|
HC ABLAT LUM/SAC NERVE SNGL LEVEL
|
Facility
|
OP
|
$3,628.00
|
|
|
Service Code
|
CPT 64635
|
| Hospital Charge Code |
909000262
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$328.37 |
| Max. Negotiated Rate |
$16,122.00 |
| Rate for Payer: Adventist Health Commercial |
$725.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,729.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,481.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,822.94
|
| Rate for Payer: Cash Price |
$1,632.60
|
| Rate for Payer: Cash Price |
$1,632.60
|
| Rate for Payer: Cash Price |
$1,632.60
|
| Rate for Payer: Cigna of CA HMO |
$2,321.92
|
| Rate for Payer: Cigna of CA PPO |
$2,684.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,729.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,481.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,349.61
|
| Rate for Payer: EPIC Health Plan Senior |
$2,481.19
|
| Rate for Payer: Galaxy Health WC |
$3,083.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,176.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,069.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$328.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,481.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,419.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$371.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,481.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$870.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,126.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,324.79
|
| Rate for Payer: Multiplan Commercial |
$2,902.40
|
| Rate for Payer: Multiplan WC |
$3,953.34
|
| Rate for Payer: Networks By Design Commercial |
$2,358.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,083.80
|
| Rate for Payer: Prime Health Services WC |
$3,913.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,176.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,984.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,481.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,729.31
|
| Rate for Payer: Vantage Medical Group Senior |
$2,481.19
|
|
|
HC ABL IE GT 1 TMR PER ORGN INC IG
|
Facility
|
IP
|
$22,185.00
|
|
|
Service Code
|
CPT 0600T
|
| Hospital Charge Code |
909000600
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,437.00 |
| Max. Negotiated Rate |
$18,857.25 |
| Rate for Payer: Adventist Health Commercial |
$4,437.00
|
| Rate for Payer: Cash Price |
$9,983.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,874.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8,874.00
|
| Rate for Payer: Galaxy Health WC |
$18,857.25
|
| Rate for Payer: Global Benefits Group Commercial |
$13,311.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,797.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,452.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,732.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,324.40
|
| Rate for Payer: Multiplan Commercial |
$17,748.00
|
| Rate for Payer: Networks By Design Commercial |
$14,420.25
|
| Rate for Payer: Prime Health Services Commercial |
$18,857.25
|
|
|
HC ABL IE GT 1 TMR PER ORGN INC IG
|
Facility
|
OP
|
$22,185.00
|
|
|
Service Code
|
CPT 0600T
|
| Hospital Charge Code |
909000600
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$570.02 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$4,437.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19,842.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,551.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,228.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,712.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$9,983.25
|
| Rate for Payer: Cash Price |
$9,983.25
|
| Rate for Payer: Cash Price |
$9,983.25
|
| Rate for Payer: Cigna of CA HMO |
$14,198.40
|
| Rate for Payer: Cigna of CA PPO |
$16,416.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19,842.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,551.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,228.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$17,858.47
|
| Rate for Payer: EPIC Health Plan Senior |
$13,228.50
|
| Rate for Payer: Galaxy Health WC |
$18,857.25
|
| Rate for Payer: Global Benefits Group Commercial |
$13,311.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$21,694.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,228.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,797.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,452.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,228.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,324.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16,667.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,726.19
|
| Rate for Payer: Multiplan Commercial |
$17,748.00
|
| Rate for Payer: Multiplan WC |
$21,077.25
|
| Rate for Payer: Networks By Design Commercial |
$14,420.25
|
| Rate for Payer: Prime Health Services Commercial |
$18,857.25
|
| Rate for Payer: Prime Health Services WC |
$20,862.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13,311.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$13,228.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19,842.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,551.35
|
| Rate for Payer: Vantage Medical Group Senior |
$13,228.50
|
|
|
HC ABL IE GT 1 TMR PR ORG INC FL US
|
Facility
|
OP
|
$22,185.00
|
|
|
Service Code
|
CPT 0601T
|
| Hospital Charge Code |
909000601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$570.02 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$4,437.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13,086.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19,842.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,551.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,228.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,712.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$9,983.25
|
| Rate for Payer: Cash Price |
$9,983.25
|
| Rate for Payer: Cash Price |
$9,983.25
|
| Rate for Payer: Cigna of CA HMO |
$14,198.40
|
| Rate for Payer: Cigna of CA PPO |
$16,416.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19,842.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,551.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,228.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$17,858.47
|
| Rate for Payer: EPIC Health Plan Senior |
$13,228.50
|
| Rate for Payer: Galaxy Health WC |
$18,857.25
|
| Rate for Payer: Global Benefits Group Commercial |
$13,311.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$21,694.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,228.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,797.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,452.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,228.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,324.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16,667.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,726.19
|
| Rate for Payer: Multiplan Commercial |
$17,748.00
|
| Rate for Payer: Multiplan WC |
$21,077.25
|
| Rate for Payer: Networks By Design Commercial |
$14,420.25
|
| Rate for Payer: Prime Health Services Commercial |
$18,857.25
|
| Rate for Payer: Prime Health Services WC |
$20,862.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13,311.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$13,228.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19,842.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,551.35
|
| Rate for Payer: Vantage Medical Group Senior |
$13,228.50
|
|
|
HC ABL IE GT 1 TMR PR ORG INC FL US
|
Facility
|
IP
|
$22,185.00
|
|
|
Service Code
|
CPT 0601T
|
| Hospital Charge Code |
909000601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,437.00 |
| Max. Negotiated Rate |
$18,857.25 |
| Rate for Payer: Adventist Health Commercial |
$4,437.00
|
| Rate for Payer: Cash Price |
$9,983.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,874.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8,874.00
|
| Rate for Payer: Galaxy Health WC |
$18,857.25
|
| Rate for Payer: Global Benefits Group Commercial |
$13,311.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,797.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,452.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,732.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,324.40
|
| Rate for Payer: Multiplan Commercial |
$17,748.00
|
| Rate for Payer: Networks By Design Commercial |
$14,420.25
|
| Rate for Payer: Prime Health Services Commercial |
$18,857.25
|
|
|
HC ABO BLOOD GROUP
|
Facility
|
OP
|
$253.00
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
900904523
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.42 |
| Max. Negotiated Rate |
$215.05 |
| Rate for Payer: Adventist Health Commercial |
$50.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$165.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.46
|
| Rate for Payer: Blue Shield of California Commercial |
$169.26
|
| Rate for Payer: Blue Shield of California EPN |
$111.83
|
| Rate for Payer: Cash Price |
$113.85
|
| Rate for Payer: Cash Price |
$113.85
|
| Rate for Payer: Cigna of CA HMO |
$161.92
|
| Rate for Payer: Cigna of CA PPO |
$187.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.04
|
| Rate for Payer: EPIC Health Plan Senior |
$2.99
|
| Rate for Payer: Galaxy Health WC |
$215.05
|
| Rate for Payer: Global Benefits Group Commercial |
$151.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$168.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.01
|
| Rate for Payer: Multiplan Commercial |
$202.40
|
| Rate for Payer: Networks By Design Commercial |
$164.45
|
| Rate for Payer: Prime Health Services Commercial |
$215.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$151.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$151.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.42
|
| Rate for Payer: United Healthcare All Other HMO |
$2.42
|
| Rate for Payer: United Healthcare HMO Rider |
$2.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$2.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.29
|
| Rate for Payer: Vantage Medical Group Senior |
$2.99
|
|
|
HC ABO BLOOD GROUP
|
Facility
|
IP
|
$253.00
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
900904523
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.60 |
| Max. Negotiated Rate |
$215.05 |
| Rate for Payer: Adventist Health Commercial |
$50.60
|
| Rate for Payer: Cash Price |
$113.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.20
|
| Rate for Payer: EPIC Health Plan Senior |
$101.20
|
| Rate for Payer: Galaxy Health WC |
$215.05
|
| Rate for Payer: Global Benefits Group Commercial |
$151.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$168.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$156.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.72
|
| Rate for Payer: Multiplan Commercial |
$202.40
|
| Rate for Payer: Networks By Design Commercial |
$164.45
|
| Rate for Payer: Prime Health Services Commercial |
$215.05
|
|
|
HC ABO UNIT CONFIRMATION
|
Facility
|
OP
|
$253.00
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
900904524
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Adventist Health Commercial |
$50.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$165.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.37
|
| Rate for Payer: Cash Price |
$113.85
|
| Rate for Payer: Cash Price |
$113.85
|
| Rate for Payer: Cash Price |
$113.85
|
| Rate for Payer: Cigna of CA HMO |
$161.92
|
| Rate for Payer: Cigna of CA PPO |
$187.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.04
|
| Rate for Payer: EPIC Health Plan Senior |
$2.99
|
| Rate for Payer: Galaxy Health WC |
$215.05
|
| Rate for Payer: Global Benefits Group Commercial |
$151.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$168.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.01
|
| Rate for Payer: Multiplan Commercial |
$202.40
|
| Rate for Payer: Networks By Design Commercial |
$164.45
|
| Rate for Payer: Prime Health Services Commercial |
$215.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$151.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$151.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.29
|
| Rate for Payer: Vantage Medical Group Senior |
$2.99
|
|
|
HC ABO UNIT CONFIRMATION
|
Facility
|
IP
|
$253.00
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
900904524
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$50.60 |
| Max. Negotiated Rate |
$215.05 |
| Rate for Payer: Adventist Health Commercial |
$50.60
|
| Rate for Payer: Cash Price |
$113.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.20
|
| Rate for Payer: EPIC Health Plan Senior |
$101.20
|
| Rate for Payer: Galaxy Health WC |
$215.05
|
| Rate for Payer: Global Benefits Group Commercial |
$151.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$168.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$156.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.72
|
| Rate for Payer: Multiplan Commercial |
$202.40
|
| Rate for Payer: Networks By Design Commercial |
$164.45
|
| Rate for Payer: Prime Health Services Commercial |
$215.05
|
|
|
HC ABSORBNT SHEET 6X14",BAG OF 10
|
Facility
|
IP
|
$7.13
|
|
| Hospital Charge Code |
901607997
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$6.06 |
| Rate for Payer: Adventist Health Commercial |
$1.43
|
| Rate for Payer: Cash Price |
$3.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.85
|
| Rate for Payer: EPIC Health Plan Senior |
$2.85
|
| Rate for Payer: Galaxy Health WC |
$6.06
|
| Rate for Payer: Global Benefits Group Commercial |
$4.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.71
|
| Rate for Payer: Multiplan Commercial |
$5.70
|
| Rate for Payer: Networks By Design Commercial |
$4.63
|
| Rate for Payer: Prime Health Services Commercial |
$6.06
|
|
|
HC ABSORBNT SHEET 6X14",BAG OF 10
|
Facility
|
OP
|
$7.13
|
|
| Hospital Charge Code |
901607997
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$6.06 |
| Rate for Payer: Adventist Health Commercial |
$1.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.38
|
| Rate for Payer: Cash Price |
$3.21
|
| Rate for Payer: Cigna of CA HMO |
$4.56
|
| Rate for Payer: Cigna of CA PPO |
$5.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.85
|
| Rate for Payer: EPIC Health Plan Senior |
$2.85
|
| Rate for Payer: Galaxy Health WC |
$6.06
|
| Rate for Payer: Global Benefits Group Commercial |
$4.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.99
|
| Rate for Payer: Multiplan Commercial |
$5.70
|
| Rate for Payer: Networks By Design Commercial |
$4.63
|
| Rate for Payer: Prime Health Services Commercial |
$6.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.56
|
| Rate for Payer: United Healthcare All Other HMO |
$3.56
|
| Rate for Payer: United Healthcare HMO Rider |
$3.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.06
|
| Rate for Payer: Vantage Medical Group Senior |
$6.06
|
|
|
HC ACCS BIO SELECTRA HOOK 375529
|
Facility
|
IP
|
$980.00
|
|
|
Service Code
|
CPT C1893
|
| Hospital Charge Code |
906812743
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$833.00 |
| Rate for Payer: Adventist Health Commercial |
$196.00
|
| Rate for Payer: Cash Price |
$441.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$392.00
|
| Rate for Payer: EPIC Health Plan Senior |
$392.00
|
| Rate for Payer: Galaxy Health WC |
$833.00
|
| Rate for Payer: Global Benefits Group Commercial |
$588.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$653.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$373.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$606.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$235.20
|
| Rate for Payer: Multiplan Commercial |
$784.00
|
| Rate for Payer: Networks By Design Commercial |
$637.00
|
| Rate for Payer: Prime Health Services Commercial |
$833.00
|
|
|
HC ACCS BIO SELECTRA HOOK 375529
|
Facility
|
OP
|
$980.00
|
|
|
Service Code
|
CPT C1893
|
| Hospital Charge Code |
906812743
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$833.00 |
| Rate for Payer: Adventist Health Commercial |
$196.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$642.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$833.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$539.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$735.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$601.82
|
| Rate for Payer: Cash Price |
$441.00
|
| Rate for Payer: Cigna of CA HMO |
$627.20
|
| Rate for Payer: Cigna of CA PPO |
$725.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$833.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$833.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$833.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$392.00
|
| Rate for Payer: EPIC Health Plan Senior |
$392.00
|
| Rate for Payer: Galaxy Health WC |
$833.00
|
| Rate for Payer: Global Benefits Group Commercial |
$588.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$653.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$373.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$606.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$235.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$686.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$686.00
|
| Rate for Payer: Multiplan Commercial |
$784.00
|
| Rate for Payer: Networks By Design Commercial |
$637.00
|
| Rate for Payer: Prime Health Services Commercial |
$833.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$588.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$588.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$490.00
|
| Rate for Payer: United Healthcare All Other HMO |
$490.00
|
| Rate for Payer: United Healthcare HMO Rider |
$490.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$490.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$833.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$833.00
|
| Rate for Payer: Vantage Medical Group Senior |
$833.00
|
|
|
HC ACCS BIO SELECTRA SLIT 383119
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812744
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$493.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.20
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
|
|
HC ACCS BIO SELECTRA SLIT 383119
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812744
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$493.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$380.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$356.18
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cigna of CA HMO |
$371.20
|
| Rate for Payer: Cigna of CA PPO |
$429.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$493.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$406.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$290.00
|
| Rate for Payer: United Healthcare All Other HMO |
$290.00
|
| Rate for Payer: United Healthcare HMO Rider |
$290.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC ACETAMINOPHEN (TYLENOL)
|
Facility
|
OP
|
$79.00
|
|
|
Service Code
|
CPT 80143
|
| Hospital Charge Code |
900911302
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.10 |
| Max. Negotiated Rate |
$67.15 |
| Rate for Payer: Adventist Health Commercial |
$15.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$51.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.17
|
| Rate for Payer: Blue Shield of California Commercial |
$52.85
|
| Rate for Payer: Blue Shield of California EPN |
$34.92
|
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: Cigna of CA HMO |
$50.56
|
| Rate for Payer: Cigna of CA PPO |
$58.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.16
|
| Rate for Payer: EPIC Health Plan Senior |
$18.64
|
| Rate for Payer: Galaxy Health WC |
$67.15
|
| Rate for Payer: Global Benefits Group Commercial |
$47.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.98
|
| Rate for Payer: Multiplan Commercial |
$63.20
|
| Rate for Payer: Networks By Design Commercial |
$51.35
|
| Rate for Payer: Prime Health Services Commercial |
$67.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$47.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$47.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.10
|
| Rate for Payer: United Healthcare All Other HMO |
$15.10
|
| Rate for Payer: United Healthcare HMO Rider |
$15.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.10
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Vantage Medical Group Senior |
$18.64
|
|
|
HC ACETAMINOPHEN (TYLENOL)
|
Facility
|
IP
|
$549.00
|
|
|
Service Code
|
CPT 80143
|
| Hospital Charge Code |
900911302
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$109.80 |
| Max. Negotiated Rate |
$466.65 |
| Rate for Payer: Adventist Health Commercial |
$109.80
|
| Rate for Payer: Cash Price |
$247.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$219.60
|
| Rate for Payer: EPIC Health Plan Senior |
$219.60
|
| Rate for Payer: Galaxy Health WC |
$466.65
|
| Rate for Payer: Global Benefits Group Commercial |
$329.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$366.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$209.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$339.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.76
|
| Rate for Payer: Multiplan Commercial |
$439.20
|
| Rate for Payer: Networks By Design Commercial |
$356.85
|
| Rate for Payer: Prime Health Services Commercial |
$466.65
|
|
|
HC ACETOACETATE, SEMIQUANTITATIVE
|
Facility
|
IP
|
$244.00
|
|
|
Service Code
|
CPT 82010
|
| Hospital Charge Code |
900910466
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.80 |
| Max. Negotiated Rate |
$207.40 |
| Rate for Payer: Adventist Health Commercial |
$48.80
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.60
|
| Rate for Payer: EPIC Health Plan Senior |
$97.60
|
| Rate for Payer: Galaxy Health WC |
$207.40
|
| Rate for Payer: Global Benefits Group Commercial |
$146.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$162.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$151.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.56
|
| Rate for Payer: Multiplan Commercial |
$195.20
|
| Rate for Payer: Networks By Design Commercial |
$158.60
|
| Rate for Payer: Prime Health Services Commercial |
$207.40
|
|
|
HC ACETOACETATE, SEMIQUANTITATIVE
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
CPT 82010
|
| Hospital Charge Code |
900910466
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.62 |
| Max. Negotiated Rate |
$80.26 |
| Rate for Payer: Adventist Health Commercial |
$8.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$80.26
|
| Rate for Payer: Blue Shield of California Commercial |
$27.43
|
| Rate for Payer: Blue Shield of California EPN |
$18.12
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Cigna of CA HMO |
$26.24
|
| Rate for Payer: Cigna of CA PPO |
$30.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.03
|
| Rate for Payer: EPIC Health Plan Senior |
$8.17
|
| Rate for Payer: Galaxy Health WC |
$34.85
|
| Rate for Payer: Global Benefits Group Commercial |
$24.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.95
|
| Rate for Payer: Multiplan Commercial |
$32.80
|
| Rate for Payer: Networks By Design Commercial |
$26.65
|
| Rate for Payer: Prime Health Services Commercial |
$34.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.62
|
| Rate for Payer: United Healthcare All Other HMO |
$6.62
|
| Rate for Payer: United Healthcare HMO Rider |
$6.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.62
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.99
|
| Rate for Payer: Vantage Medical Group Senior |
$8.17
|
|
|
HC ACETYLCHOLINESTERASE STAIN
|
Facility
|
OP
|
$519.00
|
|
|
Service Code
|
CPT 88319
|
| Hospital Charge Code |
903800020
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$70.82 |
| Max. Negotiated Rate |
$1,702.24 |
| Rate for Payer: Adventist Health Commercial |
$103.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$340.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,556.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,141.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,037.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.82
|
| Rate for Payer: Blue Shield of California Commercial |
$347.21
|
| Rate for Payer: Blue Shield of California EPN |
$229.40
|
| Rate for Payer: Cash Price |
$233.55
|
| Rate for Payer: Cash Price |
$233.55
|
| Rate for Payer: Cigna of CA HMO |
$332.16
|
| Rate for Payer: Cigna of CA PPO |
$384.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,556.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,141.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,037.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,401.23
|
| Rate for Payer: EPIC Health Plan Senior |
$1,037.95
|
| Rate for Payer: Galaxy Health WC |
$441.15
|
| Rate for Payer: Global Benefits Group Commercial |
$311.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,702.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$115.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,037.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$346.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,037.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,307.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,390.85
|
| Rate for Payer: Multiplan Commercial |
$415.20
|
| Rate for Payer: Networks By Design Commercial |
$337.35
|
| Rate for Payer: Prime Health Services Commercial |
$441.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$311.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$311.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$542.12
|
| Rate for Payer: United Healthcare All Other HMO |
$542.12
|
| Rate for Payer: United Healthcare HMO Rider |
$542.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.12
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,037.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,556.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,141.74
|
| Rate for Payer: Vantage Medical Group Senior |
$1,037.95
|
|
|
HC ACETYLCHOLINESTERASE STAIN
|
Facility
|
IP
|
$1,056.00
|
|
|
Service Code
|
CPT 88319
|
| Hospital Charge Code |
903800020
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$211.20 |
| Max. Negotiated Rate |
$897.60 |
| Rate for Payer: Adventist Health Commercial |
$211.20
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$422.40
|
| Rate for Payer: EPIC Health Plan Senior |
$422.40
|
| Rate for Payer: Galaxy Health WC |
$897.60
|
| Rate for Payer: Global Benefits Group Commercial |
$633.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$704.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$402.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$653.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.44
|
| Rate for Payer: Multiplan Commercial |
$844.80
|
| Rate for Payer: Networks By Design Commercial |
$686.40
|
| Rate for Payer: Prime Health Services Commercial |
$897.60
|
|
|
HC ACID FAST CONCENTRATION
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
CPT 87015
|
| Hospital Charge Code |
900911551
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$65.97 |
| Rate for Payer: Adventist Health Commercial |
$5.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.97
|
| Rate for Payer: Blue Shield of California Commercial |
$17.39
|
| Rate for Payer: Blue Shield of California EPN |
$11.49
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cigna of CA HMO |
$16.64
|
| Rate for Payer: Cigna of CA PPO |
$19.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.02
|
| Rate for Payer: EPIC Health Plan Senior |
$6.68
|
| Rate for Payer: Galaxy Health WC |
$22.10
|
| Rate for Payer: Global Benefits Group Commercial |
$15.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.95
|
| Rate for Payer: Multiplan Commercial |
$20.80
|
| Rate for Payer: Networks By Design Commercial |
$16.90
|
| Rate for Payer: Prime Health Services Commercial |
$22.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.41
|
| Rate for Payer: United Healthcare All Other HMO |
$5.41
|
| Rate for Payer: United Healthcare HMO Rider |
$5.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.41
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.35
|
| Rate for Payer: Vantage Medical Group Senior |
$6.68
|
|
|
HC ACID FAST CONCENTRATION
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
CPT 87015
|
| Hospital Charge Code |
900911551
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$27.80 |
| Max. Negotiated Rate |
$118.15 |
| Rate for Payer: Adventist Health Commercial |
$27.80
|
| Rate for Payer: Cash Price |
$62.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.60
|
| Rate for Payer: EPIC Health Plan Senior |
$55.60
|
| Rate for Payer: Galaxy Health WC |
$118.15
|
| Rate for Payer: Global Benefits Group Commercial |
$83.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$92.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$86.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.36
|
| Rate for Payer: Multiplan Commercial |
$111.20
|
| Rate for Payer: Networks By Design Commercial |
$90.35
|
| Rate for Payer: Prime Health Services Commercial |
$118.15
|
|
|
HC ACID HEMOGLOBIN CONFIRMATION
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
900913569
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$63.75 |
| Rate for Payer: Adventist Health Commercial |
$15.00
|
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.00
|
| Rate for Payer: EPIC Health Plan Senior |
$30.00
|
| Rate for Payer: Galaxy Health WC |
$63.75
|
| Rate for Payer: Global Benefits Group Commercial |
$45.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$46.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
| Rate for Payer: Networks By Design Commercial |
$48.75
|
| Rate for Payer: Prime Health Services Commercial |
$63.75
|
|
|
HC ACID HEMOGLOBIN CONFIRMATION
|
Facility
|
OP
|
$59.00
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
900913569
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.42 |
| Max. Negotiated Rate |
$107.99 |
| Rate for Payer: Adventist Health Commercial |
$11.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$38.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$107.99
|
| Rate for Payer: Blue Shield of California Commercial |
$39.47
|
| Rate for Payer: Blue Shield of California EPN |
$26.08
|
| Rate for Payer: Cash Price |
$26.55
|
| Rate for Payer: Cash Price |
$26.55
|
| Rate for Payer: Cigna of CA HMO |
$37.76
|
| Rate for Payer: Cigna of CA PPO |
$43.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.37
|
| Rate for Payer: EPIC Health Plan Senior |
$12.87
|
| Rate for Payer: Galaxy Health WC |
$50.15
|
| Rate for Payer: Global Benefits Group Commercial |
$35.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.25
|
| Rate for Payer: Multiplan Commercial |
$47.20
|
| Rate for Payer: Networks By Design Commercial |
$38.35
|
| Rate for Payer: Prime Health Services Commercial |
$50.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.42
|
| Rate for Payer: United Healthcare All Other HMO |
$10.42
|
| Rate for Payer: United Healthcare HMO Rider |
$10.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Vantage Medical Group Senior |
$12.87
|
|
