Rate for Payer: Cigna of CA PPO |
$1,454.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,670.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,670.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,670.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$786.00
|
| Rate for Payer: EPIC Health Plan Senior |
$786.00
|
| Rate for Payer: Galaxy Health WC |
$1,670.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,179.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,768.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$63.11
|
| Rate for Payer: InnovAge PACE Commercial |
$982.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,310.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$69.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,216.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$393.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,375.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,375.50
|
| Rate for Payer: Multiplan Commercial |
$1,473.75
|
| Rate for Payer: Networks By Design Commercial |
$1,277.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,670.25
|
| Rate for Payer: Riverside University Health System MISP |
$786.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,179.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,179.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$968.00
|
| Rate for Payer: United Healthcare All Other HMO |
$982.00
|
| Rate for Payer: United Healthcare HMO Rider |
$832.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$762.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,670.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,670.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,670.25
|
|
|
HC MYOCARD INFAR/PYP
|
Facility
|
IP
|
$1,297.00
|
|
|
Service Code
|
CPT 78466
|
| Hospital Charge Code |
909301382
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$259.40 |
| Max. Negotiated Rate |
$1,167.30 |
| Rate for Payer: Adventist Health Commercial |
$259.40
|
| Rate for Payer: Cash Price |
$713.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,037.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$518.80
|
| Rate for Payer: EPIC Health Plan Senior |
$518.80
|
| Rate for Payer: Galaxy Health WC |
$1,102.45
|
| Rate for Payer: Global Benefits Group Commercial |
$778.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,167.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$865.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$494.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$802.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$259.40
|
| Rate for Payer: Multiplan Commercial |
$972.75
|
| Rate for Payer: Networks By Design Commercial |
$843.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,102.45
|
|
|
HC MYOCARD INFAR/PYP
|
Facility
|
OP
|
$1,297.00
|
|
|
Service Code
|
CPT 78466
|
| Hospital Charge Code |
909301382
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$150.53 |
| Max. Negotiated Rate |
$1,167.30 |
| Rate for Payer: Adventist Health Commercial |
$259.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$510.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$787.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$546.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$761.73
|
| Rate for Payer: Blue Shield of California Commercial |
$787.28
|
| Rate for Payer: Blue Shield of California EPN |
$514.91
|
| Rate for Payer: Cash Price |
$713.35
|
| Rate for Payer: Cash Price |
$713.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,037.60
|
| Rate for Payer: Cigna of CA HMO |
$830.08
|
| Rate for Payer: Cigna of CA PPO |
$959.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$510.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$689.27
|
| Rate for Payer: EPIC Health Plan Senior |
$510.57
|
| Rate for Payer: Galaxy Health WC |
$1,102.45
|
| Rate for Payer: Global Benefits Group Commercial |
$778.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,167.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$837.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$150.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.57
|
| Rate for Payer: InnovAge PACE Commercial |
$765.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$865.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$166.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$510.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$259.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$684.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$684.16
|
| Rate for Payer: Multiplan Commercial |
$972.75
|
| Rate for Payer: Networks By Design Commercial |
$843.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$510.57
|
| Rate for Payer: Prime Health Services Commercial |
$1,102.45
|
| Rate for Payer: Prime Health Services Medicare |
$541.20
|
| Rate for Payer: Riverside University Health System MISP |
$561.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$778.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$778.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$761.81
|
| Rate for Payer: United Healthcare All Other HMO |
$761.81
|
| Rate for Payer: United Healthcare HMO Rider |
$761.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$761.81
|
| Rate for Payer: Upland Medical Group Pediatric |
$510.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Vantage Medical Group Senior |
$510.57
|
|
|
HC MYOGLOBIN SCREEN
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
CPT 81003
|
| Hospital Charge Code |
900910387
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$16.20 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Central Health Plan Commercial |
$14.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.20
|
| Rate for Payer: EPIC Health Plan Senior |
$7.20
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
| Rate for Payer: Networks By Design Commercial |
$11.70
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
|
|
HC MYOGLOBIN SCREEN
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
CPT 81003
|
| Hospital Charge Code |
900910387
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$1.83 |
| Max. Negotiated Rate |
$16.36 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$2.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$16.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.32
|
| Rate for Payer: Blue Shield of California Commercial |
$10.93
|
| Rate for Payer: Blue Shield of California EPN |
$7.15
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Central Health Plan Commercial |
$14.40
|
| Rate for Payer: Cigna of CA HMO |
$11.52
|
| Rate for Payer: Cigna of CA PPO |
$13.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.04
|
| Rate for Payer: EPIC Health Plan Senior |
$2.25
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.25
|
| Rate for Payer: InnovAge PACE Commercial |
$3.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.02
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
| Rate for Payer: Networks By Design Commercial |
$11.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2.25
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: Prime Health Services Medicare |
$2.38
|
| Rate for Payer: Riverside University Health System MISP |
$2.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.83
|
| Rate for Payer: United Healthcare All Other HMO |
$1.83
|
| Rate for Payer: United Healthcare HMO Rider |
$1.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.83
|
| Rate for Payer: Upland Medical Group Pediatric |
$2.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.48
|
| Rate for Payer: Vantage Medical Group Senior |
$2.25
|
|
|
HC MYOGLOBIN (SERUM)
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 83874
|
| Hospital Charge Code |
900910825
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Central Health Plan Commercial |
$24.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
|
|
HC MYOGLOBIN (SERUM)
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 83874
|
| Hospital Charge Code |
900910825
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$94.23 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.92
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$94.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.12
|
| Rate for Payer: Blue Shield of California Commercial |
$18.21
|
| Rate for Payer: Blue Shield of California EPN |
$11.91
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Central Health Plan Commercial |
$24.00
|
| Rate for Payer: Cigna of CA HMO |
$19.20
|
| Rate for Payer: Cigna of CA PPO |
$22.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.44
|
| Rate for Payer: EPIC Health Plan Senior |
$12.92
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.92
|
| Rate for Payer: InnovAge PACE Commercial |
$19.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.31
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.92
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
| Rate for Payer: Prime Health Services Medicare |
$13.70
|
| Rate for Payer: Riverside University Health System MISP |
$14.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.47
|
| Rate for Payer: United Healthcare All Other HMO |
$10.47
|
| Rate for Payer: United Healthcare HMO Rider |
$10.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.47
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.21
|
| Rate for Payer: Vantage Medical Group Senior |
$12.92
|
|
|
HC MYOMO
|
Facility
|
OP
|
$18,750.00
|
|
|
Service Code
|
CPT L3999
|
| Hospital Charge Code |
915380020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6,140.62 |
| Max. Negotiated Rate |
$16,875.00 |
| Rate for Payer: Adventist Health Commercial |
$7,687.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,937.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,312.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,062.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,011.88
|
| Rate for Payer: Blue Shield of California Commercial |
$14,493.75
|
| Rate for Payer: Blue Shield of California EPN |
$9,450.00
|
| Rate for Payer: Cash Price |
$10,312.50
|
| Rate for Payer: Central Health Plan Commercial |
$15,000.00
|
| Rate for Payer: Cigna of CA HMO |
$13,125.00
|
| Rate for Payer: Cigna of CA PPO |
$13,125.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,937.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,937.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15,937.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,500.00
|
| Rate for Payer: EPIC Health Plan Senior |
$7,500.00
|
| Rate for Payer: Galaxy Health WC |
$15,937.50
|
| Rate for Payer: Global Benefits Group Commercial |
$11,250.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,875.00
|
| Rate for Payer: InnovAge PACE Commercial |
$9,375.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,506.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,143.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,606.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,687.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,125.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13,125.00
|
| Rate for Payer: Multiplan Commercial |
$14,062.50
|
| Rate for Payer: Networks By Design Commercial |
$9,375.00
|
| Rate for Payer: Prime Health Services Commercial |
$15,937.50
|
| Rate for Payer: Riverside University Health System MISP |
$7,500.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,250.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11,250.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,036.88
|
| Rate for Payer: United Healthcare All Other HMO |
$6,849.38
|
| Rate for Payer: United Healthcare HMO Rider |
$6,701.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,140.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,937.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,937.50
|
| Rate for Payer: Vantage Medical Group Senior |
$15,937.50
|
|
|
HC MYOMO
|
Facility
|
IP
|
$18,750.00
|
|
|
Service Code
|
CPT L3999
|
| Hospital Charge Code |
905380020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,750.00 |
| Max. Negotiated Rate |
$16,875.00 |
| Rate for Payer: Adventist Health Commercial |
$3,750.00
|
| Rate for Payer: Blue Shield of California Commercial |
$14,493.75
|
| Rate for Payer: Blue Shield of California EPN |
$9,450.00
|
| Rate for Payer: Cash Price |
$10,312.50
|
| Rate for Payer: Central Health Plan Commercial |
$15,000.00
|
| Rate for Payer: Cigna of CA HMO |
$13,125.00
|
| Rate for Payer: Cigna of CA PPO |
$13,125.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,500.00
|
| Rate for Payer: EPIC Health Plan Senior |
$7,500.00
|
| Rate for Payer: Galaxy Health WC |
$15,937.50
|
| Rate for Payer: Global Benefits Group Commercial |
$11,250.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,875.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,506.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,143.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,606.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,750.00
|
| Rate for Payer: Multiplan Commercial |
$14,062.50
|
| Rate for Payer: Networks By Design Commercial |
$12,187.50
|
| Rate for Payer: Prime Health Services Commercial |
$15,937.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,036.88
|
| Rate for Payer: United Healthcare All Other HMO |
$6,849.38
|
| Rate for Payer: United Healthcare HMO Rider |
$6,701.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,140.62
|
|
|
HC MYOMO
|
Facility
|
IP
|
$18,750.00
|
|
|
Service Code
|
CPT L3999
|
| Hospital Charge Code |
915380020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,750.00 |
| Max. Negotiated Rate |
$16,875.00 |
| Rate for Payer: Adventist Health Commercial |
$3,750.00
|
| Rate for Payer: Blue Shield of California Commercial |
$14,493.75
|
| Rate for Payer: Blue Shield of California EPN |
$9,450.00
|
| Rate for Payer: Cash Price |
$10,312.50
|
| Rate for Payer: Central Health Plan Commercial |
$15,000.00
|
| Rate for Payer: Cigna of CA HMO |
$13,125.00
|
| Rate for Payer: Cigna of CA PPO |
$13,125.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,500.00
|
| Rate for Payer: EPIC Health Plan Senior |
$7,500.00
|
| Rate for Payer: Galaxy Health WC |
$15,937.50
|
| Rate for Payer: Global Benefits Group Commercial |
$11,250.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,875.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,506.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,143.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,606.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,750.00
|
| Rate for Payer: Multiplan Commercial |
$14,062.50
|
| Rate for Payer: Networks By Design Commercial |
$12,187.50
|
| Rate for Payer: Prime Health Services Commercial |
$15,937.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,036.88
|
| Rate for Payer: United Healthcare All Other HMO |
$6,849.38
|
| Rate for Payer: United Healthcare HMO Rider |
$6,701.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,140.62
|
|
|
HC MYOMO
|
Facility
|
OP
|
$18,750.00
|
|
|
Service Code
|
CPT L3999
|
| Hospital Charge Code |
905380020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6,140.62 |
| Max. Negotiated Rate |
$16,875.00 |
| Rate for Payer: Adventist Health Commercial |
$7,687.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,937.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,312.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,062.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,011.88
|
| Rate for Payer: Blue Shield of California Commercial |
$14,493.75
|
| Rate for Payer: Blue Shield of California EPN |
$9,450.00
|
| Rate for Payer: Cash Price |
$10,312.50
|
| Rate for Payer: Central Health Plan Commercial |
$15,000.00
|
| Rate for Payer: Cigna of CA HMO |
$13,125.00
|
| Rate for Payer: Cigna of CA PPO |
$13,125.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,937.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,937.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15,937.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,500.00
|
| Rate for Payer: EPIC Health Plan Senior |
$7,500.00
|
| Rate for Payer: Galaxy Health WC |
$15,937.50
|
| Rate for Payer: Global Benefits Group Commercial |
$11,250.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,875.00
|
| Rate for Payer: InnovAge PACE Commercial |
$9,375.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,506.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,143.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,606.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,687.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,125.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13,125.00
|
| Rate for Payer: Multiplan Commercial |
$14,062.50
|
| Rate for Payer: Networks By Design Commercial |
$9,375.00
|
| Rate for Payer: Prime Health Services Commercial |
$15,937.50
|
| Rate for Payer: Riverside University Health System MISP |
$7,500.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,250.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11,250.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,036.88
|
| Rate for Payer: United Healthcare All Other HMO |
$6,849.38
|
| Rate for Payer: United Healthcare HMO Rider |
$6,701.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,140.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,937.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,937.50
|
| Rate for Payer: Vantage Medical Group Senior |
$15,937.50
|
|
|
HC MYO-ORTHOSIS
|
Facility
|
IP
|
$6,567.00
|
|
|
Service Code
|
CPT E0770
|
| Hospital Charge Code |
905370770
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$1,313.40 |
| Max. Negotiated Rate |
$5,910.30 |
| Rate for Payer: Adventist Health Commercial |
$1,313.40
|
| Rate for Payer: Cash Price |
$3,611.85
|
| Rate for Payer: Central Health Plan Commercial |
$5,253.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,626.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,626.80
|
| Rate for Payer: Galaxy Health WC |
$5,581.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,940.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,910.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,380.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,502.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,064.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,313.40
|
| Rate for Payer: Multiplan Commercial |
$4,925.25
|
| Rate for Payer: Networks By Design Commercial |
$4,268.55
|
| Rate for Payer: Prime Health Services Commercial |
$5,581.95
|
|
|
HC MYO-ORTHOSIS
|
Facility
|
OP
|
$6,567.00
|
|
|
Service Code
|
CPT E0770
|
| Hospital Charge Code |
905370770
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$1,313.40 |
| Max. Negotiated Rate |
$5,910.30 |
| Rate for Payer: Adventist Health Commercial |
$1,313.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,988.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,581.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,611.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,925.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,179.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,856.80
|
| Rate for Payer: Blue Shield of California Commercial |
$4,012.44
|
| Rate for Payer: Blue Shield of California EPN |
$2,620.23
|
| Rate for Payer: Cash Price |
$3,611.85
|
| Rate for Payer: Central Health Plan Commercial |
$5,253.60
|
| Rate for Payer: Cigna of CA HMO |
$4,202.88
|
| Rate for Payer: Cigna of CA PPO |
$4,859.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,581.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,581.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,581.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,626.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,626.80
|
| Rate for Payer: Galaxy Health WC |
$5,581.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,940.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,910.30
|
| Rate for Payer: InnovAge PACE Commercial |
$3,283.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,380.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,064.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,313.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,596.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,596.90
|
| Rate for Payer: Multiplan Commercial |
$4,925.25
|
| Rate for Payer: Networks By Design Commercial |
$4,268.55
|
| Rate for Payer: Prime Health Services Commercial |
$5,581.95
|
| Rate for Payer: Riverside University Health System MISP |
$2,626.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,940.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,940.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,283.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,283.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,283.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,283.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,581.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,581.95
|
| Rate for Payer: Vantage Medical Group Senior |
$5,581.95
|
|
|
HC MYRINGOTOMY TUBE INFLATION
|
Facility
|
OP
|
$3,151.00
|
|
|
Service Code
|
CPT 69420
|
| Hospital Charge Code |
900501377
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$106.11 |
| Max. Negotiated Rate |
$8,114.00 |
| Rate for Payer: Adventist Health Commercial |
$630.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$295.06
|
| 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 |
$470.13
|
| Rate for Payer: Cash Price |
$1,733.05
|
| Rate for Payer: Cash Price |
$1,733.05
|
| Rate for Payer: Cash Price |
$1,733.05
|
| Rate for Payer: Cash Price |
$1,733.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,520.80
|
| Rate for Payer: Cigna of CA HMO |
$2,016.64
|
| Rate for Payer: Cigna of CA PPO |
$2,331.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$442.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$295.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$398.33
|
| Rate for Payer: EPIC Health Plan Senior |
$295.06
|
| Rate for Payer: Galaxy Health WC |
$2,678.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,890.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,835.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$483.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$295.06
|
| Rate for Payer: InnovAge PACE Commercial |
$442.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,101.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$630.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$395.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$395.38
|
| Rate for Payer: Multiplan Commercial |
$2,363.25
|
| Rate for Payer: Multiplan WC |
$470.13
|
| Rate for Payer: Networks By Design Commercial |
$2,048.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$295.06
|
| Rate for Payer: Preferred Health Network WC |
$479.72
|
| Rate for Payer: Prime Health Services Commercial |
$2,678.35
|
| Rate for Payer: Prime Health Services Medicare |
$312.76
|
| Rate for Payer: Prime Health Services WC |
$465.33
|
| Rate for Payer: Riverside University Health System MISP |
$324.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,890.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,575.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,575.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,575.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,575.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$295.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Vantage Medical Group Senior |
$295.06
|
|
|
HC MYRINGOTOMY TUBE INFLATION
|
Facility
|
IP
|
$3,151.00
|
|
|
Service Code
|
CPT 69420
|
| Hospital Charge Code |
900501377
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$630.20 |
| Max. Negotiated Rate |
$2,835.90 |
| Rate for Payer: Adventist Health Commercial |
$630.20
|
| Rate for Payer: Cash Price |
$1,733.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,520.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,260.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,260.40
|
| Rate for Payer: Galaxy Health WC |
$2,678.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,890.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,835.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,101.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,200.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,950.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$630.20
|
| Rate for Payer: Multiplan Commercial |
$2,363.25
|
| Rate for Payer: Networks By Design Commercial |
$2,048.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,678.35
|
|
|
HC NA (POC)
|
Facility
|
OP
|
$91.00
|
|
|
Service Code
|
CPT 84295
|
| Hospital Charge Code |
900912116
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$81.90 |
| Rate for Payer: Adventist Health Commercial |
$18.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$55.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.08
|
| Rate for Payer: Blue Shield of California Commercial |
$55.24
|
| Rate for Payer: Blue Shield of California EPN |
$36.13
|
| Rate for Payer: Cash Price |
$50.05
|
| Rate for Payer: Cash Price |
$50.05
|
| Rate for Payer: Central Health Plan Commercial |
$72.80
|
| Rate for Payer: Cigna of CA HMO |
$58.24
|
| Rate for Payer: Cigna of CA PPO |
$67.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.49
|
| Rate for Payer: EPIC Health Plan Senior |
$4.81
|
| Rate for Payer: Galaxy Health WC |
$77.35
|
| Rate for Payer: Global Benefits Group Commercial |
$54.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$81.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.81
|
| Rate for Payer: InnovAge PACE Commercial |
$7.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.45
|
| Rate for Payer: Multiplan Commercial |
$68.25
|
| Rate for Payer: Networks By Design Commercial |
$59.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.81
|
| Rate for Payer: Prime Health Services Commercial |
$77.35
|
| Rate for Payer: Prime Health Services Medicare |
$5.10
|
| Rate for Payer: Riverside University Health System MISP |
$5.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$54.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$54.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.90
|
| Rate for Payer: United Healthcare All Other HMO |
$3.90
|
| Rate for Payer: United Healthcare HMO Rider |
$3.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.90
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.29
|
| Rate for Payer: Vantage Medical Group Senior |
$4.81
|
|
|
HC NA (POC)
|
Facility
|
IP
|
$91.00
|
|
|
Service Code
|
CPT 84295
|
| Hospital Charge Code |
900912116
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.20 |
| Max. Negotiated Rate |
$81.90 |
| Rate for Payer: Adventist Health Commercial |
$18.20
|
| Rate for Payer: Cash Price |
$50.05
|
| Rate for Payer: Central Health Plan Commercial |
$72.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.40
|
| Rate for Payer: EPIC Health Plan Senior |
$36.40
|
| Rate for Payer: Galaxy Health WC |
$77.35
|
| Rate for Payer: Global Benefits Group Commercial |
$54.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$81.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$56.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.20
|
| Rate for Payer: Multiplan Commercial |
$68.25
|
| Rate for Payer: Networks By Design Commercial |
$59.15
|
| Rate for Payer: Prime Health Services Commercial |
$77.35
|
|
|
HC NARROW ML BRIM KAFO
|
Facility
|
OP
|
$2,855.00
|
|
|
Service Code
|
CPT L2525
|
| Hospital Charge Code |
905352525
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$714.69 |
| Max. Negotiated Rate |
$2,569.50 |
| Rate for Payer: Adventist Health Commercial |
$1,170.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,426.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,570.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,141.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,676.74
|
| Rate for Payer: Blue Shield of California Commercial |
$2,206.91
|
| Rate for Payer: Blue Shield of California EPN |
$1,438.92
|
| Rate for Payer: Cash Price |
$1,570.25
|
| Rate for Payer: Cash Price |
$1,570.25
|
| Rate for Payer: Central Health Plan Commercial |
$2,284.00
|
| Rate for Payer: Cigna of CA HMO |
$1,998.50
|
| Rate for Payer: Cigna of CA PPO |
$1,998.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,426.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,426.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,426.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,142.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,142.00
|
| Rate for Payer: Galaxy Health WC |
$2,426.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,713.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,569.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$714.69
|
| Rate for Payer: InnovAge PACE Commercial |
$1,427.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,904.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$789.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,767.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,170.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,998.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,998.50
|
| Rate for Payer: Multiplan Commercial |
$2,141.25
|
| Rate for Payer: Networks By Design Commercial |
$1,427.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,426.75
|
| Rate for Payer: Riverside University Health System MISP |
$1,142.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,713.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,713.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,071.48
|
| Rate for Payer: United Healthcare All Other HMO |
$1,042.93
|
| Rate for Payer: United Healthcare HMO Rider |
$1,020.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$935.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,426.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,426.75
|
| Rate for Payer: Vantage Medical Group Senior |
$2,426.75
|
|
