|
HC AMPLATZ TRACT MASTER
|
Facility
|
OP
|
$792.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
909001099
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$158.40 |
| Max. Negotiated Rate |
$673.20 |
| Rate for Payer: Adventist Health Commercial |
$158.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$435.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$594.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$458.73
|
| Rate for Payer: Blue Shield of California Commercial |
$584.50
|
| Rate for Payer: Blue Shield of California EPN |
$384.91
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cigna of CA HMO |
$554.40
|
| Rate for Payer: Cigna of CA PPO |
$554.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$673.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$673.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$316.80
|
| Rate for Payer: EPIC Health Plan Senior |
$316.80
|
| Rate for Payer: Galaxy Health WC |
$673.20
|
| Rate for Payer: Global Benefits Group Commercial |
$475.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$528.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$301.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$490.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$554.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$554.40
|
| Rate for Payer: Multiplan Commercial |
$633.60
|
| Rate for Payer: Networks By Design Commercial |
$396.00
|
| Rate for Payer: Prime Health Services Commercial |
$673.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$475.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$475.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$297.24
|
| Rate for Payer: United Healthcare All Other HMO |
$289.32
|
| Rate for Payer: United Healthcare HMO Rider |
$283.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$259.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$673.20
|
| Rate for Payer: Vantage Medical Group Senior |
$673.20
|
|
|
HC AMPUTATION FINGER/THUMB SNGL
|
Facility
|
OP
|
$12,411.00
|
|
|
Service Code
|
CPT 26910
|
| Hospital Charge Code |
900501259
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$645.83 |
| Max. Negotiated Rate |
$10,549.35 |
| Rate for Payer: Adventist Health Commercial |
$2,482.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,122.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Cash Price |
$5,584.95
|
| Rate for Payer: Cash Price |
$5,584.95
|
| Rate for Payer: Cash Price |
$5,584.95
|
| Rate for Payer: Cigna of CA HMO |
$7,943.04
|
| Rate for Payer: Cigna of CA PPO |
$9,184.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,534.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,122.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,565.51
|
| Rate for Payer: EPIC Health Plan Senior |
$4,122.60
|
| Rate for Payer: Galaxy Health WC |
$10,549.35
|
| Rate for Payer: Global Benefits Group Commercial |
$7,446.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,761.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,122.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,278.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$645.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,122.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,978.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,194.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,524.28
|
| Rate for Payer: Multiplan Commercial |
$9,928.80
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$8,067.15
|
| Rate for Payer: Prime Health Services Commercial |
$10,549.35
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,446.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,205.50
|
| Rate for Payer: United Healthcare All Other HMO |
$6,205.50
|
| Rate for Payer: United Healthcare HMO Rider |
$6,205.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,205.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,122.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Vantage Medical Group Senior |
$4,122.60
|
|
|
HC AMPUTATION FINGER/THUMB SNGL
|
Facility
|
IP
|
$12,411.00
|
|
|
Service Code
|
CPT 26910
|
| Hospital Charge Code |
900501259
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,482.20 |
| Max. Negotiated Rate |
$10,549.35 |
| Rate for Payer: Adventist Health Commercial |
$2,482.20
|
| Rate for Payer: Cash Price |
$5,584.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,964.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,964.40
|
| Rate for Payer: Galaxy Health WC |
$10,549.35
|
| Rate for Payer: Global Benefits Group Commercial |
$7,446.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,278.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,728.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,682.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,978.64
|
| Rate for Payer: Multiplan Commercial |
$9,928.80
|
| Rate for Payer: Networks By Design Commercial |
$8,067.15
|
| Rate for Payer: Prime Health Services Commercial |
$10,549.35
|
|
|
HC AMPUTATION FINGER/THUMB W/V-Y
|
Facility
|
IP
|
$10,650.00
|
|
|
Service Code
|
CPT 26952
|
| Hospital Charge Code |
900501462
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,130.00 |
| Max. Negotiated Rate |
$9,052.50 |
| Rate for Payer: Adventist Health Commercial |
$2,130.00
|
| Rate for Payer: Cash Price |
$4,792.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,260.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,260.00
|
| Rate for Payer: Galaxy Health WC |
$9,052.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,390.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,103.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,057.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,592.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,556.00
|
| Rate for Payer: Multiplan Commercial |
$8,520.00
|
| Rate for Payer: Networks By Design Commercial |
$6,922.50
|
| Rate for Payer: Prime Health Services Commercial |
$9,052.50
|
|
|
HC AMPUTATION FINGER/THUMB W/V-Y
|
Facility
|
OP
|
$10,650.00
|
|
|
Service Code
|
CPT 26952
|
| Hospital Charge Code |
900501462
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$590.65 |
| Max. Negotiated Rate |
$12,491.00 |
| Rate for Payer: Adventist Health Commercial |
$2,130.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,122.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,712.00
|
| Rate for Payer: Cash Price |
$4,792.50
|
| Rate for Payer: Cash Price |
$4,792.50
|
| Rate for Payer: Cash Price |
$4,792.50
|
| Rate for Payer: Cigna of CA HMO |
$6,816.00
|
| Rate for Payer: Cigna of CA PPO |
$7,881.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,534.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,122.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,565.51
|
| Rate for Payer: EPIC Health Plan Senior |
$4,122.60
|
| Rate for Payer: Galaxy Health WC |
$9,052.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,390.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,761.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,122.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,103.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$590.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,122.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,556.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,194.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,524.28
|
| Rate for Payer: Multiplan Commercial |
$8,520.00
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$6,922.50
|
| Rate for Payer: Prime Health Services Commercial |
$9,052.50
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,390.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,325.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5,325.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,325.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,325.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,122.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Vantage Medical Group Senior |
$4,122.60
|
|
|
HC AMPUTATION OF TOE
|
Facility
|
IP
|
$8,506.00
|
|
|
Service Code
|
CPT 28820
|
| Hospital Charge Code |
900501402
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,701.20 |
| Max. Negotiated Rate |
$7,230.10 |
| Rate for Payer: Adventist Health Commercial |
$1,701.20
|
| Rate for Payer: Cash Price |
$3,827.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,402.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,402.40
|
| Rate for Payer: Galaxy Health WC |
$7,230.10
|
| Rate for Payer: Global Benefits Group Commercial |
$5,103.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,673.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,240.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,265.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,041.44
|
| Rate for Payer: Multiplan Commercial |
$6,804.80
|
| Rate for Payer: Networks By Design Commercial |
$5,528.90
|
| Rate for Payer: Prime Health Services Commercial |
$7,230.10
|
|
|
HC AMPUTATION OF TOE
|
Facility
|
OP
|
$8,506.00
|
|
|
Service Code
|
CPT 28820
|
| Hospital Charge Code |
900501402
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$433.62 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$1,701.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,122.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$3,827.70
|
| Rate for Payer: Cash Price |
$3,827.70
|
| Rate for Payer: Cash Price |
$3,827.70
|
| Rate for Payer: Cigna of CA HMO |
$5,443.84
|
| Rate for Payer: Cigna of CA PPO |
$6,294.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,534.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,122.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,565.51
|
| Rate for Payer: EPIC Health Plan Senior |
$4,122.60
|
| Rate for Payer: Galaxy Health WC |
$7,230.10
|
| Rate for Payer: Global Benefits Group Commercial |
$5,103.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,761.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,122.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,673.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$433.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,122.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,041.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,194.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,524.28
|
| Rate for Payer: Multiplan Commercial |
$6,804.80
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$5,528.90
|
| Rate for Payer: Prime Health Services Commercial |
$7,230.10
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,103.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,253.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,253.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,253.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,253.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,122.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Vantage Medical Group Senior |
$4,122.60
|
|
|
HC AMYLASE
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
900910236
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$64.10 |
| Rate for Payer: Adventist Health Commercial |
$7.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$64.10
|
| Rate for Payer: Blue Shield of California Commercial |
$25.42
|
| Rate for Payer: Blue Shield of California EPN |
$16.80
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cigna of CA HMO |
$24.32
|
| Rate for Payer: Cigna of CA PPO |
$28.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.75
|
| Rate for Payer: EPIC Health Plan Senior |
$6.48
|
| Rate for Payer: Galaxy Health WC |
$32.30
|
| Rate for Payer: Global Benefits Group Commercial |
$22.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.68
|
| Rate for Payer: Multiplan Commercial |
$30.40
|
| Rate for Payer: Networks By Design Commercial |
$24.70
|
| Rate for Payer: Prime Health Services Commercial |
$32.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.25
|
| Rate for Payer: United Healthcare All Other HMO |
$5.25
|
| Rate for Payer: United Healthcare HMO Rider |
$5.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.25
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: Vantage Medical Group Senior |
$6.48
|
|
|
HC AMYLASE
|
Facility
|
IP
|
$258.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
900910236
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$51.60 |
| Max. Negotiated Rate |
$219.30 |
| Rate for Payer: Adventist Health Commercial |
$51.60
|
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.20
|
| Rate for Payer: EPIC Health Plan Senior |
$103.20
|
| Rate for Payer: Galaxy Health WC |
$219.30
|
| Rate for Payer: Global Benefits Group Commercial |
$154.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$172.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$159.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.92
|
| Rate for Payer: Multiplan Commercial |
$206.40
|
| Rate for Payer: Networks By Design Commercial |
$167.70
|
| Rate for Payer: Prime Health Services Commercial |
$219.30
|
|
|
HC AMYLASE BODY FLUID
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
900910242
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$64.10 |
| Rate for Payer: Adventist Health Commercial |
$7.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$64.10
|
| Rate for Payer: Blue Shield of California Commercial |
$25.42
|
| Rate for Payer: Blue Shield of California EPN |
$16.80
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cigna of CA HMO |
$24.32
|
| Rate for Payer: Cigna of CA PPO |
$28.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.75
|
| Rate for Payer: EPIC Health Plan Senior |
$6.48
|
| Rate for Payer: Galaxy Health WC |
$32.30
|
| Rate for Payer: Global Benefits Group Commercial |
$22.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.68
|
| Rate for Payer: Multiplan Commercial |
$30.40
|
| Rate for Payer: Networks By Design Commercial |
$24.70
|
| Rate for Payer: Prime Health Services Commercial |
$32.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.25
|
| Rate for Payer: United Healthcare All Other HMO |
$5.25
|
| Rate for Payer: United Healthcare HMO Rider |
$5.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.25
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: Vantage Medical Group Senior |
$6.48
|
|
|
HC AMYLASE BODY FLUID
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
900910242
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$47.60 |
| Rate for Payer: Adventist Health Commercial |
$11.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.40
|
| Rate for Payer: EPIC Health Plan Senior |
$22.40
|
| Rate for Payer: Galaxy Health WC |
$47.60
|
| Rate for Payer: Global Benefits Group Commercial |
$33.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$37.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.44
|
| Rate for Payer: Multiplan Commercial |
$44.80
|
| Rate for Payer: Networks By Design Commercial |
$36.40
|
| Rate for Payer: Prime Health Services Commercial |
$47.60
|
|
|
HC AMYLASE URINE
|
Facility
|
IP
|
$258.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
900910237
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$51.60 |
| Max. Negotiated Rate |
$219.30 |
| Rate for Payer: Adventist Health Commercial |
$51.60
|
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.20
|
| Rate for Payer: EPIC Health Plan Senior |
$103.20
|
| Rate for Payer: Galaxy Health WC |
$219.30
|
| Rate for Payer: Global Benefits Group Commercial |
$154.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$172.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$159.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.92
|
| Rate for Payer: Multiplan Commercial |
$206.40
|
| Rate for Payer: Networks By Design Commercial |
$167.70
|
| Rate for Payer: Prime Health Services Commercial |
$219.30
|
|
|
HC AMYLASE URINE
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
900910237
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$64.10 |
| Rate for Payer: Adventist Health Commercial |
$11.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$36.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$64.10
|
| Rate for Payer: Blue Shield of California Commercial |
$37.46
|
| Rate for Payer: Blue Shield of California EPN |
$24.75
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna of CA HMO |
$35.84
|
| Rate for Payer: Cigna of CA PPO |
$41.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.75
|
| Rate for Payer: EPIC Health Plan Senior |
$6.48
|
| Rate for Payer: Galaxy Health WC |
$47.60
|
| Rate for Payer: Global Benefits Group Commercial |
$33.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$37.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.68
|
| Rate for Payer: Multiplan Commercial |
$44.80
|
| Rate for Payer: Networks By Design Commercial |
$36.40
|
| Rate for Payer: Prime Health Services Commercial |
$47.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.25
|
| Rate for Payer: United Healthcare All Other HMO |
$5.25
|
| Rate for Payer: United Healthcare HMO Rider |
$5.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.25
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: Vantage Medical Group Senior |
$6.48
|
|
|
HC ANAEROBIC MIC PANEL
|
Facility
|
IP
|
$313.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
900912405
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$62.60 |
| Max. Negotiated Rate |
$266.05 |
| Rate for Payer: Adventist Health Commercial |
$62.60
|
| Rate for Payer: Cash Price |
$140.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.20
|
| Rate for Payer: EPIC Health Plan Senior |
$125.20
|
| Rate for Payer: Galaxy Health WC |
$266.05
|
| Rate for Payer: Global Benefits Group Commercial |
$187.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$208.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$119.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$193.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.12
|
| Rate for Payer: Multiplan Commercial |
$250.40
|
| Rate for Payer: Networks By Design Commercial |
$203.45
|
| Rate for Payer: Prime Health Services Commercial |
$266.05
|
|
|
HC ANAEROBIC MIC PANEL
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
900912405
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.01 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Commercial |
$17.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$57.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.38
|
| Rate for Payer: Blue Shield of California Commercial |
$58.87
|
| Rate for Payer: Blue Shield of California EPN |
$38.90
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna of CA HMO |
$56.32
|
| Rate for Payer: Cigna of CA PPO |
$65.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.68
|
| Rate for Payer: EPIC Health Plan Senior |
$8.65
|
| Rate for Payer: Galaxy Health WC |
$74.80
|
| Rate for Payer: Global Benefits Group Commercial |
$52.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.59
|
| Rate for Payer: Multiplan Commercial |
$70.40
|
| Rate for Payer: Networks By Design Commercial |
$57.20
|
| Rate for Payer: Prime Health Services Commercial |
$74.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.01
|
| Rate for Payer: United Healthcare All Other HMO |
$7.01
|
| Rate for Payer: United Healthcare HMO Rider |
$7.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.01
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.52
|
| Rate for Payer: Vantage Medical Group Senior |
$8.65
|
|
|
HC ANALOGUE CONTROL UNB OR EQUAL
|
Facility
|
IP
|
$5,055.00
|
|
|
Service Code
|
CPT L7272
|
| Hospital Charge Code |
905357272
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,011.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,011.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,274.75
|
| Rate for Payer: Cash Price |
$2,274.75
|
| Rate for Payer: Cigna of CA HMO |
$3,538.50
|
| Rate for Payer: Cigna of CA PPO |
$3,538.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,022.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,022.00
|
| Rate for Payer: Galaxy Health WC |
$4,296.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,033.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,371.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,925.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,129.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,213.20
|
| Rate for Payer: Multiplan Commercial |
$4,044.00
|
| Rate for Payer: Networks By Design Commercial |
$2,527.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,296.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,897.14
|
| Rate for Payer: United Healthcare All Other HMO |
$1,846.59
|
| Rate for Payer: United Healthcare HMO Rider |
$1,806.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,655.51
|
|
|
HC ANALOGUE CONTROL UNB OR EQUAL
|
Facility
|
OP
|
$5,055.00
|
|
|
Service Code
|
CPT L7272
|
| Hospital Charge Code |
905357272
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,213.20 |
| Max. Negotiated Rate |
$4,296.75 |
| Rate for Payer: Adventist Health Commercial |
$2,072.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,296.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,780.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,791.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,927.86
|
| Rate for Payer: Blue Shield of California Commercial |
$3,730.59
|
| Rate for Payer: Blue Shield of California EPN |
$2,456.73
|
| Rate for Payer: Cash Price |
$2,274.75
|
| Rate for Payer: Cigna of CA HMO |
$3,538.50
|
| Rate for Payer: Cigna of CA PPO |
$3,538.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,296.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,296.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,296.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,022.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,022.00
|
| Rate for Payer: Galaxy Health WC |
$4,296.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,033.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,371.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,925.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,129.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,213.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,538.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,538.50
|
| Rate for Payer: Multiplan Commercial |
$4,044.00
|
| Rate for Payer: Networks By Design Commercial |
$2,527.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,296.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,033.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,033.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,897.14
|
| Rate for Payer: United Healthcare All Other HMO |
$1,846.59
|
| Rate for Payer: United Healthcare HMO Rider |
$1,806.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,655.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,296.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,296.75
|
| Rate for Payer: Vantage Medical Group Senior |
$4,296.75
|
|
|
HC ANA PANEL
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913646
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.53 |
| Max. Negotiated Rate |
$150.42 |
| Rate for Payer: Adventist Health Commercial |
$30.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$101.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.42
|
| Rate for Payer: Blue Shield of California Commercial |
$103.03
|
| Rate for Payer: Blue Shield of California EPN |
$68.07
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cigna of CA HMO |
$98.56
|
| Rate for Payer: Cigna of CA PPO |
$113.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.21
|
| Rate for Payer: EPIC Health Plan Senior |
$17.93
|
| Rate for Payer: Galaxy Health WC |
$130.90
|
| Rate for Payer: Global Benefits Group Commercial |
$92.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$102.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.03
|
| Rate for Payer: Multiplan Commercial |
$123.20
|
| Rate for Payer: Networks By Design Commercial |
$100.10
|
| Rate for Payer: Prime Health Services Commercial |
$130.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$92.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$92.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.53
|
| Rate for Payer: United Healthcare All Other HMO |
$14.53
|
| Rate for Payer: United Healthcare HMO Rider |
$14.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC ANA PANEL
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913646
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$34.20 |
| Max. Negotiated Rate |
$145.35 |
| Rate for Payer: Adventist Health Commercial |
$34.20
|
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.40
|
| Rate for Payer: EPIC Health Plan Senior |
$68.40
|
| Rate for Payer: Galaxy Health WC |
$145.35
|
| Rate for Payer: Global Benefits Group Commercial |
$102.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$114.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$105.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.04
|
| Rate for Payer: Multiplan Commercial |
$136.80
|
| Rate for Payer: Networks By Design Commercial |
$111.15
|
| Rate for Payer: Prime Health Services Commercial |
$145.35
|
|
|
HC ANCR CATH UMBILICAL UMB-E
|
Facility
|
OP
|
$22.63
|
|
| Hospital Charge Code |
901603825
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$19.24 |
| Rate for Payer: Adventist Health Commercial |
$4.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.90
|
| Rate for Payer: Cash Price |
$10.18
|
| Rate for Payer: Cigna of CA HMO |
$14.48
|
| Rate for Payer: Cigna of CA PPO |
$16.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.05
|
| Rate for Payer: EPIC Health Plan Senior |
$9.05
|
| Rate for Payer: Galaxy Health WC |
$19.24
|
| Rate for Payer: Global Benefits Group Commercial |
$13.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.84
|
| Rate for Payer: Multiplan Commercial |
$18.10
|
| Rate for Payer: Networks By Design Commercial |
$14.71
|
| Rate for Payer: Prime Health Services Commercial |
$19.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.31
|
| Rate for Payer: United Healthcare All Other HMO |
$11.31
|
| Rate for Payer: United Healthcare HMO Rider |
$11.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.24
|
| Rate for Payer: Vantage Medical Group Senior |
$19.24
|
|
|
HC ANCR CATH UMBILICAL UMB-E
|
Facility
|
IP
|
$22.63
|
|
| Hospital Charge Code |
901603825
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$19.24 |
| Rate for Payer: Adventist Health Commercial |
$4.53
|
| Rate for Payer: Cash Price |
$10.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.05
|
| Rate for Payer: EPIC Health Plan Senior |
$9.05
|
| Rate for Payer: Galaxy Health WC |
$19.24
|
| Rate for Payer: Global Benefits Group Commercial |
$13.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.43
|
| Rate for Payer: Multiplan Commercial |
$18.10
|
| Rate for Payer: Networks By Design Commercial |
$14.71
|
| Rate for Payer: Prime Health Services Commercial |
$19.24
|
|
|
HC ANESTHESIA LEVEL I 1ST 15MIN
|
Facility
|
OP
|
$821.00
|
|
| Hospital Charge Code |
904900400
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$164.20 |
| Max. Negotiated Rate |
$697.85 |
| Rate for Payer: Adventist Health Commercial |
$164.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$538.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$697.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$451.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$615.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$504.18
|
| Rate for Payer: Cash Price |
$369.45
|
| Rate for Payer: Cigna of CA HMO |
$525.44
|
| Rate for Payer: Cigna of CA PPO |
$607.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$697.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$697.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$697.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$328.40
|
| Rate for Payer: EPIC Health Plan Senior |
$328.40
|
| Rate for Payer: Galaxy Health WC |
$697.85
|
| Rate for Payer: Global Benefits Group Commercial |
$492.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$547.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$312.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$508.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$197.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$574.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$574.70
|
| Rate for Payer: Multiplan Commercial |
$656.80
|
| Rate for Payer: Networks By Design Commercial |
$533.65
|
| Rate for Payer: Prime Health Services Commercial |
$697.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$492.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$492.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$410.50
|
| Rate for Payer: United Healthcare All Other HMO |
$410.50
|
| Rate for Payer: United Healthcare HMO Rider |
$410.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$410.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$697.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$697.85
|
| Rate for Payer: Vantage Medical Group Senior |
$697.85
|
|
|
HC ANESTHESIA LEVEL I 1ST 15MIN
|
Facility
|
IP
|
$821.00
|
|
| Hospital Charge Code |
904900400
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$164.20 |
| Max. Negotiated Rate |
$697.85 |
| Rate for Payer: Adventist Health Commercial |
$164.20
|
| Rate for Payer: Cash Price |
$369.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$328.40
|
| Rate for Payer: EPIC Health Plan Senior |
$328.40
|
| Rate for Payer: Galaxy Health WC |
$697.85
|
| Rate for Payer: Global Benefits Group Commercial |
$492.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$547.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$312.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$508.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$197.04
|
| Rate for Payer: Multiplan Commercial |
$656.80
|
| Rate for Payer: Networks By Design Commercial |
$533.65
|
| Rate for Payer: Prime Health Services Commercial |
$697.85
|
|
|
HC ANESTHESIA LEVEL I ADD'L 15MIN
|
Facility
|
IP
|
$204.00
|
|
| Hospital Charge Code |
904900401
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$173.40 |
| Rate for Payer: Adventist Health Commercial |
$40.80
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.60
|
| Rate for Payer: EPIC Health Plan Senior |
$81.60
|
| Rate for Payer: Galaxy Health WC |
$173.40
|
| Rate for Payer: Global Benefits Group Commercial |
$122.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$136.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$126.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.96
|
| Rate for Payer: Multiplan Commercial |
$163.20
|
| Rate for Payer: Networks By Design Commercial |
$132.60
|
| Rate for Payer: Prime Health Services Commercial |
$173.40
|
|
|
HC ANESTHESIA LEVEL I ADD'L 15MIN
|
Facility
|
OP
|
$204.00
|
|
| Hospital Charge Code |
904900401
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$173.40 |
| Rate for Payer: Adventist Health Commercial |
$40.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$133.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$173.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$112.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$153.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.28
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cigna of CA HMO |
$130.56
|
| Rate for Payer: Cigna of CA PPO |
$150.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$173.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$173.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$173.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.60
|
| Rate for Payer: EPIC Health Plan Senior |
$81.60
|
| Rate for Payer: Galaxy Health WC |
$173.40
|
| Rate for Payer: Global Benefits Group Commercial |
$122.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$136.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$126.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$142.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$142.80
|
| Rate for Payer: Multiplan Commercial |
$163.20
|
| Rate for Payer: Networks By Design Commercial |
$132.60
|
| Rate for Payer: Prime Health Services Commercial |
$173.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$122.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$122.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$102.00
|
| Rate for Payer: United Healthcare All Other HMO |
$102.00
|
| Rate for Payer: United Healthcare HMO Rider |
$102.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$102.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$173.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$173.40
|
| Rate for Payer: Vantage Medical Group Senior |
$173.40
|
|
