|
HC BLOOD DRAW FOR VAD
|
Facility
|
OP
|
$397.00
|
|
|
Service Code
|
CPT 36591
|
| Hospital Charge Code |
912936591
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$79.40 |
| Max. Negotiated Rate |
$337.45 |
| Rate for Payer: Adventist Health Commercial |
$79.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$260.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$211.46
|
| Rate for Payer: Blue Shield of California Commercial |
$265.59
|
| Rate for Payer: Blue Shield of California EPN |
$175.47
|
| Rate for Payer: Cash Price |
$178.65
|
| Rate for Payer: Cash Price |
$178.65
|
| Rate for Payer: Cigna of CA HMO |
$254.08
|
| Rate for Payer: Cigna of CA PPO |
$293.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.10
|
| Rate for Payer: EPIC Health Plan Senior |
$163.78
|
| Rate for Payer: Galaxy Health WC |
$337.45
|
| Rate for Payer: Global Benefits Group Commercial |
$238.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$264.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$151.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.47
|
| Rate for Payer: Multiplan Commercial |
$317.60
|
| Rate for Payer: Networks By Design Commercial |
$258.05
|
| Rate for Payer: Prime Health Services Commercial |
$337.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$238.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$238.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$198.50
|
| Rate for Payer: United Healthcare All Other HMO |
$198.50
|
| Rate for Payer: United Healthcare HMO Rider |
$198.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$198.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$163.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
|
HC BLOOD DRAW FOR VAD
|
Facility
|
OP
|
$337.00
|
|
|
Service Code
|
CPT 36591
|
| Hospital Charge Code |
901200031
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$67.40 |
| Max. Negotiated Rate |
$286.45 |
| Rate for Payer: Adventist Health Commercial |
$67.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$221.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$211.46
|
| Rate for Payer: Blue Shield of California Commercial |
$225.45
|
| Rate for Payer: Blue Shield of California EPN |
$148.95
|
| Rate for Payer: Cash Price |
$151.65
|
| Rate for Payer: Cash Price |
$151.65
|
| Rate for Payer: Cigna of CA HMO |
$215.68
|
| Rate for Payer: Cigna of CA PPO |
$249.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.10
|
| Rate for Payer: EPIC Health Plan Senior |
$163.78
|
| Rate for Payer: Galaxy Health WC |
$286.45
|
| Rate for Payer: Global Benefits Group Commercial |
$202.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$224.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.47
|
| Rate for Payer: Multiplan Commercial |
$269.60
|
| Rate for Payer: Networks By Design Commercial |
$219.05
|
| Rate for Payer: Prime Health Services Commercial |
$286.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$202.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$202.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$168.50
|
| Rate for Payer: United Healthcare All Other HMO |
$168.50
|
| Rate for Payer: United Healthcare HMO Rider |
$168.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$168.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$163.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
|
HC BLOOD DRAW FOR VAD
|
Facility
|
IP
|
$337.00
|
|
|
Service Code
|
CPT 36591
|
| Hospital Charge Code |
901200031
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$67.40 |
| Max. Negotiated Rate |
$286.45 |
| Rate for Payer: Adventist Health Commercial |
$67.40
|
| Rate for Payer: Cash Price |
$151.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.80
|
| Rate for Payer: EPIC Health Plan Senior |
$134.80
|
| Rate for Payer: Galaxy Health WC |
$286.45
|
| Rate for Payer: Global Benefits Group Commercial |
$202.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$224.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$208.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.88
|
| Rate for Payer: Multiplan Commercial |
$269.60
|
| Rate for Payer: Networks By Design Commercial |
$219.05
|
| Rate for Payer: Prime Health Services Commercial |
$286.45
|
|
|
HC BLOOD DRAW FOR VAD
|
Facility
|
IP
|
$397.00
|
|
|
Service Code
|
CPT 36591
|
| Hospital Charge Code |
912936591
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$79.40 |
| Max. Negotiated Rate |
$337.45 |
| Rate for Payer: Adventist Health Commercial |
$79.40
|
| Rate for Payer: Cash Price |
$178.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$158.80
|
| Rate for Payer: EPIC Health Plan Senior |
$158.80
|
| Rate for Payer: Galaxy Health WC |
$337.45
|
| Rate for Payer: Global Benefits Group Commercial |
$238.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$264.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$151.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$245.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.28
|
| Rate for Payer: Multiplan Commercial |
$317.60
|
| Rate for Payer: Networks By Design Commercial |
$258.05
|
| Rate for Payer: Prime Health Services Commercial |
$337.45
|
|
|
HC BLOOD DRAW LT 3YRS FEM/JUGULAR
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
CPT 36400
|
| Hospital Charge Code |
900501687
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$25.60 |
| Max. Negotiated Rate |
$108.80 |
| Rate for Payer: Adventist Health Commercial |
$25.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.20
|
| Rate for Payer: EPIC Health Plan Senior |
$51.20
|
| Rate for Payer: Galaxy Health WC |
$108.80
|
| Rate for Payer: Global Benefits Group Commercial |
$76.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$85.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$79.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.72
|
| Rate for Payer: Multiplan Commercial |
$102.40
|
| Rate for Payer: Networks By Design Commercial |
$83.20
|
| Rate for Payer: Prime Health Services Commercial |
$108.80
|
|
|
HC BLOOD DRAW LT 3YRS FEM/JUGULAR
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
CPT 36400
|
| Hospital Charge Code |
900501687
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$25.60 |
| Max. Negotiated Rate |
$3,171.00 |
| Rate for Payer: Adventist Health Commercial |
$25.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$108.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$70.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$96.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,489.00
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna of CA HMO |
$81.92
|
| Rate for Payer: Cigna of CA PPO |
$94.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$108.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$108.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$108.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.20
|
| Rate for Payer: EPIC Health Plan Senior |
$51.20
|
| Rate for Payer: Galaxy Health WC |
$108.80
|
| Rate for Payer: Global Benefits Group Commercial |
$76.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$85.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$79.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$89.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$89.60
|
| Rate for Payer: Multiplan Commercial |
$102.40
|
| Rate for Payer: Networks By Design Commercial |
$83.20
|
| Rate for Payer: Prime Health Services Commercial |
$108.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$76.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$64.00
|
| Rate for Payer: United Healthcare All Other HMO |
$64.00
|
| Rate for Payer: United Healthcare HMO Rider |
$64.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$64.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$108.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$108.80
|
| Rate for Payer: Vantage Medical Group Senior |
$108.80
|
|
|
HC BLOOD GAS
|
Facility
|
IP
|
$1,077.00
|
|
|
Service Code
|
CPT 82803
|
| Hospital Charge Code |
900801107
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$215.40 |
| Max. Negotiated Rate |
$915.45 |
| Rate for Payer: Adventist Health Commercial |
$215.40
|
| Rate for Payer: Cash Price |
$484.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$430.80
|
| Rate for Payer: EPIC Health Plan Senior |
$430.80
|
| Rate for Payer: Galaxy Health WC |
$915.45
|
| Rate for Payer: Global Benefits Group Commercial |
$646.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$718.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$410.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$666.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$258.48
|
| Rate for Payer: Multiplan Commercial |
$861.60
|
| Rate for Payer: Networks By Design Commercial |
$700.05
|
| Rate for Payer: Prime Health Services Commercial |
$915.45
|
|
|
HC BLOOD GAS
|
Facility
|
OP
|
$1,077.00
|
|
|
Service Code
|
CPT 82803
|
| Hospital Charge Code |
900801107
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.91 |
| Max. Negotiated Rate |
$915.45 |
| Rate for Payer: Adventist Health Commercial |
$215.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$706.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$39.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$191.11
|
| Rate for Payer: Blue Shield of California Commercial |
$720.51
|
| Rate for Payer: Blue Shield of California EPN |
$476.03
|
| Rate for Payer: Cash Price |
$484.65
|
| Rate for Payer: Cash Price |
$484.65
|
| Rate for Payer: Cigna of CA HMO |
$689.28
|
| Rate for Payer: Cigna of CA PPO |
$796.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.19
|
| Rate for Payer: EPIC Health Plan Senior |
$26.07
|
| Rate for Payer: Galaxy Health WC |
$915.45
|
| Rate for Payer: Global Benefits Group Commercial |
$646.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$42.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$26.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$718.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$258.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.93
|
| Rate for Payer: Multiplan Commercial |
$861.60
|
| Rate for Payer: Networks By Design Commercial |
$700.05
|
| Rate for Payer: Prime Health Services Commercial |
$915.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$646.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$646.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.11
|
| Rate for Payer: United Healthcare All Other HMO |
$21.11
|
| Rate for Payer: United Healthcare HMO Rider |
$21.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.11
|
| Rate for Payer: Upland Medical Group Pediatric |
$26.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$39.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.68
|
| Rate for Payer: Vantage Medical Group Senior |
$26.07
|
|
|
HC BLOOD GAS AND COOXIMETRY
|
Facility
|
OP
|
$1,571.00
|
|
|
Service Code
|
CPT 82805
|
| Hospital Charge Code |
900801109
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.82 |
| Max. Negotiated Rate |
$1,335.35 |
| Rate for Payer: Adventist Health Commercial |
$314.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,030.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$118.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$86.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$78.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$277.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,051.00
|
| Rate for Payer: Blue Shield of California EPN |
$694.38
|
| Rate for Payer: Cash Price |
$706.95
|
| Rate for Payer: Cash Price |
$706.95
|
| Rate for Payer: Cigna of CA HMO |
$1,005.44
|
| Rate for Payer: Cigna of CA PPO |
$1,162.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$118.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$86.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$78.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.34
|
| Rate for Payer: EPIC Health Plan Senior |
$78.77
|
| Rate for Payer: Galaxy Health WC |
$1,335.35
|
| Rate for Payer: Global Benefits Group Commercial |
$942.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$129.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$40.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$78.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,047.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$78.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$377.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$99.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$105.55
|
| Rate for Payer: Multiplan Commercial |
$1,256.80
|
| Rate for Payer: Networks By Design Commercial |
$1,021.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,335.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$942.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$942.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$63.80
|
| Rate for Payer: United Healthcare All Other HMO |
$63.80
|
| Rate for Payer: United Healthcare HMO Rider |
$63.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$63.80
|
| Rate for Payer: Upland Medical Group Pediatric |
$78.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$118.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$86.65
|
| Rate for Payer: Vantage Medical Group Senior |
$78.77
|
|
|
HC BLOOD GAS AND COOXIMETRY
|
Facility
|
IP
|
$1,571.00
|
|
|
Service Code
|
CPT 82805
|
| Hospital Charge Code |
900801109
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$314.20 |
| Max. Negotiated Rate |
$1,335.35 |
| Rate for Payer: Adventist Health Commercial |
$314.20
|
| Rate for Payer: Cash Price |
$706.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$628.40
|
| Rate for Payer: EPIC Health Plan Senior |
$628.40
|
| Rate for Payer: Galaxy Health WC |
$1,335.35
|
| Rate for Payer: Global Benefits Group Commercial |
$942.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,047.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$598.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$972.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$377.04
|
| Rate for Payer: Multiplan Commercial |
$1,256.80
|
| Rate for Payer: Networks By Design Commercial |
$1,021.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,335.35
|
|
|
HC BLOOD GAS CHLORIDE
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
CPT 82435
|
| Hospital Charge Code |
900801121
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.73 |
| Max. Negotiated Rate |
$103.70 |
| Rate for Payer: Adventist Health Commercial |
$24.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$80.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.82
|
| Rate for Payer: Blue Shield of California Commercial |
$81.62
|
| Rate for Payer: Blue Shield of California EPN |
$53.92
|
| Rate for Payer: Cash Price |
$54.90
|
| Rate for Payer: Cash Price |
$54.90
|
| Rate for Payer: Cigna of CA HMO |
$78.08
|
| Rate for Payer: Cigna of CA PPO |
$90.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.21
|
| Rate for Payer: EPIC Health Plan Senior |
$4.60
|
| Rate for Payer: Galaxy Health WC |
$103.70
|
| Rate for Payer: Global Benefits Group Commercial |
$73.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$81.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.16
|
| Rate for Payer: Multiplan Commercial |
$97.60
|
| Rate for Payer: Networks By Design Commercial |
$79.30
|
| Rate for Payer: Prime Health Services Commercial |
$103.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$73.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$73.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.73
|
| Rate for Payer: United Healthcare All Other HMO |
$3.73
|
| Rate for Payer: United Healthcare HMO Rider |
$3.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.73
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.06
|
| Rate for Payer: Vantage Medical Group Senior |
$4.60
|
|
|
HC BLOOD GAS CHLORIDE
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
CPT 82435
|
| Hospital Charge Code |
900801121
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$103.70 |
| Rate for Payer: Adventist Health Commercial |
$24.40
|
| Rate for Payer: Cash Price |
$54.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.80
|
| Rate for Payer: EPIC Health Plan Senior |
$48.80
|
| Rate for Payer: Galaxy Health WC |
$103.70
|
| Rate for Payer: Global Benefits Group Commercial |
$73.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$81.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.28
|
| Rate for Payer: Multiplan Commercial |
$97.60
|
| Rate for Payer: Networks By Design Commercial |
$79.30
|
| Rate for Payer: Prime Health Services Commercial |
$103.70
|
|
|
HC BLOOD GASES CH
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 82805
|
| Hospital Charge Code |
900912188
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$34.00 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.00
|
| Rate for Payer: EPIC Health Plan Senior |
$16.00
|
| Rate for Payer: Galaxy Health WC |
$34.00
|
| Rate for Payer: Global Benefits Group Commercial |
$24.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.60
|
| Rate for Payer: Multiplan Commercial |
$32.00
|
| Rate for Payer: Networks By Design Commercial |
$26.00
|
| Rate for Payer: Prime Health Services Commercial |
$34.00
|
|
|
HC BLOOD GASES CH
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 82805
|
| Hospital Charge Code |
900912188
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$277.69 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$118.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$86.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$78.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$277.69
|
| Rate for Payer: Blue Shield of California Commercial |
$26.76
|
| Rate for Payer: Blue Shield of California EPN |
$17.68
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna of CA HMO |
$25.60
|
| Rate for Payer: Cigna of CA PPO |
$29.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$118.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$86.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$78.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.34
|
| Rate for Payer: EPIC Health Plan Senior |
$78.77
|
| Rate for Payer: Galaxy Health WC |
$34.00
|
| Rate for Payer: Global Benefits Group Commercial |
$24.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$129.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$40.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$78.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$78.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$99.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$105.55
|
| Rate for Payer: Multiplan Commercial |
$32.00
|
| Rate for Payer: Networks By Design Commercial |
$26.00
|
| Rate for Payer: Prime Health Services Commercial |
$34.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$63.80
|
| Rate for Payer: United Healthcare All Other HMO |
$63.80
|
| Rate for Payer: United Healthcare HMO Rider |
$63.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$63.80
|
| Rate for Payer: Upland Medical Group Pediatric |
$78.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$118.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$86.65
|
| Rate for Payer: Vantage Medical Group Senior |
$78.77
|
|
|
HC BLOOD GAS POTASSIUM
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
900801122
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$103.70 |
| Rate for Payer: Adventist Health Commercial |
$24.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$80.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.82
|
| Rate for Payer: Blue Shield of California Commercial |
$81.62
|
| Rate for Payer: Blue Shield of California EPN |
$53.92
|
| Rate for Payer: Cash Price |
$54.90
|
| Rate for Payer: Cash Price |
$54.90
|
| Rate for Payer: Cigna of CA HMO |
$78.08
|
| Rate for Payer: Cigna of CA PPO |
$90.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.43
|
| Rate for Payer: EPIC Health Plan Senior |
$4.76
|
| Rate for Payer: Galaxy Health WC |
$103.70
|
| Rate for Payer: Global Benefits Group Commercial |
$73.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$81.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.38
|
| Rate for Payer: Multiplan Commercial |
$97.60
|
| Rate for Payer: Networks By Design Commercial |
$79.30
|
| Rate for Payer: Prime Health Services Commercial |
$103.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$73.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$73.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.85
|
| Rate for Payer: United Healthcare All Other HMO |
$3.85
|
| Rate for Payer: United Healthcare HMO Rider |
$3.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.85
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.24
|
| Rate for Payer: Vantage Medical Group Senior |
$4.76
|
|
|
HC BLOOD GAS POTASSIUM
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
900801122
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$103.70 |
| Rate for Payer: Adventist Health Commercial |
$24.40
|
| Rate for Payer: Cash Price |
$54.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.80
|
| Rate for Payer: EPIC Health Plan Senior |
$48.80
|
| Rate for Payer: Galaxy Health WC |
$103.70
|
| Rate for Payer: Global Benefits Group Commercial |
$73.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$81.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.28
|
| Rate for Payer: Multiplan Commercial |
$97.60
|
| Rate for Payer: Networks By Design Commercial |
$79.30
|
| Rate for Payer: Prime Health Services Commercial |
$103.70
|
|
|
HC BLOOD GAS SODIUM
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
CPT 84295
|
| Hospital Charge Code |
900801123
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$103.70 |
| Rate for Payer: Adventist Health Commercial |
$24.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$80.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.35
|
| Rate for Payer: Blue Shield of California Commercial |
$81.62
|
| Rate for Payer: Blue Shield of California EPN |
$53.92
|
| Rate for Payer: Cash Price |
$54.90
|
| Rate for Payer: Cash Price |
$54.90
|
| Rate for Payer: Cigna of CA HMO |
$78.08
|
| Rate for Payer: Cigna of CA PPO |
$90.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.49
|
| Rate for Payer: EPIC Health Plan Senior |
$4.81
|
| Rate for Payer: Galaxy Health WC |
$103.70
|
| Rate for Payer: Global Benefits Group Commercial |
$73.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$81.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.45
|
| Rate for Payer: Multiplan Commercial |
$97.60
|
| Rate for Payer: Networks By Design Commercial |
$79.30
|
| Rate for Payer: Prime Health Services Commercial |
$103.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$73.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$73.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.90
|
| Rate for Payer: United Healthcare All Other HMO |
$3.90
|
| Rate for Payer: United Healthcare HMO Rider |
$3.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.90
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.29
|
| Rate for Payer: Vantage Medical Group Senior |
$4.81
|
|
|
HC BLOOD GAS SODIUM
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
CPT 84295
|
| Hospital Charge Code |
900801123
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$103.70 |
| Rate for Payer: Adventist Health Commercial |
$24.40
|
| Rate for Payer: Cash Price |
$54.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.80
|
| Rate for Payer: EPIC Health Plan Senior |
$48.80
|
| Rate for Payer: Galaxy Health WC |
$103.70
|
| Rate for Payer: Global Benefits Group Commercial |
$73.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$81.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.28
|
| Rate for Payer: Multiplan Commercial |
$97.60
|
| Rate for Payer: Networks By Design Commercial |
$79.30
|
| Rate for Payer: Prime Health Services Commercial |
$103.70
|
|
|
HC BLOOD OCCULT FECES
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
CPT 82274
|
| Hospital Charge Code |
900911638
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$39.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.80
|
| Rate for Payer: Blue Shield of California Commercial |
$40.14
|
| Rate for Payer: Blue Shield of California EPN |
$26.52
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna of CA HMO |
$38.40
|
| Rate for Payer: Cigna of CA PPO |
$44.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.49
|
| Rate for Payer: EPIC Health Plan Senior |
$15.92
|
| Rate for Payer: Galaxy Health WC |
$51.00
|
| Rate for Payer: Global Benefits Group Commercial |
$36.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.33
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: Networks By Design Commercial |
$39.00
|
| Rate for Payer: Prime Health Services Commercial |
$51.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.90
|
| Rate for Payer: United Healthcare All Other HMO |
$12.90
|
| Rate for Payer: United Healthcare HMO Rider |
$12.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.90
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.51
|
| Rate for Payer: Vantage Medical Group Senior |
$15.92
|
|
|
HC BLOOD OCCULT FECES
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
CPT 82274
|
| Hospital Charge Code |
900911638
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$114.75 |
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.00
|
| Rate for Payer: EPIC Health Plan Senior |
$54.00
|
| Rate for Payer: Galaxy Health WC |
$114.75
|
| Rate for Payer: Global Benefits Group Commercial |
$81.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$90.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$83.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.40
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: Networks By Design Commercial |
$87.75
|
| Rate for Payer: Prime Health Services Commercial |
$114.75
|
|
|
HC BLOOD PH PCO2 P02 (POC)
|
Facility
|
IP
|
$251.00
|
|
|
Service Code
|
CPT 82803
|
| Hospital Charge Code |
900912112
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.20 |
| Max. Negotiated Rate |
$213.35 |
| Rate for Payer: Adventist Health Commercial |
$50.20
|
| Rate for Payer: Cash Price |
$112.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.40
|
| Rate for Payer: EPIC Health Plan Senior |
$100.40
|
| Rate for Payer: Galaxy Health WC |
$213.35
|
| Rate for Payer: Global Benefits Group Commercial |
$150.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$167.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.24
|
| Rate for Payer: Multiplan Commercial |
$200.80
|
| Rate for Payer: Networks By Design Commercial |
$163.15
|
| Rate for Payer: Prime Health Services Commercial |
$213.35
|
|
|
HC BLOOD PH PCO2 P02 (POC)
|
Facility
|
OP
|
$251.00
|
|
|
Service Code
|
CPT 82803
|
| Hospital Charge Code |
900912112
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.91 |
| Max. Negotiated Rate |
$213.35 |
| Rate for Payer: Adventist Health Commercial |
$50.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$164.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$39.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$191.11
|
| Rate for Payer: Blue Shield of California Commercial |
$167.92
|
| Rate for Payer: Blue Shield of California EPN |
$110.94
|
| Rate for Payer: Cash Price |
$112.95
|
| Rate for Payer: Cash Price |
$112.95
|
| Rate for Payer: Cigna of CA HMO |
$160.64
|
| Rate for Payer: Cigna of CA PPO |
$185.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.19
|
| Rate for Payer: EPIC Health Plan Senior |
$26.07
|
| Rate for Payer: Galaxy Health WC |
$213.35
|
| Rate for Payer: Global Benefits Group Commercial |
$150.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$42.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$26.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$167.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.93
|
| Rate for Payer: Multiplan Commercial |
$200.80
|
| Rate for Payer: Networks By Design Commercial |
$163.15
|
| Rate for Payer: Prime Health Services Commercial |
$213.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$150.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$150.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.11
|
| Rate for Payer: United Healthcare All Other HMO |
$21.11
|
| Rate for Payer: United Healthcare HMO Rider |
$21.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.11
|
| Rate for Payer: Upland Medical Group Pediatric |
$26.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$39.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.68
|
| Rate for Payer: Vantage Medical Group Senior |
$26.07
|
|
|
HC BLOOD/PLASMA VOLUME
|
Facility
|
IP
|
$1,452.00
|
|
|
Service Code
|
CPT 78111
|
| Hospital Charge Code |
909301331
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$290.40 |
| Max. Negotiated Rate |
$1,234.20 |
| Rate for Payer: Adventist Health Commercial |
$290.40
|
| Rate for Payer: Cash Price |
$653.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$580.80
|
| Rate for Payer: EPIC Health Plan Senior |
$580.80
|
| Rate for Payer: Galaxy Health WC |
$1,234.20
|
| Rate for Payer: Global Benefits Group Commercial |
$871.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$968.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$553.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$898.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$348.48
|
| Rate for Payer: Multiplan Commercial |
$1,161.60
|
| Rate for Payer: Networks By Design Commercial |
$943.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,234.20
|
|
|
HC BLOOD/PLASMA VOLUME
|
Facility
|
OP
|
$1,452.00
|
|
|
Service Code
|
CPT 78111
|
| Hospital Charge Code |
909301331
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$88.05 |
| Max. Negotiated Rate |
$2,720.33 |
| Rate for Payer: Adventist Health Commercial |
$290.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$952.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,488.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,824.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,658.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$891.67
|
| Rate for Payer: Blue Shield of California Commercial |
$888.62
|
| Rate for Payer: Blue Shield of California EPN |
$586.61
|
| Rate for Payer: Cash Price |
$653.40
|
| Rate for Payer: Cash Price |
$653.40
|
| Rate for Payer: Cigna of CA HMO |
$929.28
|
| Rate for Payer: Cigna of CA PPO |
$1,074.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,488.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,824.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,658.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,239.30
|
| Rate for Payer: EPIC Health Plan Senior |
$1,658.74
|
| Rate for Payer: Galaxy Health WC |
$1,234.20
|
| Rate for Payer: Global Benefits Group Commercial |
$871.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,720.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$88.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,658.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$968.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$99.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,658.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$348.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,090.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,222.71
|
| Rate for Payer: Multiplan Commercial |
$1,161.60
|
| Rate for Payer: Networks By Design Commercial |
$943.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,234.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$871.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$871.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,174.62
|
| Rate for Payer: United Healthcare All Other HMO |
$1,174.62
|
| Rate for Payer: United Healthcare HMO Rider |
$1,174.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,174.62
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,658.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,488.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,824.61
|
| Rate for Payer: Vantage Medical Group Senior |
$1,658.74
|
|
|
HC BNDG BULKEE II ROLL 3.4"X3.6YD
|
Facility
|
OP
|
$4.35
|
|
|
Service Code
|
CPT A6446
|
| Hospital Charge Code |
901607953
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$3.70 |
| Rate for Payer: Adventist Health Commercial |
$0.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.67
|
| Rate for Payer: Cash Price |
$1.96
|
| Rate for Payer: Cigna of CA HMO |
$2.78
|
| Rate for Payer: Cigna of CA PPO |
$3.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.74
|
| Rate for Payer: EPIC Health Plan Senior |
$1.74
|
| Rate for Payer: Galaxy Health WC |
$3.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.04
|
| Rate for Payer: Multiplan Commercial |
$3.48
|
| Rate for Payer: Networks By Design Commercial |
$2.83
|
| Rate for Payer: Prime Health Services Commercial |
$3.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.17
|
| Rate for Payer: United Healthcare All Other HMO |
$2.17
|
| Rate for Payer: United Healthcare HMO Rider |
$2.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.70
|
| Rate for Payer: Vantage Medical Group Senior |
$3.70
|
|
