|
HC BLLN DILATION URETERAL STRCTR
|
Facility
|
OP
|
$3,260.00
|
|
|
Service Code
|
CPT 50706
|
| Hospital Charge Code |
909050706
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$652.00 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$652.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,771.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,793.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,445.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$1,467.00
|
| Rate for Payer: Cash Price |
$1,467.00
|
| Rate for Payer: Cash Price |
$1,467.00
|
| Rate for Payer: Cigna of CA HMO |
$2,086.40
|
| Rate for Payer: Cigna of CA PPO |
$2,412.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,771.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,771.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,771.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,282.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,304.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,304.00
|
| Rate for Payer: Galaxy Health WC |
$2,771.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,956.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,175.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,070.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,329.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,923.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$782.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,282.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,282.00
|
| Rate for Payer: Multiplan Commercial |
$2,608.00
|
| Rate for Payer: Networks By Design Commercial |
$2,119.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,771.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,956.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,630.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,771.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,771.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,771.00
|
|
|
HC BLLN DILATION URETERAL STRCTR
|
Facility
|
IP
|
$3,260.00
|
|
|
Service Code
|
CPT 50706
|
| Hospital Charge Code |
909050706
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$652.00 |
| Max. Negotiated Rate |
$2,771.00 |
| Rate for Payer: Adventist Health Commercial |
$652.00
|
| Rate for Payer: Cash Price |
$1,467.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,282.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,304.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,304.00
|
| Rate for Payer: Galaxy Health WC |
$2,771.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,956.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,070.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,923.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$782.40
|
| Rate for Payer: Multiplan Commercial |
$2,608.00
|
| Rate for Payer: Networks By Design Commercial |
$2,119.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,771.00
|
|
|
HC BLOOD ADMINISTRATION
|
Facility
|
OP
|
$2,506.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
946100364
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$260.15 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$501.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$260.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$851.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$624.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$567.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$1,127.70
|
| Rate for Payer: Cash Price |
$1,127.70
|
| Rate for Payer: Cash Price |
$1,127.70
|
| Rate for Payer: Cash Price |
$1,127.70
|
| Rate for Payer: Cigna of CA HMO |
$1,603.84
|
| Rate for Payer: Cigna of CA PPO |
$1,854.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$851.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$624.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$567.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,754.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$936.24
|
| Rate for Payer: EPIC Health Plan Senior |
$624.16
|
| Rate for Payer: Galaxy Health WC |
$2,130.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,503.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$930.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$567.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,591.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$909.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$794.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$601.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$714.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$760.34
|
| Rate for Payer: Multiplan Commercial |
$2,004.80
|
| Rate for Payer: Networks By Design Commercial |
$1,628.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,130.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,503.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,503.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$567.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$851.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$624.16
|
| Rate for Payer: Vantage Medical Group Senior |
$567.42
|
|
|
HC BLOOD ADMINISTRATION
|
Facility
|
IP
|
$2,506.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
946100364
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$501.20 |
| Max. Negotiated Rate |
$2,130.10 |
| Rate for Payer: Adventist Health Commercial |
$501.20
|
| Rate for Payer: Cash Price |
$1,127.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,754.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,002.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,002.40
|
| Rate for Payer: Galaxy Health WC |
$2,130.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,503.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,591.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,478.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$601.44
|
| Rate for Payer: Multiplan Commercial |
$2,004.80
|
| Rate for Payer: Networks By Design Commercial |
$1,628.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,130.10
|
|
|
HC BLOOD ADMINISTRATION
|
Facility
|
OP
|
$2,506.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
941100364
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$260.15 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$501.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$260.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$851.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$624.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$567.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$1,127.70
|
| Rate for Payer: Cash Price |
$1,127.70
|
| Rate for Payer: Cash Price |
$1,127.70
|
| Rate for Payer: Cash Price |
$1,127.70
|
| Rate for Payer: Cigna of CA HMO |
$1,603.84
|
| Rate for Payer: Cigna of CA PPO |
$1,854.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$851.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$624.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$567.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,754.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$936.24
|
| Rate for Payer: EPIC Health Plan Senior |
$624.16
|
| Rate for Payer: Galaxy Health WC |
$2,130.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,503.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$930.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$567.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,591.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$909.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$794.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$601.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$714.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$760.34
|
| Rate for Payer: Multiplan Commercial |
$2,004.80
|
| Rate for Payer: Networks By Design Commercial |
$1,628.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,130.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,503.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,503.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$567.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$851.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$624.16
|
| Rate for Payer: Vantage Medical Group Senior |
$567.42
|
|
|
HC BLOOD ADMINISTRATION
|
Facility
|
IP
|
$2,506.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
941100364
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$501.20 |
| Max. Negotiated Rate |
$2,130.10 |
| Rate for Payer: Adventist Health Commercial |
$501.20
|
| Rate for Payer: Cash Price |
$1,127.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,754.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,002.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,002.40
|
| Rate for Payer: Galaxy Health WC |
$2,130.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,503.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,591.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,478.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$601.44
|
| Rate for Payer: Multiplan Commercial |
$2,004.80
|
| Rate for Payer: Networks By Design Commercial |
$1,628.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,130.10
|
|
|
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 |
$171.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$220.98
|
| Rate for Payer: Blue Shield of California Commercial |
$183.02
|
| Rate for Payer: Blue Shield of California Commercial |
$276.71
|
| 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 |
$256.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$277.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| Rate for Payer: Galaxy Health WC |
$337.45
|
| Rate for Payer: Global Benefits Group Commercial |
$238.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$252.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$144.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$215.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$229.30
|
| 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 |
$171.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$277.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$252.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$234.23
|
| 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 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 |
$171.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$220.98
|
| Rate for Payer: Blue Shield of California Commercial |
$155.36
|
| Rate for Payer: Blue Shield of California Commercial |
$234.89
|
| 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 |
$256.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$235.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| Rate for Payer: Galaxy Health WC |
$286.45
|
| Rate for Payer: Global Benefits Group Commercial |
$202.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$214.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$122.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$215.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$229.30
|
| 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 |
$171.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$235.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$214.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$198.83
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$89.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$81.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$75.52
|
| 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 |
$2,601.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$89.60
|
| 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: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$81.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$75.52
|
| 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
|
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 |
$160.87
|
| 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 |
$199.71
|
| Rate for Payer: Blue Shield of California Commercial |
$496.50
|
| Rate for Payer: Blue Shield of California Commercial |
$750.67
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$753.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.02
|
| Rate for Payer: EPIC Health Plan Senior |
$28.68
|
| Rate for Payer: Galaxy Health WC |
$915.45
|
| Rate for Payer: Global Benefits Group Commercial |
$646.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$683.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$36.50
|
| 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
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$753.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$683.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$635.43
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,099.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$997.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$926.89
|
| 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 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 |
$236.03
|
| 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 |
$290.19
|
| Rate for Payer: Blue Shield of California Commercial |
$1,094.99
|
| Rate for Payer: Blue Shield of California Commercial |
$724.23
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,099.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$129.97
|
| Rate for Payer: EPIC Health Plan Senior |
$86.65
|
| 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/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$997.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$46.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$110.28
|
| 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 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 |
$38.24
|
| 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 |
$47.88
|
| Rate for Payer: Blue Shield of California Commercial |
$56.24
|
| Rate for Payer: Blue Shield of California Commercial |
$85.03
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$85.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.59
|
| Rate for Payer: EPIC Health Plan Senior |
$5.06
|
| Rate for Payer: Galaxy Health WC |
$103.70
|
| Rate for Payer: Global Benefits Group Commercial |
$73.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$77.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.44
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$85.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$77.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.98
|
| 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
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 82805
|
| Hospital Charge Code |
900912188
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$290.19 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$236.03
|
| 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 |
$290.19
|
| Rate for Payer: Blue Shield of California Commercial |
$18.44
|
| Rate for Payer: Blue Shield of California Commercial |
$27.88
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$129.97
|
| Rate for Payer: EPIC Health Plan Senior |
$86.65
|
| Rate for Payer: Galaxy Health WC |
$34.00
|
| Rate for Payer: Global Benefits Group Commercial |
$24.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$25.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$46.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$110.28
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$25.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.60
|
| 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 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: United Healthcare HMO Rider |
$3.85
|
| Rate for Payer: Adventist Health Commercial |
$24.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$38.24
|
| 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 |
$47.88
|
| Rate for Payer: Blue Shield of California Commercial |
$56.24
|
| Rate for Payer: Blue Shield of California Commercial |
$85.03
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$85.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.85
|
| Rate for Payer: EPIC Health Plan Senior |
$5.24
|
| Rate for Payer: Galaxy Health WC |
$103.70
|
| Rate for Payer: Global Benefits Group Commercial |
$73.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$77.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.66
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$85.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$77.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.98
|
| 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
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$85.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$77.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.98
|
| 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 |
$39.98
|
| 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 |
$49.48
|
| Rate for Payer: Blue Shield of California Commercial |
$56.24
|
| Rate for Payer: Blue Shield of California Commercial |
$85.03
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$85.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.94
|
| Rate for Payer: EPIC Health Plan Senior |
$5.29
|
| Rate for Payer: Galaxy Health WC |
$103.70
|
| Rate for Payer: Global Benefits Group Commercial |
$73.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$77.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.73
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$94.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$85.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$79.65
|
| 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
|
|
