|
HC AMPHETAMINES CONF & ID
|
Facility
OP
|
$225.00
|
|
|
Service Code
|
CPT 80324
|
| Hospital Charge Code |
900910520
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$191.25 |
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$191.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$123.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$123.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.05
|
| Rate for Payer: BCBS Transplant Transplant |
$135.00
|
| Rate for Payer: Blue Shield of California Commercial |
$145.35
|
| Rate for Payer: Blue Shield of California EPN |
$115.20
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Cigna of CA HMO |
$144.00
|
| Rate for Payer: Cigna of CA PPO |
$166.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$191.25
|
| Rate for Payer: Dignity Health Media |
$191.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$191.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$90.00
|
| Rate for Payer: Galaxy Health WC |
$191.25
|
| Rate for Payer: Global Benefits Group Commercial |
$135.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$168.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$150.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.00
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| Rate for Payer: Networks By Design Commercial |
$146.25
|
| Rate for Payer: Prime Health Services Commercial |
$191.25
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$135.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$135.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$135.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$112.50
|
| Rate for Payer: United Healthcare All Other HMO |
$112.50
|
| Rate for Payer: United Healthcare HMO Rider |
$112.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$112.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$191.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$191.25
|
| Rate for Payer: Vantage Medical Group Senior |
$191.25
|
|
|
HC AMPICILLIN E TEST
|
Facility
OP
|
$10.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
900912448
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$20.58 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.58
|
| Rate for Payer: BCBS Transplant Transplant |
$6.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6.46
|
| Rate for Payer: Blue Shield of California EPN |
$5.12
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cigna of CA HMO |
$6.40
|
| Rate for Payer: Cigna of CA PPO |
$7.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.12
|
| Rate for Payer: Dignity Health Media |
$4.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.41
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4.75
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.75
|
| Rate for Payer: Galaxy Health WC |
$8.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.79
|
| Rate for Payer: Heritage Provider Network Transplant |
$7.79
|
| Rate for Payer: IEHP Medi-Cal |
$7.70
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$7.70
|
| Rate for Payer: IEHP Medicare Advantage |
$4.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.36
|
| Rate for Payer: Multiplan Commercial |
$8.00
|
| Rate for Payer: Networks By Design Commercial |
$6.50
|
| Rate for Payer: Prime Health Services Commercial |
$8.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$6.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.00
|
| 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: Vantage Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Vantage Medical Group Senior |
$4.75
|
|
|
HC AMPUTATION FINGER/THUMB SNGL
|
Facility
IP
|
$12,697.00
|
|
|
Service Code
|
CPT 26910
|
| Hospital Charge Code |
900501259
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,047.28 |
| Max. Negotiated Rate |
$10,792.45 |
| Rate for Payer: Cash Price |
$5,713.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,078.80
|
| Rate for Payer: Galaxy Health WC |
$10,792.45
|
| Rate for Payer: Global Benefits Group Commercial |
$7,618.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,468.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,837.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,047.28
|
| Rate for Payer: Multiplan Commercial |
$10,157.60
|
| Rate for Payer: Networks By Design Commercial |
$8,253.05
|
| Rate for Payer: Prime Health Services Commercial |
$10,792.45
|
|
|
HC AMPUTATION FINGER/THUMB SNGL
|
Facility
OP
|
$12,697.00
|
|
|
Service Code
|
CPT 26910
|
| Hospital Charge Code |
900501259
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$645.83 |
| Max. Negotiated Rate |
$10,792.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: BCBS Transplant Transplant |
$7,618.20
|
| Rate for Payer: Cash Price |
$5,713.65
|
| Rate for Payer: Cash Price |
$5,713.65
|
| Rate for Payer: Cash Price |
$5,713.65
|
| Rate for Payer: Cigna of CA PPO |
$9,395.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Media |
$4,044.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,459.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,044.21
|
| Rate for Payer: Galaxy Health WC |
$10,792.45
|
| Rate for Payer: Global Benefits Group Commercial |
$7,618.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9,522.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,632.50
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,632.50
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$4,044.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,468.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$645.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,047.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,095.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,419.24
|
| Rate for Payer: Multiplan Commercial |
$10,157.60
|
| Rate for Payer: Networks By Design Commercial |
$8,253.05
|
| Rate for Payer: Prime Health Services Commercial |
$10,792.45
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$7,618.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,618.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,348.50
|
| Rate for Payer: United Healthcare All Other HMO |
$6,348.50
|
| Rate for Payer: United Healthcare HMO Rider |
$6,348.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,348.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
HC AMPUTATION FINGER/THUMB W/V-Y
|
Facility
IP
|
$12,530.00
|
|
|
Service Code
|
CPT 26952
|
| Hospital Charge Code |
900501462
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$3,007.20 |
| Max. Negotiated Rate |
$10,650.50 |
| Rate for Payer: Cash Price |
$5,638.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,012.00
|
| Rate for Payer: Galaxy Health WC |
$10,650.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,518.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,357.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,773.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,007.20
|
| Rate for Payer: Multiplan Commercial |
$10,024.00
|
| Rate for Payer: Networks By Design Commercial |
$8,144.50
|
| Rate for Payer: Prime Health Services Commercial |
$10,650.50
|
|
|
HC AMPUTATION FINGER/THUMB W/V-Y
|
Facility
OP
|
$12,530.00
|
|
|
Service Code
|
CPT 26952
|
| Hospital Charge Code |
900501462
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$590.65 |
| Max. Negotiated Rate |
$12,491.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,049.00
|
| Rate for Payer: BCBS Transplant Transplant |
$7,518.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,234.61
|
| Rate for Payer: Blue Shield of California EPN |
$7,317.52
|
| Rate for Payer: Cash Price |
$5,638.50
|
| Rate for Payer: Cash Price |
$5,638.50
|
| Rate for Payer: Cigna of CA PPO |
$9,272.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Media |
$4,044.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,459.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,044.21
|
| Rate for Payer: Galaxy Health WC |
$10,650.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,518.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9,397.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,632.50
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,632.50
|
| Rate for Payer: IEHP Medi-Cal |
$6,551.62
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$6,551.62
|
| Rate for Payer: IEHP Medicare Advantage |
$4,044.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,357.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$590.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,007.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,095.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,419.24
|
| Rate for Payer: Multiplan Commercial |
$10,024.00
|
| Rate for Payer: Networks By Design Commercial |
$8,144.50
|
| Rate for Payer: Prime Health Services Commercial |
$10,650.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$7,518.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,518.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,518.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
HC AMPUTATION OF TOE
|
Facility
OP
|
$10,007.00
|
|
|
Service Code
|
CPT 28820
|
| Hospital Charge Code |
900501402
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$433.62 |
| Max. Negotiated Rate |
$8,505.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: BCBS Transplant Transplant |
$6,004.20
|
| Rate for Payer: Cash Price |
$4,503.15
|
| Rate for Payer: Cash Price |
$4,503.15
|
| Rate for Payer: Cash Price |
$4,503.15
|
| Rate for Payer: Cigna of CA PPO |
$7,405.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Media |
$4,044.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,459.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,044.21
|
| Rate for Payer: Galaxy Health WC |
$8,505.95
|
| Rate for Payer: Global Benefits Group Commercial |
$6,004.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7,505.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,632.50
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,632.50
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$4,044.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,674.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$433.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,401.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,095.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,419.24
|
| Rate for Payer: Multiplan Commercial |
$8,005.60
|
| Rate for Payer: Networks By Design Commercial |
$6,504.55
|
| Rate for Payer: Prime Health Services Commercial |
$8,505.95
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$6,004.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,004.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,003.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5,003.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5,003.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,003.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
HC AMPUTATION OF TOE
|
Facility
IP
|
$10,007.00
|
|
|
Service Code
|
CPT 28820
|
| Hospital Charge Code |
900501402
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,401.68 |
| Max. Negotiated Rate |
$8,505.95 |
| Rate for Payer: Cash Price |
$4,503.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,002.80
|
| Rate for Payer: Galaxy Health WC |
$8,505.95
|
| Rate for Payer: Global Benefits Group Commercial |
$6,004.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,674.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,812.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,401.68
|
| Rate for Payer: Multiplan Commercial |
$8,005.60
|
| Rate for Payer: Networks By Design Commercial |
$6,504.55
|
| Rate for Payer: Prime Health Services Commercial |
$8,505.95
|
|
|
HC AMYLASE
|
Facility
OP
|
$17.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
900910236
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$59.21 |
| Rate for Payer: Aetna of CA HMO/PPO |
$53.88
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.72
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.21
|
| Rate for Payer: BCBS Transplant Transplant |
$10.20
|
| Rate for Payer: Blue Shield of California Commercial |
$10.98
|
| Rate for Payer: Blue Shield of California EPN |
$8.70
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cigna of CA HMO |
$10.88
|
| Rate for Payer: Cigna of CA PPO |
$12.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.72
|
| Rate for Payer: Dignity Health Media |
$6.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.75
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.48
|
| Rate for Payer: Galaxy Health WC |
$14.45
|
| Rate for Payer: Global Benefits Group Commercial |
$10.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$12.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.63
|
| Rate for Payer: Heritage Provider Network Transplant |
$10.63
|
| Rate for Payer: IEHP Medi-Cal |
$10.50
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$10.50
|
| Rate for Payer: IEHP Medicare Advantage |
$6.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.68
|
| Rate for Payer: Multiplan Commercial |
$13.60
|
| Rate for Payer: Networks By Design Commercial |
$11.05
|
| Rate for Payer: Prime Health Services Commercial |
$14.45
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$10.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.25
|
| Rate for Payer: United Healthcare All Other HMO |
$5.25
|
| Rate for Payer: United Healthcare HMO Rider |
$5.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: Vantage Medical Group Senior |
$6.48
|
|
|
HC AMYLASE BODY FLUID
|
Facility
OP
|
$17.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
900910242
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$59.21 |
| Rate for Payer: Aetna of CA HMO/PPO |
$53.88
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.72
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.21
|
| Rate for Payer: BCBS Transplant Transplant |
$10.20
|
| Rate for Payer: Blue Shield of California Commercial |
$10.98
|
| Rate for Payer: Blue Shield of California EPN |
$8.70
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cigna of CA HMO |
$10.88
|
| Rate for Payer: Cigna of CA PPO |
$12.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.72
|
| Rate for Payer: Dignity Health Media |
$6.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.75
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.48
|
| Rate for Payer: Galaxy Health WC |
$14.45
|
| Rate for Payer: Global Benefits Group Commercial |
$10.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$12.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.63
|
| Rate for Payer: Heritage Provider Network Transplant |
$10.63
|
| Rate for Payer: IEHP Medi-Cal |
$10.50
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$10.50
|
| Rate for Payer: IEHP Medicare Advantage |
$6.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.68
|
| Rate for Payer: Multiplan Commercial |
$13.60
|
| Rate for Payer: Networks By Design Commercial |
$11.05
|
| Rate for Payer: Prime Health Services Commercial |
$14.45
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$10.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.25
|
| Rate for Payer: United Healthcare All Other HMO |
$5.25
|
| Rate for Payer: United Healthcare HMO Rider |
$5.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: Vantage Medical Group Senior |
$6.48
|
|
|
HC AMYLASE URINE
|
Facility
OP
|
$25.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
900910237
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$59.21 |
| Rate for Payer: Aetna of CA HMO/PPO |
$53.88
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.72
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.21
|
| Rate for Payer: BCBS Transplant Transplant |
$15.00
|
| Rate for Payer: Blue Shield of California Commercial |
$16.15
|
| Rate for Payer: Blue Shield of California EPN |
$12.80
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cigna of CA HMO |
$16.00
|
| Rate for Payer: Cigna of CA PPO |
$18.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.72
|
| Rate for Payer: Dignity Health Media |
$6.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.75
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.48
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$18.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.63
|
| Rate for Payer: Heritage Provider Network Transplant |
$10.63
|
| Rate for Payer: IEHP Medi-Cal |
$10.50
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$10.50
|
| Rate for Payer: IEHP Medicare Advantage |
$6.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.68
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.25
|
| Rate for Payer: United Healthcare All Other HMO |
$5.25
|
| Rate for Payer: United Healthcare HMO Rider |
$5.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: Vantage Medical Group Senior |
$6.48
|
|
|
HC ANAEROBIC MIC PANEL
|
Facility
OP
|
$34.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
900912405
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.01 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$71.89
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12.98
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$78.87
|
| Rate for Payer: BCBS Transplant Transplant |
$20.40
|
| Rate for Payer: Blue Shield of California Commercial |
$21.96
|
| Rate for Payer: Blue Shield of California EPN |
$17.41
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cigna of CA HMO |
$21.76
|
| Rate for Payer: Cigna of CA PPO |
$25.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.98
|
| Rate for Payer: Dignity Health Media |
$8.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8.65
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.65
|
| Rate for Payer: Galaxy Health WC |
$28.90
|
| Rate for Payer: Global Benefits Group Commercial |
$20.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$25.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.19
|
| Rate for Payer: Heritage Provider Network Transplant |
$14.19
|
| Rate for Payer: IEHP Medi-Cal |
$14.01
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$14.01
|
| Rate for Payer: IEHP Medicare Advantage |
$8.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.59
|
| Rate for Payer: Multiplan Commercial |
$27.20
|
| Rate for Payer: Networks By Design Commercial |
$22.10
|
| Rate for Payer: Prime Health Services Commercial |
$28.90
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.01
|
| Rate for Payer: United Healthcare All Other HMO |
$7.01
|
| Rate for Payer: United Healthcare HMO Rider |
$7.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.52
|
| Rate for Payer: Vantage Medical Group Senior |
$8.65
|
|
|
HC ANA PANEL
|
Facility
OP
|
$185.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913646
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.53 |
| Max. Negotiated Rate |
$157.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$136.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$26.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$138.94
|
| Rate for Payer: BCBS Transplant Transplant |
$111.00
|
| Rate for Payer: Blue Shield of California Commercial |
$119.51
|
| Rate for Payer: Blue Shield of California EPN |
$94.72
|
| Rate for Payer: Cash Price |
$83.25
|
| Rate for Payer: Cash Price |
$83.25
|
| Rate for Payer: Cigna of CA HMO |
$118.40
|
| Rate for Payer: Cigna of CA PPO |
$136.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.90
|
| Rate for Payer: Dignity Health Media |
$17.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.21
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$17.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.93
|
| Rate for Payer: Galaxy Health WC |
$157.25
|
| Rate for Payer: Global Benefits Group Commercial |
$111.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$138.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.41
|
| Rate for Payer: Heritage Provider Network Transplant |
$29.41
|
| Rate for Payer: IEHP Medi-Cal |
$29.05
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$29.05
|
| Rate for Payer: IEHP Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$123.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.03
|
| Rate for Payer: Multiplan Commercial |
$148.00
|
| Rate for Payer: Networks By Design Commercial |
$120.25
|
| Rate for Payer: Prime Health Services Commercial |
$157.25
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$111.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$111.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$111.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.53
|
| Rate for Payer: United Healthcare All Other HMO |
$14.53
|
| Rate for Payer: United Healthcare HMO Rider |
$14.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC ANESTHESIA LEVEL I 1ST 15MIN
|
Facility
OP
|
$798.00
|
|
| Hospital Charge Code |
904900400
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$191.52 |
| Max. Negotiated Rate |
$678.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$523.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$678.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$438.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$438.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$475.45
|
| Rate for Payer: BCBS Transplant Transplant |
$478.80
|
| Rate for Payer: Blue Shield of California Commercial |
$588.13
|
| Rate for Payer: Blue Shield of California EPN |
$466.03
|
| Rate for Payer: Cash Price |
$359.10
|
| Rate for Payer: Cigna of CA HMO |
$510.72
|
| Rate for Payer: Cigna of CA PPO |
$590.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$678.30
|
| Rate for Payer: Dignity Health Media |
$678.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$678.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$319.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$319.20
|
| Rate for Payer: Galaxy Health WC |
$678.30
|
| Rate for Payer: Global Benefits Group Commercial |
$478.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$598.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$532.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$304.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$191.52
|
| Rate for Payer: Multiplan Commercial |
$638.40
|
| Rate for Payer: Networks By Design Commercial |
$518.70
|
| Rate for Payer: Prime Health Services Commercial |
$678.30
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$478.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$478.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$478.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$399.00
|
| Rate for Payer: United Healthcare All Other HMO |
$399.00
|
| Rate for Payer: United Healthcare HMO Rider |
$399.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$399.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$678.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$678.30
|
| Rate for Payer: Vantage Medical Group Senior |
$678.30
|
|
|
HC ANESTHESIA LEVEL I 1ST 15MIN
|
Facility
IP
|
$798.00
|
|
| Hospital Charge Code |
904900400
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$191.52 |
| Max. Negotiated Rate |
$678.30 |
| Rate for Payer: Cash Price |
$359.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$319.20
|
| Rate for Payer: Galaxy Health WC |
$678.30
|
| Rate for Payer: Global Benefits Group Commercial |
$478.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$532.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$304.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$191.52
|
| Rate for Payer: Multiplan Commercial |
$638.40
|
| Rate for Payer: Networks By Design Commercial |
$518.70
|
| Rate for Payer: Prime Health Services Commercial |
$678.30
|
|
|
HC ANESTHESIA LEVEL I ADD'L 15MIN
|
Facility
IP
|
$199.00
|
|
| Hospital Charge Code |
904900401
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$47.76 |
| Max. Negotiated Rate |
$169.15 |
| Rate for Payer: Cash Price |
$89.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.60
|
| Rate for Payer: Galaxy Health WC |
$169.15
|
| Rate for Payer: Global Benefits Group Commercial |
$119.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$132.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$75.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.76
|
| Rate for Payer: Multiplan Commercial |
$159.20
|
| Rate for Payer: Networks By Design Commercial |
$129.35
|
| Rate for Payer: Prime Health Services Commercial |
$169.15
|
|
|
HC ANESTHESIA LEVEL I ADD'L 15MIN
|
Facility
OP
|
$199.00
|
|
| Hospital Charge Code |
904900401
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$47.76 |
| Max. Negotiated Rate |
$169.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$130.52
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$169.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$109.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$109.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$118.56
|
| Rate for Payer: BCBS Transplant Transplant |
$119.40
|
| Rate for Payer: Blue Shield of California Commercial |
$146.66
|
| Rate for Payer: Blue Shield of California EPN |
$116.22
|
| Rate for Payer: Cash Price |
$89.55
|
| Rate for Payer: Cigna of CA HMO |
$127.36
|
| Rate for Payer: Cigna of CA PPO |
$147.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$169.15
|
| Rate for Payer: Dignity Health Media |
$169.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$169.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$79.60
|
| Rate for Payer: Galaxy Health WC |
$169.15
|
| Rate for Payer: Global Benefits Group Commercial |
$119.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$149.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$132.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$75.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.76
|
| Rate for Payer: Multiplan Commercial |
$159.20
|
| Rate for Payer: Networks By Design Commercial |
$129.35
|
| Rate for Payer: Prime Health Services Commercial |
$169.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$119.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$119.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$119.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.50
|
| Rate for Payer: United Healthcare All Other HMO |
$99.50
|
| Rate for Payer: United Healthcare HMO Rider |
$99.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$99.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$169.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$169.15
|
| Rate for Payer: Vantage Medical Group Senior |
$169.15
|
|
|
HC ANESTHESIA LEVEL II 1ST 15MIN
|
Facility
IP
|
$1,673.00
|
|
| Hospital Charge Code |
904900402
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$401.52 |
| Max. Negotiated Rate |
$1,422.05 |
| Rate for Payer: Cash Price |
$752.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$669.20
|
| Rate for Payer: Galaxy Health WC |
$1,422.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,003.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,115.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$637.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$401.52
|
| Rate for Payer: Multiplan Commercial |
$1,338.40
|
| Rate for Payer: Networks By Design Commercial |
$1,087.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,422.05
|
|
|
HC ANESTHESIA LEVEL II 1ST 15MIN
|
Facility
OP
|
$1,673.00
|
|
| Hospital Charge Code |
904900402
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$401.52 |
| Max. Negotiated Rate |
$1,422.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,097.32
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,422.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$920.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$920.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$996.77
|
| Rate for Payer: BCBS Transplant Transplant |
$1,003.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,233.00
|
| Rate for Payer: Blue Shield of California EPN |
$977.03
|
| Rate for Payer: Cash Price |
$752.85
|
| Rate for Payer: Cigna of CA HMO |
$1,070.72
|
| Rate for Payer: Cigna of CA PPO |
$1,238.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,422.05
|
| Rate for Payer: Dignity Health Media |
$1,422.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,422.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$669.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$669.20
|
| Rate for Payer: Galaxy Health WC |
$1,422.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,003.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,254.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,115.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$637.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$401.52
|
| Rate for Payer: Multiplan Commercial |
$1,338.40
|
| Rate for Payer: Networks By Design Commercial |
$1,087.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,422.05
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,003.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,003.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,003.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$836.50
|
| Rate for Payer: United Healthcare All Other HMO |
$836.50
|
| Rate for Payer: United Healthcare HMO Rider |
$836.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$836.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,422.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,422.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1,422.05
|
|
|
HC ANESTHESIA LEVEL II ADD'L 15MIN
|
Facility
IP
|
$276.00
|
|
| Hospital Charge Code |
904900403
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$66.24 |
| Max. Negotiated Rate |
$234.60 |
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$110.40
|
| Rate for Payer: Galaxy Health WC |
$234.60
|
| Rate for Payer: Global Benefits Group Commercial |
$165.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$184.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$105.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.24
|
| Rate for Payer: Multiplan Commercial |
$220.80
|
| Rate for Payer: Networks By Design Commercial |
$179.40
|
| Rate for Payer: Prime Health Services Commercial |
$234.60
|
|
|
HC ANESTHESIA LEVEL II ADD'L 15MIN
|
Facility
OP
|
$276.00
|
|
| Hospital Charge Code |
904900403
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$66.24 |
| Max. Negotiated Rate |
$234.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$181.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$234.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$151.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$164.44
|
| Rate for Payer: BCBS Transplant Transplant |
$165.60
|
| Rate for Payer: Blue Shield of California Commercial |
$203.41
|
| Rate for Payer: Blue Shield of California EPN |
$161.18
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cigna of CA HMO |
$176.64
|
| Rate for Payer: Cigna of CA PPO |
$204.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$234.60
|
| Rate for Payer: Dignity Health Media |
$234.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$234.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$110.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$110.40
|
| Rate for Payer: Galaxy Health WC |
$234.60
|
| Rate for Payer: Global Benefits Group Commercial |
$165.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$207.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$184.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$105.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.24
|
| Rate for Payer: Multiplan Commercial |
$220.80
|
| Rate for Payer: Networks By Design Commercial |
$179.40
|
| Rate for Payer: Prime Health Services Commercial |
$234.60
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$165.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$165.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$165.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$138.00
|
| Rate for Payer: United Healthcare All Other HMO |
$138.00
|
| Rate for Payer: United Healthcare HMO Rider |
$138.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$138.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$234.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$234.60
|
| Rate for Payer: Vantage Medical Group Senior |
$234.60
|
|
|
HC ANESTHESIA LEVEL III 1ST 15MIN
|
Facility
OP
|
$2,859.00
|
|
| Hospital Charge Code |
904900404
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$686.16 |
| Max. Negotiated Rate |
$2,430.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,875.22
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,430.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,572.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,572.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,703.39
|
| Rate for Payer: BCBS Transplant Transplant |
$1,715.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,107.08
|
| Rate for Payer: Blue Shield of California EPN |
$1,669.66
|
| Rate for Payer: Cash Price |
$1,286.55
|
| Rate for Payer: Cigna of CA HMO |
$1,829.76
|
| Rate for Payer: Cigna of CA PPO |
$2,115.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,430.15
|
| Rate for Payer: Dignity Health Media |
$2,430.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,430.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,143.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,143.60
|
| Rate for Payer: Galaxy Health WC |
$2,430.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,715.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,144.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,906.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,089.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$686.16
|
| Rate for Payer: Multiplan Commercial |
$2,287.20
|
| Rate for Payer: Networks By Design Commercial |
$1,858.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,430.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,715.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,715.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,715.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,429.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,429.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,429.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,429.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,430.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,430.15
|
| Rate for Payer: Vantage Medical Group Senior |
$2,430.15
|
|
|
HC ANESTHESIA LEVEL III 1ST 15MIN
|
Facility
IP
|
$2,859.00
|
|
| Hospital Charge Code |
904900404
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$686.16 |
| Max. Negotiated Rate |
$2,430.15 |
| Rate for Payer: Cash Price |
$1,286.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,143.60
|
| Rate for Payer: Galaxy Health WC |
$2,430.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,715.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,906.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,089.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$686.16
|
| Rate for Payer: Multiplan Commercial |
$2,287.20
|
| Rate for Payer: Networks By Design Commercial |
$1,858.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,430.15
|
|
|
HC ANESTHESIA LEVEL III ADD'L 15MIN
|
Facility
OP
|
$485.00
|
|
| Hospital Charge Code |
904900405
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$116.40 |
| Max. Negotiated Rate |
$412.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$318.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$412.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$266.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$266.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$288.96
|
| Rate for Payer: BCBS Transplant Transplant |
$291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$357.44
|
| Rate for Payer: Blue Shield of California EPN |
$283.24
|
| Rate for Payer: Cash Price |
$218.25
|
| Rate for Payer: Cigna of CA HMO |
$310.40
|
| Rate for Payer: Cigna of CA PPO |
$358.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$412.25
|
| Rate for Payer: Dignity Health Media |
$412.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$412.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$194.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$194.00
|
| Rate for Payer: Galaxy Health WC |
$412.25
|
| Rate for Payer: Global Benefits Group Commercial |
$291.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$363.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$323.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$184.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.40
|
| Rate for Payer: Multiplan Commercial |
$388.00
|
| Rate for Payer: Networks By Design Commercial |
$315.25
|
| Rate for Payer: Prime Health Services Commercial |
$412.25
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$291.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$291.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$291.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$242.50
|
| Rate for Payer: United Healthcare All Other HMO |
$242.50
|
| Rate for Payer: United Healthcare HMO Rider |
$242.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$242.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$412.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$412.25
|
| Rate for Payer: Vantage Medical Group Senior |
$412.25
|
|
|
HC ANESTHESIA LEVEL III ADD'L 15MIN
|
Facility
IP
|
$485.00
|
|
| Hospital Charge Code |
904900405
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$116.40 |
| Max. Negotiated Rate |
$412.25 |
| Rate for Payer: Cash Price |
$218.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$194.00
|
| Rate for Payer: Galaxy Health WC |
$412.25
|
| Rate for Payer: Global Benefits Group Commercial |
$291.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$323.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$184.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.40
|
| Rate for Payer: Multiplan Commercial |
$388.00
|
| Rate for Payer: Networks By Design Commercial |
$315.25
|
| Rate for Payer: Prime Health Services Commercial |
$412.25
|
|
