|
HC ALLIGATOR RETRIEVAL DEVICE
|
Facility
|
OP
|
$6,250.00
|
|
| Hospital Charge Code |
909020108
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,250.00 |
| Max. Negotiated Rate |
$5,312.50 |
| Rate for Payer: Networks By Design Commercial |
$4,062.50
|
| Rate for Payer: Adventist Health Commercial |
$1,250.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,099.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,312.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,437.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,687.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,010.62
|
| Rate for Payer: Cash Price |
$2,812.50
|
| Rate for Payer: Cigna of CA HMO |
$4,000.00
|
| Rate for Payer: Cigna of CA PPO |
$4,625.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,312.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,312.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,312.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,375.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,500.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,500.00
|
| Rate for Payer: Galaxy Health WC |
$5,312.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,750.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,968.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,268.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,687.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,500.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,375.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,375.00
|
| Rate for Payer: Multiplan Commercial |
$5,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,312.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,750.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,750.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,125.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,125.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,125.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,125.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,312.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,312.50
|
| Rate for Payer: Vantage Medical Group Senior |
$5,312.50
|
|
|
HC ALPHA 1 ANTITRYPSN
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
CPT 82103
|
| Hospital Charge Code |
900910838
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.89 |
| Max. Negotiated Rate |
$138.56 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.78
|
| Rate for Payer: Vantage Medical Group Senior |
$13.44
|
| Rate for Payer: Vantage Medical Group Senior |
$13.44
|
| Rate for Payer: Adventist Health Commercial |
$22.60
|
| Rate for Payer: Adventist Health Commercial |
$12.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$111.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$111.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$138.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$138.56
|
| Rate for Payer: Blue Shield of California Commercial |
$28.58
|
| Rate for Payer: Blue Shield of California Commercial |
$52.09
|
| Rate for Payer: Blue Shield of California Commercial |
$43.21
|
| Rate for Payer: Blue Shield of California Commercial |
$78.76
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$50.85
|
| Rate for Payer: Cash Price |
$50.85
|
| Rate for Payer: Cigna of CA HMO |
$39.68
|
| Rate for Payer: Cigna of CA HMO |
$72.32
|
| Rate for Payer: Cigna of CA PPO |
$83.62
|
| Rate for Payer: Cigna of CA PPO |
$45.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.44
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$79.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$43.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.18
|
| Rate for Payer: EPIC Health Plan Senior |
$14.78
|
| Rate for Payer: EPIC Health Plan Senior |
$14.78
|
| Rate for Payer: Galaxy Health WC |
$96.05
|
| Rate for Payer: Galaxy Health WC |
$52.70
|
| Rate for Payer: Global Benefits Group Commercial |
$67.80
|
| Rate for Payer: Global Benefits Group Commercial |
$37.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.04
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$71.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$39.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.01
|
| Rate for Payer: Multiplan Commercial |
$49.60
|
| Rate for Payer: Multiplan Commercial |
$90.40
|
| Rate for Payer: Networks By Design Commercial |
$40.30
|
| Rate for Payer: Networks By Design Commercial |
$73.45
|
| Rate for Payer: Prime Health Services Commercial |
$96.05
|
| Rate for Payer: Prime Health Services Commercial |
$52.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$37.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$37.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.89
|
| Rate for Payer: United Healthcare All Other HMO |
$10.89
|
| Rate for Payer: United Healthcare All Other HMO |
$10.89
|
| Rate for Payer: United Healthcare HMO Rider |
$10.89
|
| Rate for Payer: United Healthcare HMO Rider |
$10.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.89
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.44
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.16
|
|
|
HC ALPHA 1 ANTITRYPSN
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
CPT 82103
|
| Hospital Charge Code |
900910838
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.60 |
| Max. Negotiated Rate |
$96.05 |
| Rate for Payer: Adventist Health Commercial |
$22.60
|
| Rate for Payer: Cash Price |
$50.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$79.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.20
|
| Rate for Payer: EPIC Health Plan Senior |
$45.20
|
| Rate for Payer: Galaxy Health WC |
$96.05
|
| Rate for Payer: Global Benefits Group Commercial |
$67.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$71.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$66.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.12
|
| Rate for Payer: Multiplan Commercial |
$90.40
|
| Rate for Payer: Networks By Design Commercial |
$73.45
|
| Rate for Payer: Prime Health Services Commercial |
$96.05
|
|
|
HC ALPHA-FETOPROTEIN BLOOD
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
CPT 82105
|
| Hospital Charge Code |
900910947
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.58 |
| Max. Negotiated Rate |
$173.17 |
| Rate for Payer: Adventist Health Commercial |
$28.00
|
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$139.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$139.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$173.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$173.17
|
| Rate for Payer: Blue Shield of California Commercial |
$124.47
|
| Rate for Payer: Blue Shield of California Commercial |
$64.54
|
| Rate for Payer: Blue Shield of California Commercial |
$188.19
|
| Rate for Payer: Blue Shield of California Commercial |
$97.58
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna of CA HMO |
$172.80
|
| Rate for Payer: Cigna of CA HMO |
$89.60
|
| Rate for Payer: Cigna of CA PPO |
$103.60
|
| Rate for Payer: Cigna of CA PPO |
$199.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.77
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$98.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$189.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.67
|
| Rate for Payer: EPIC Health Plan Senior |
$18.45
|
| Rate for Payer: EPIC Health Plan Senior |
$18.45
|
| Rate for Payer: Galaxy Health WC |
$119.00
|
| Rate for Payer: Galaxy Health WC |
$229.50
|
| Rate for Payer: Global Benefits Group Commercial |
$84.00
|
| Rate for Payer: Global Benefits Group Commercial |
$162.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$142.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$142.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$88.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$171.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$161.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$161.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.47
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: Multiplan Commercial |
$112.00
|
| Rate for Payer: Networks By Design Commercial |
$175.50
|
| Rate for Payer: Networks By Design Commercial |
$91.00
|
| Rate for Payer: Prime Health Services Commercial |
$119.00
|
| Rate for Payer: Prime Health Services Commercial |
$229.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$84.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$162.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$84.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$162.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.58
|
| Rate for Payer: United Healthcare All Other HMO |
$13.58
|
| Rate for Payer: United Healthcare All Other HMO |
$13.58
|
| Rate for Payer: United Healthcare HMO Rider |
$13.58
|
| Rate for Payer: United Healthcare HMO Rider |
$13.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.58
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.45
|
| Rate for Payer: Vantage Medical Group Senior |
$16.77
|
| Rate for Payer: Vantage Medical Group Senior |
$16.77
|
|
|
HC ALPHA-FETOPROTEIN BLOOD
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
CPT 82105
|
| Hospital Charge Code |
900910947
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$54.00 |
| Max. Negotiated Rate |
$229.50 |
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$189.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.00
|
| Rate for Payer: EPIC Health Plan Senior |
$108.00
|
| Rate for Payer: Galaxy Health WC |
$229.50
|
| Rate for Payer: Global Benefits Group Commercial |
$162.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$171.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$159.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.80
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: Networks By Design Commercial |
$175.50
|
| Rate for Payer: Prime Health Services Commercial |
$229.50
|
|
|
HC ALT
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 84460
|
| Hospital Charge Code |
900910233
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$83.30 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$68.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.20
|
| Rate for Payer: EPIC Health Plan Senior |
$39.20
|
| Rate for Payer: Galaxy Health WC |
$83.30
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$62.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$57.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.52
|
| Rate for Payer: Multiplan Commercial |
$78.40
|
| Rate for Payer: Networks By Design Commercial |
$63.70
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
|
|
HC ALT
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 84460
|
| Hospital Charge Code |
900910233
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$53.99 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$43.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$43.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.99
|
| Rate for Payer: Blue Shield of California Commercial |
$45.18
|
| Rate for Payer: Blue Shield of California Commercial |
$23.05
|
| Rate for Payer: Blue Shield of California Commercial |
$68.31
|
| Rate for Payer: Blue Shield of California Commercial |
$34.85
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna of CA HMO |
$62.72
|
| Rate for Payer: Cigna of CA HMO |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Cigna of CA PPO |
$72.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$68.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.74
|
| Rate for Payer: EPIC Health Plan Senior |
$5.83
|
| Rate for Payer: EPIC Health Plan Senior |
$5.83
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Galaxy Health WC |
$83.30
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.69
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$62.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.10
|
| Rate for Payer: Multiplan Commercial |
$78.40
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Networks By Design Commercial |
$63.70
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.29
|
| Rate for Payer: United Healthcare All Other HMO |
$4.29
|
| Rate for Payer: United Healthcare All Other HMO |
$4.29
|
| Rate for Payer: United Healthcare HMO Rider |
$4.29
|
| Rate for Payer: United Healthcare HMO Rider |
$4.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.29
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.30
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.83
|
| Rate for Payer: Vantage Medical Group Senior |
$5.30
|
| Rate for Payer: Vantage Medical Group Senior |
$5.30
|
|
|
HC ALT SINGLE
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 84460
|
| Hospital Charge Code |
900910510
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$53.99 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$43.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$43.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.99
|
| Rate for Payer: Blue Shield of California Commercial |
$45.18
|
| Rate for Payer: Blue Shield of California Commercial |
$23.05
|
| Rate for Payer: Blue Shield of California Commercial |
$68.31
|
| Rate for Payer: Blue Shield of California Commercial |
$34.85
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna of CA HMO |
$62.72
|
| Rate for Payer: Cigna of CA HMO |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Cigna of CA PPO |
$72.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$68.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.74
|
| Rate for Payer: EPIC Health Plan Senior |
$5.83
|
| Rate for Payer: EPIC Health Plan Senior |
$5.83
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Galaxy Health WC |
$83.30
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.69
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$62.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.10
|
| Rate for Payer: Multiplan Commercial |
$78.40
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Networks By Design Commercial |
$63.70
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.29
|
| Rate for Payer: United Healthcare All Other HMO |
$4.29
|
| Rate for Payer: United Healthcare All Other HMO |
$4.29
|
| Rate for Payer: United Healthcare HMO Rider |
$4.29
|
| Rate for Payer: United Healthcare HMO Rider |
$4.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.29
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.30
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.83
|
| Rate for Payer: Vantage Medical Group Senior |
$5.30
|
| Rate for Payer: Vantage Medical Group Senior |
$5.30
|
|
|
HC ALT SINGLE
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 84460
|
| Hospital Charge Code |
900910510
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$83.30 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$68.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.20
|
| Rate for Payer: EPIC Health Plan Senior |
$39.20
|
| Rate for Payer: Galaxy Health WC |
$83.30
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$62.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$57.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.52
|
| Rate for Payer: Multiplan Commercial |
$78.40
|
| Rate for Payer: Networks By Design Commercial |
$63.70
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
|
|
HC AMBULATORY SURGICAL BOOT EA
|
Facility
|
IP
|
$445.00
|
|
|
Service Code
|
CPT L3260
|
| Hospital Charge Code |
905353260
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$89.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$89.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$200.25
|
| Rate for Payer: Cash Price |
$200.25
|
| Rate for Payer: Cigna of CA HMO |
$311.50
|
| Rate for Payer: Cigna of CA PPO |
$311.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$311.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$178.00
|
| Rate for Payer: EPIC Health Plan Senior |
$178.00
|
| Rate for Payer: Galaxy Health WC |
$378.25
|
| Rate for Payer: Global Benefits Group Commercial |
$267.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$282.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$262.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.80
|
| Rate for Payer: Multiplan Commercial |
$356.00
|
| Rate for Payer: Networks By Design Commercial |
$289.25
|
| Rate for Payer: Prime Health Services Commercial |
$378.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$167.01
|
| Rate for Payer: United Healthcare All Other HMO |
$162.56
|
| Rate for Payer: United Healthcare HMO Rider |
$159.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$145.74
|
|
|
HC AMBULATORY SURGICAL BOOT EA
|
Facility
|
OP
|
$445.00
|
|
|
Service Code
|
CPT L3260
|
| Hospital Charge Code |
905353260
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$106.80 |
| Max. Negotiated Rate |
$378.25 |
| Rate for Payer: Adventist Health Commercial |
$182.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$244.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$333.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$269.36
|
| Rate for Payer: Blue Shield of California Commercial |
$342.20
|
| Rate for Payer: Blue Shield of California Commercial |
$225.62
|
| Rate for Payer: Cash Price |
$200.25
|
| Rate for Payer: Cash Price |
$200.25
|
| Rate for Payer: Cigna of CA HMO |
$311.50
|
| Rate for Payer: Cigna of CA PPO |
$311.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$378.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$378.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$311.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$178.00
|
| Rate for Payer: EPIC Health Plan Senior |
$178.00
|
| Rate for Payer: Galaxy Health WC |
$378.25
|
| Rate for Payer: Global Benefits Group Commercial |
$267.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$128.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$282.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$145.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$262.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$311.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$311.50
|
| Rate for Payer: Multiplan Commercial |
$356.00
|
| Rate for Payer: Networks By Design Commercial |
$222.50
|
| Rate for Payer: Prime Health Services Commercial |
$378.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$267.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$267.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$167.01
|
| Rate for Payer: United Healthcare All Other HMO |
$162.56
|
| Rate for Payer: United Healthcare HMO Rider |
$159.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$145.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$378.25
|
| Rate for Payer: Vantage Medical Group Senior |
$378.25
|
|
|
HC AMIKACIN
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
CPT 80150
|
| Hospital Charge Code |
900910405
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.21 |
| Max. Negotiated Rate |
$155.59 |
| Rate for Payer: Adventist Health Commercial |
$34.40
|
| Rate for Payer: Adventist Health Commercial |
$10.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$125.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$125.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.59
|
| Rate for Payer: Blue Shield of California Commercial |
$23.51
|
| Rate for Payer: Blue Shield of California Commercial |
$119.88
|
| Rate for Payer: Blue Shield of California Commercial |
$35.55
|
| Rate for Payer: Blue Shield of California Commercial |
$79.29
|
| Rate for Payer: Cash Price |
$22.95
|
| Rate for Payer: Cash Price |
$22.95
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cigna of CA HMO |
$32.64
|
| Rate for Payer: Cigna of CA HMO |
$110.08
|
| Rate for Payer: Cigna of CA PPO |
$127.28
|
| Rate for Payer: Cigna of CA PPO |
$37.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$120.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.88
|
| Rate for Payer: EPIC Health Plan Senior |
$16.59
|
| Rate for Payer: EPIC Health Plan Senior |
$16.59
|
| Rate for Payer: Galaxy Health WC |
$146.20
|
| Rate for Payer: Galaxy Health WC |
$43.35
|
| Rate for Payer: Global Benefits Group Commercial |
$103.20
|
| Rate for Payer: Global Benefits Group Commercial |
$30.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24.73
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$109.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$32.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.21
|
| Rate for Payer: Multiplan Commercial |
$40.80
|
| Rate for Payer: Multiplan Commercial |
$137.60
|
| Rate for Payer: Networks By Design Commercial |
$33.15
|
| Rate for Payer: Networks By Design Commercial |
$111.80
|
| Rate for Payer: Prime Health Services Commercial |
$146.20
|
| Rate for Payer: Prime Health Services Commercial |
$43.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$103.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$103.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.21
|
| Rate for Payer: United Healthcare All Other HMO |
$12.21
|
| Rate for Payer: United Healthcare All Other HMO |
$12.21
|
| Rate for Payer: United Healthcare HMO Rider |
$12.21
|
| Rate for Payer: United Healthcare HMO Rider |
$12.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.21
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.08
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.59
|
| Rate for Payer: Vantage Medical Group Senior |
$15.08
|
| Rate for Payer: Vantage Medical Group Senior |
$15.08
|
|
|
HC AMIKACIN
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
CPT 80150
|
| Hospital Charge Code |
900910405
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.40 |
| Max. Negotiated Rate |
$146.20 |
| Rate for Payer: Adventist Health Commercial |
$34.40
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$120.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.80
|
| Rate for Payer: EPIC Health Plan Senior |
$68.80
|
| Rate for Payer: Galaxy Health WC |
$146.20
|
| Rate for Payer: Global Benefits Group Commercial |
$103.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$109.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$101.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.28
|
| Rate for Payer: Multiplan Commercial |
$137.60
|
| Rate for Payer: Networks By Design Commercial |
$111.80
|
| Rate for Payer: Prime Health Services Commercial |
$146.20
|
|
|
HC AMMONIA
|
Facility
|
IP
|
$449.00
|
|
|
Service Code
|
CPT 82140
|
| Hospital Charge Code |
900910276
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$89.80 |
| Max. Negotiated Rate |
$381.65 |
| Rate for Payer: Adventist Health Commercial |
$89.80
|
| Rate for Payer: Cash Price |
$202.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$314.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$179.60
|
| Rate for Payer: EPIC Health Plan Senior |
$179.60
|
| Rate for Payer: Galaxy Health WC |
$381.65
|
| Rate for Payer: Global Benefits Group Commercial |
$269.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$285.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$264.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.76
|
| Rate for Payer: Multiplan Commercial |
$359.20
|
| Rate for Payer: Networks By Design Commercial |
$291.85
|
| Rate for Payer: Prime Health Services Commercial |
$381.65
|
|
|
HC AMMONIA
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT 82140
|
| Hospital Charge Code |
900910276
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.80 |
| Max. Negotiated Rate |
$150.44 |
| Rate for Payer: Adventist Health Commercial |
$24.80
|
| Rate for Payer: Adventist Health Commercial |
$89.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$121.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$121.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.44
|
| Rate for Payer: Blue Shield of California Commercial |
$206.99
|
| Rate for Payer: Blue Shield of California Commercial |
$57.16
|
| Rate for Payer: Blue Shield of California Commercial |
$312.95
|
| Rate for Payer: Blue Shield of California Commercial |
$86.43
|
| Rate for Payer: Cash Price |
$202.05
|
| Rate for Payer: Cash Price |
$202.05
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna of CA HMO |
$287.36
|
| Rate for Payer: Cigna of CA HMO |
$79.36
|
| Rate for Payer: Cigna of CA PPO |
$91.76
|
| Rate for Payer: Cigna of CA PPO |
$332.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$86.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$314.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.04
|
| Rate for Payer: EPIC Health Plan Senior |
$16.03
|
| Rate for Payer: EPIC Health Plan Senior |
$16.03
|
| Rate for Payer: Galaxy Health WC |
$105.40
|
| Rate for Payer: Galaxy Health WC |
$381.65
|
| Rate for Payer: Global Benefits Group Commercial |
$74.40
|
| Rate for Payer: Global Benefits Group Commercial |
$269.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.89
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$78.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$285.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.52
|
| Rate for Payer: Multiplan Commercial |
$359.20
|
| Rate for Payer: Multiplan Commercial |
$99.20
|
| Rate for Payer: Networks By Design Commercial |
$291.85
|
| Rate for Payer: Networks By Design Commercial |
$80.60
|
| Rate for Payer: Prime Health Services Commercial |
$105.40
|
| Rate for Payer: Prime Health Services Commercial |
$381.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$74.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$269.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$74.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$269.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.80
|
| Rate for Payer: United Healthcare All Other HMO |
$11.80
|
| Rate for Payer: United Healthcare All Other HMO |
$11.80
|
| Rate for Payer: United Healthcare HMO Rider |
$11.80
|
| Rate for Payer: United Healthcare HMO Rider |
$11.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.80
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.57
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.03
|
| Rate for Payer: Vantage Medical Group Senior |
$14.57
|
| Rate for Payer: Vantage Medical Group Senior |
$14.57
|
|
|
HC AMNIOCENTESIS DIAGNOSTIC
|
Facility
|
IP
|
$1,476.00
|
|
|
Service Code
|
CPT 59000
|
| Hospital Charge Code |
910400080
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$295.20 |
| Max. Negotiated Rate |
$1,254.60 |
| Rate for Payer: Adventist Health Commercial |
$295.20
|
| Rate for Payer: Cash Price |
$664.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,033.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$590.40
|
| Rate for Payer: EPIC Health Plan Senior |
$590.40
|
| Rate for Payer: Galaxy Health WC |
$1,254.60
|
| Rate for Payer: Global Benefits Group Commercial |
$885.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$937.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$870.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$354.24
|
| Rate for Payer: Multiplan Commercial |
$1,180.80
|
| Rate for Payer: Networks By Design Commercial |
$959.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,254.60
|
|
|
HC AMNIOCENTESIS DIAGNOSTIC
|
Facility
|
OP
|
$1,476.00
|
|
|
Service Code
|
CPT 59000
|
| Hospital Charge Code |
910400080
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$175.98 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$295.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$559.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,776.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,303.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,184.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$664.20
|
| Rate for Payer: Cash Price |
$664.20
|
| Rate for Payer: Cash Price |
$664.20
|
| Rate for Payer: Cigna of CA HMO |
$944.64
|
| Rate for Payer: Cigna of CA PPO |
$1,092.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,776.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,303.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,184.62
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,033.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,954.62
|
| Rate for Payer: EPIC Health Plan Senior |
$1,303.08
|
| Rate for Payer: Galaxy Health WC |
$1,254.60
|
| Rate for Payer: Global Benefits Group Commercial |
$885.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,942.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$175.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,184.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$937.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$199.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,658.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$354.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,492.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,587.39
|
| Rate for Payer: Multiplan Commercial |
$1,180.80
|
| Rate for Payer: Networks By Design Commercial |
$959.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,254.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$885.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$885.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$738.00
|
| Rate for Payer: United Healthcare All Other HMO |
$738.00
|
| Rate for Payer: United Healthcare HMO Rider |
$738.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$738.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,184.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,776.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,303.08
|
| Rate for Payer: Vantage Medical Group Senior |
$1,184.62
|
|
|
HC AMNIOCENTESIS DIAGNOSTIC ADDL FETUS
|
Facility
|
IP
|
$1,476.00
|
|
|
Service Code
|
CPT 59000
|
| Hospital Charge Code |
910400081
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$295.20 |
| Max. Negotiated Rate |
$1,254.60 |
| Rate for Payer: Adventist Health Commercial |
$295.20
|
| Rate for Payer: Cash Price |
$664.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,033.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$590.40
|
| Rate for Payer: EPIC Health Plan Senior |
$590.40
|
| Rate for Payer: Galaxy Health WC |
$1,254.60
|
| Rate for Payer: Global Benefits Group Commercial |
$885.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$937.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$870.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$354.24
|
| Rate for Payer: Multiplan Commercial |
$1,180.80
|
| Rate for Payer: Networks By Design Commercial |
$959.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,254.60
|
|
|
HC AMNIOCENTESIS DIAGNOSTIC ADDL FETUS
|
Facility
|
OP
|
$1,476.00
|
|
|
Service Code
|
CPT 59000
|
| Hospital Charge Code |
910400081
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$175.98 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$295.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$559.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,776.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,303.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,184.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$664.20
|
| Rate for Payer: Cash Price |
$664.20
|
| Rate for Payer: Cash Price |
$664.20
|
| Rate for Payer: Cigna of CA HMO |
$944.64
|
| Rate for Payer: Cigna of CA PPO |
$1,092.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,776.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,303.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,184.62
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,033.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,954.62
|
| Rate for Payer: EPIC Health Plan Senior |
$1,303.08
|
| Rate for Payer: Galaxy Health WC |
$1,254.60
|
| Rate for Payer: Global Benefits Group Commercial |
$885.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,942.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$175.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,184.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$937.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$199.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,658.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$354.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,492.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,587.39
|
| Rate for Payer: Multiplan Commercial |
$1,180.80
|
| Rate for Payer: Networks By Design Commercial |
$959.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,254.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$885.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$885.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$738.00
|
| Rate for Payer: United Healthcare All Other HMO |
$738.00
|
| Rate for Payer: United Healthcare HMO Rider |
$738.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$738.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,184.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,776.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,303.08
|
| Rate for Payer: Vantage Medical Group Senior |
$1,184.62
|
|
|
HC AMNIOCENTESIS THERAPEUTIC
|
Facility
|
OP
|
$3,305.00
|
|
|
Service Code
|
CPT 59001
|
| Hospital Charge Code |
910400082
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$234.95 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$661.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,258.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$587.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$391.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$1,487.25
|
| Rate for Payer: Cash Price |
$1,487.25
|
| Rate for Payer: Cash Price |
$1,487.25
|
| Rate for Payer: Cigna of CA HMO |
$2,115.20
|
| Rate for Payer: Cigna of CA PPO |
$2,445.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$587.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$391.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,313.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$646.68
|
| Rate for Payer: EPIC Health Plan Senior |
$431.12
|
| Rate for Payer: Galaxy Health WC |
$2,809.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,983.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$642.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$234.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$391.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,098.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$265.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$548.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$793.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$493.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$525.19
|
| Rate for Payer: Multiplan Commercial |
$2,644.00
|
| Rate for Payer: Networks By Design Commercial |
$2,148.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,809.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,983.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,983.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,652.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,652.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,652.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,652.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$391.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$587.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.12
|
| Rate for Payer: Vantage Medical Group Senior |
$391.93
|
|
|
HC AMNIOCENTESIS THERAPEUTIC
|
Facility
|
IP
|
$3,305.00
|
|
|
Service Code
|
CPT 59001
|
| Hospital Charge Code |
910400082
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$661.00 |
| Max. Negotiated Rate |
$2,809.25 |
| Rate for Payer: Adventist Health Commercial |
$661.00
|
| Rate for Payer: Cash Price |
$1,487.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,313.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,322.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,322.00
|
| Rate for Payer: Galaxy Health WC |
$2,809.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,983.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,098.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,949.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$793.20
|
| Rate for Payer: Multiplan Commercial |
$2,644.00
|
| Rate for Payer: Networks By Design Commercial |
$2,148.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,809.25
|
|
|
HC AMNIOCENTESIS THERAPEUTIC
|
Facility
|
IP
|
$3,305.00
|
|
|
Service Code
|
CPT 59001
|
| Hospital Charge Code |
910400082
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$661.00 |
| Max. Negotiated Rate |
$2,809.25 |
| Rate for Payer: Adventist Health Commercial |
$661.00
|
| Rate for Payer: Cash Price |
$1,487.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,313.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,322.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,322.00
|
| Rate for Payer: Galaxy Health WC |
$2,809.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,983.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,098.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,949.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$793.20
|
| Rate for Payer: Multiplan Commercial |
$2,644.00
|
| Rate for Payer: Networks By Design Commercial |
$2,148.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,809.25
|
|
|
HC AMNIOCENTESIS THERAPEUTIC
|
Facility
|
OP
|
$3,305.00
|
|
|
Service Code
|
CPT 59001
|
| Hospital Charge Code |
910400082
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$234.95 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$661.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,258.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$587.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$391.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$1,487.25
|
| Rate for Payer: Cash Price |
$1,487.25
|
| Rate for Payer: Cash Price |
$1,487.25
|
| Rate for Payer: Cash Price |
$1,487.25
|
| Rate for Payer: Cigna of CA HMO |
$2,115.20
|
| Rate for Payer: Cigna of CA PPO |
$2,445.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$587.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$391.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,313.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$646.68
|
| Rate for Payer: EPIC Health Plan Senior |
$431.12
|
| Rate for Payer: Galaxy Health WC |
$2,809.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,983.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$642.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$234.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$391.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,098.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$265.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$548.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$793.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$493.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$525.19
|
| Rate for Payer: Multiplan Commercial |
$2,644.00
|
| Rate for Payer: Networks By Design Commercial |
$2,148.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,809.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,983.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,983.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,091.00
|
| Rate for Payer: United Healthcare All Other HMO |
$839.00
|
| Rate for Payer: United Healthcare HMO Rider |
$635.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$581.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$391.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$587.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.12
|
| Rate for Payer: Vantage Medical Group Senior |
$391.93
|
|
|
HC AMNIOCENTESIS THERAPEUTIC ADDL FETUS
|
Facility
|
IP
|
$3,305.00
|
|
|
Service Code
|
CPT 59001
|
| Hospital Charge Code |
910400083
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$661.00 |
| Max. Negotiated Rate |
$2,809.25 |
| Rate for Payer: Adventist Health Commercial |
$661.00
|
| Rate for Payer: Cash Price |
$1,487.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,313.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,322.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,322.00
|
| Rate for Payer: Galaxy Health WC |
$2,809.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,983.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,098.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,949.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$793.20
|
| Rate for Payer: Multiplan Commercial |
$2,644.00
|
| Rate for Payer: Networks By Design Commercial |
$2,148.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,809.25
|
|
|
HC AMNIOCENTESIS THERAPEUTIC ADDL FETUS
|
Facility
|
OP
|
$3,305.00
|
|
|
Service Code
|
CPT 59001
|
| Hospital Charge Code |
910400083
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$234.95 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Dignity Health Medi-Cal |
$431.12
|
| Rate for Payer: Adventist Health Commercial |
$661.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,258.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$587.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$391.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$1,487.25
|
| Rate for Payer: Cash Price |
$1,487.25
|
| Rate for Payer: Cash Price |
$1,487.25
|
| Rate for Payer: Cigna of CA HMO |
$2,115.20
|
| Rate for Payer: Cigna of CA PPO |
$2,445.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$587.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$391.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,313.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$646.68
|
| Rate for Payer: EPIC Health Plan Senior |
$431.12
|
| Rate for Payer: Galaxy Health WC |
$2,809.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,983.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$642.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$234.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$391.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,098.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$265.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$548.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$793.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$493.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$525.19
|
| Rate for Payer: Multiplan Commercial |
$2,644.00
|
| Rate for Payer: Networks By Design Commercial |
$2,148.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,809.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,983.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,983.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,652.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,652.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,652.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,652.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$391.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$587.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.12
|
| Rate for Payer: Vantage Medical Group Senior |
$391.93
|
|
