|
HC BTTN MINI 1 14FRX1.0CM BLLN LP
|
Facility
|
OP
|
$246.96
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901696293
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.39 |
| Max. Negotiated Rate |
$209.92 |
| Rate for Payer: Adventist Health Commercial |
$49.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$120.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$209.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$135.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$185.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$158.47
|
| Rate for Payer: Cash Price |
$111.13
|
| Rate for Payer: Cash Price |
$111.13
|
| Rate for Payer: Cigna of CA HMO |
$158.05
|
| Rate for Payer: Cigna of CA PPO |
$182.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$209.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$209.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$209.92
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$172.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.78
|
| Rate for Payer: EPIC Health Plan Senior |
$98.78
|
| Rate for Payer: Galaxy Health WC |
$209.92
|
| Rate for Payer: Global Benefits Group Commercial |
$148.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$156.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$89.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$145.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$172.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$172.87
|
| Rate for Payer: Multiplan Commercial |
$197.57
|
| Rate for Payer: Networks By Design Commercial |
$160.52
|
| Rate for Payer: Prime Health Services Commercial |
$209.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$148.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$148.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.48
|
| Rate for Payer: United Healthcare All Other HMO |
$123.48
|
| Rate for Payer: United Healthcare HMO Rider |
$123.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$209.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$209.92
|
| Rate for Payer: Vantage Medical Group Senior |
$209.92
|
|
|
HC BTTN MINI 1 14FRX1.0CM BLLN LP
|
Facility
|
IP
|
$246.96
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901696293
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.39 |
| Max. Negotiated Rate |
$209.92 |
| Rate for Payer: EPIC Health Plan Senior |
$98.78
|
| Rate for Payer: Galaxy Health WC |
$209.92
|
| Rate for Payer: Adventist Health Commercial |
$49.39
|
| Rate for Payer: Cash Price |
$111.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$172.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.78
|
| Rate for Payer: Global Benefits Group Commercial |
$148.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$156.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$145.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.27
|
| Rate for Payer: Multiplan Commercial |
$197.57
|
| Rate for Payer: Networks By Design Commercial |
$160.52
|
| Rate for Payer: Prime Health Services Commercial |
$209.92
|
|
|
HC BTTN MINI 1 14FRX1.2CM BLLN LP
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901696294
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$493.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$120.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$372.19
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cigna of CA HMO |
$371.20
|
| Rate for Payer: Cigna of CA PPO |
$429.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$493.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$406.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$368.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$210.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$342.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$406.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$290.00
|
| Rate for Payer: United Healthcare All Other HMO |
$290.00
|
| Rate for Payer: United Healthcare HMO Rider |
$290.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC BTTN MINI 1 14FRX1.2CM BLLN LP
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901696294
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$493.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$406.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$368.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$342.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.20
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
|
|
HC BTTN MINI 1 14FRX1.7CM BLLN LP
|
Facility
|
IP
|
$568.40
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901696296
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$113.68 |
| Max. Negotiated Rate |
$483.14 |
| Rate for Payer: Adventist Health Commercial |
$113.68
|
| Rate for Payer: Cash Price |
$255.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$397.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$227.36
|
| Rate for Payer: EPIC Health Plan Senior |
$227.36
|
| Rate for Payer: Galaxy Health WC |
$483.14
|
| Rate for Payer: Global Benefits Group Commercial |
$341.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$360.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$335.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.42
|
| Rate for Payer: Multiplan Commercial |
$454.72
|
| Rate for Payer: Networks By Design Commercial |
$369.46
|
| Rate for Payer: Prime Health Services Commercial |
$483.14
|
|
|
HC BTTN MINI 1 14FRX1.7CM BLLN LP
|
Facility
|
OP
|
$568.40
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901696296
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$113.68 |
| Max. Negotiated Rate |
$483.14 |
| Rate for Payer: Adventist Health Commercial |
$113.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$120.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$483.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$312.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$426.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$364.74
|
| Rate for Payer: Cash Price |
$255.78
|
| Rate for Payer: Cash Price |
$255.78
|
| Rate for Payer: Cigna of CA HMO |
$363.78
|
| Rate for Payer: Cigna of CA PPO |
$420.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$483.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$483.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$483.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$397.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$227.36
|
| Rate for Payer: EPIC Health Plan Senior |
$227.36
|
| Rate for Payer: Galaxy Health WC |
$483.14
|
| Rate for Payer: Global Benefits Group Commercial |
$341.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$360.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$206.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$335.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$397.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$397.88
|
| Rate for Payer: Multiplan Commercial |
$454.72
|
| Rate for Payer: Networks By Design Commercial |
$369.46
|
| Rate for Payer: Prime Health Services Commercial |
$483.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$341.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$341.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$284.20
|
| Rate for Payer: United Healthcare All Other HMO |
$284.20
|
| Rate for Payer: United Healthcare HMO Rider |
$284.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$284.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$483.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$483.14
|
| Rate for Payer: Vantage Medical Group Senior |
$483.14
|
|
|
HC BTTN MINI 1 14FRX2.0CM BLLN LP
|
Facility
|
OP
|
$643.45
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901696297
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$120.13 |
| Max. Negotiated Rate |
$546.93 |
| Rate for Payer: Adventist Health Commercial |
$128.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$120.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$546.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$353.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$482.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$412.90
|
| Rate for Payer: Cash Price |
$289.55
|
| Rate for Payer: Cash Price |
$289.55
|
| Rate for Payer: Cigna of CA HMO |
$411.81
|
| Rate for Payer: Cigna of CA PPO |
$476.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$546.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$546.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$546.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$450.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$257.38
|
| Rate for Payer: EPIC Health Plan Senior |
$257.38
|
| Rate for Payer: Galaxy Health WC |
$546.93
|
| Rate for Payer: Global Benefits Group Commercial |
$386.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$408.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$233.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$379.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$450.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$450.42
|
| Rate for Payer: Multiplan Commercial |
$514.76
|
| Rate for Payer: Networks By Design Commercial |
$418.24
|
| Rate for Payer: Prime Health Services Commercial |
$546.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$386.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$386.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$321.73
|
| Rate for Payer: United Healthcare All Other HMO |
$321.73
|
| Rate for Payer: United Healthcare HMO Rider |
$321.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$321.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$546.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$546.93
|
| Rate for Payer: Vantage Medical Group Senior |
$546.93
|
|
|
HC BTTN MINI 1 14FRX2.0CM BLLN LP
|
Facility
|
IP
|
$643.45
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901696297
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$128.69 |
| Max. Negotiated Rate |
$546.93 |
| Rate for Payer: Adventist Health Commercial |
$128.69
|
| Rate for Payer: Cash Price |
$289.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$450.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$257.38
|
| Rate for Payer: EPIC Health Plan Senior |
$257.38
|
| Rate for Payer: Galaxy Health WC |
$546.93
|
| Rate for Payer: Global Benefits Group Commercial |
$386.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$408.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$379.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.43
|
| Rate for Payer: Multiplan Commercial |
$514.76
|
| Rate for Payer: Networks By Design Commercial |
$418.24
|
| Rate for Payer: Prime Health Services Commercial |
$546.93
|
|
|
HC BTTN MINI 14FRX1.5CM
|
Facility
|
IP
|
$512.60
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901696295
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$102.52 |
| Max. Negotiated Rate |
$435.71 |
| Rate for Payer: Adventist Health Commercial |
$102.52
|
| Rate for Payer: Cash Price |
$230.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$358.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$205.04
|
| Rate for Payer: EPIC Health Plan Senior |
$205.04
|
| Rate for Payer: Galaxy Health WC |
$435.71
|
| Rate for Payer: Global Benefits Group Commercial |
$307.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$325.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$302.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.02
|
| Rate for Payer: Multiplan Commercial |
$410.08
|
| Rate for Payer: Networks By Design Commercial |
$333.19
|
| Rate for Payer: Prime Health Services Commercial |
$435.71
|
|
|
HC BTTN MINI 14FRX1.5CM
|
Facility
|
OP
|
$512.60
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901696295
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$102.52 |
| Max. Negotiated Rate |
$435.71 |
| Rate for Payer: Adventist Health Commercial |
$102.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$120.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$435.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$281.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$384.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$328.94
|
| Rate for Payer: Cash Price |
$230.67
|
| Rate for Payer: Cash Price |
$230.67
|
| Rate for Payer: Cigna of CA HMO |
$328.06
|
| Rate for Payer: Cigna of CA PPO |
$379.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$435.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$435.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$435.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$358.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$205.04
|
| Rate for Payer: EPIC Health Plan Senior |
$205.04
|
| Rate for Payer: Galaxy Health WC |
$435.71
|
| Rate for Payer: Global Benefits Group Commercial |
$307.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$325.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$186.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$302.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$358.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$358.82
|
| Rate for Payer: Multiplan Commercial |
$410.08
|
| Rate for Payer: Networks By Design Commercial |
$333.19
|
| Rate for Payer: Prime Health Services Commercial |
$435.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$307.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$307.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$256.30
|
| Rate for Payer: United Healthcare All Other HMO |
$256.30
|
| Rate for Payer: United Healthcare HMO Rider |
$256.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$256.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$435.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$435.71
|
| Rate for Payer: Vantage Medical Group Senior |
$435.71
|
|
|
HC BUFFY COAT EXAM
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
CPT 85009
|
| Hospital Charge Code |
900910196
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$38.36 |
| Rate for Payer: Adventist Health Commercial |
$2.80
|
| Rate for Payer: Adventist Health Commercial |
$53.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.36
|
| Rate for Payer: Blue Shield of California Commercial |
$122.17
|
| Rate for Payer: Blue Shield of California Commercial |
$6.45
|
| Rate for Payer: Blue Shield of California Commercial |
$184.71
|
| Rate for Payer: Blue Shield of California Commercial |
$9.76
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cigna of CA HMO |
$169.60
|
| Rate for Payer: Cigna of CA HMO |
$8.96
|
| Rate for Payer: Cigna of CA PPO |
$10.36
|
| Rate for Payer: Cigna of CA PPO |
$196.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$185.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.37
|
| Rate for Payer: EPIC Health Plan Senior |
$5.58
|
| Rate for Payer: EPIC Health Plan Senior |
$5.58
|
| Rate for Payer: Galaxy Health WC |
$11.90
|
| Rate for Payer: Galaxy Health WC |
$225.25
|
| Rate for Payer: Global Benefits Group Commercial |
$8.40
|
| Rate for Payer: Global Benefits Group Commercial |
$159.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.31
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$168.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.79
|
| Rate for Payer: Multiplan Commercial |
$212.00
|
| Rate for Payer: Multiplan Commercial |
$11.20
|
| Rate for Payer: Networks By Design Commercial |
$172.25
|
| Rate for Payer: Networks By Design Commercial |
$9.10
|
| Rate for Payer: Prime Health Services Commercial |
$11.90
|
| Rate for Payer: Prime Health Services Commercial |
$225.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$159.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$159.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.10
|
| Rate for Payer: United Healthcare All Other HMO |
$4.10
|
| Rate for Payer: United Healthcare All Other HMO |
$4.10
|
| Rate for Payer: United Healthcare HMO Rider |
$4.10
|
| Rate for Payer: United Healthcare HMO Rider |
$4.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.10
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.07
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.58
|
| Rate for Payer: Vantage Medical Group Senior |
$5.07
|
| Rate for Payer: Vantage Medical Group Senior |
$5.07
|
|
|
HC BUFFY COAT EXAM
|
Facility
|
IP
|
$265.00
|
|
|
Service Code
|
CPT 85009
|
| Hospital Charge Code |
900910196
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$53.00 |
| Max. Negotiated Rate |
$225.25 |
| Rate for Payer: EPIC Health Plan Senior |
$106.00
|
| Rate for Payer: Galaxy Health WC |
$225.25
|
| Rate for Payer: Adventist Health Commercial |
$53.00
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$185.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.00
|
| Rate for Payer: Global Benefits Group Commercial |
$159.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$168.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.60
|
| Rate for Payer: Multiplan Commercial |
$212.00
|
| Rate for Payer: Networks By Design Commercial |
$172.25
|
| Rate for Payer: Prime Health Services Commercial |
$225.25
|
|
|
HC BULB RESERVOIR JACKSON PRATT
|
Facility
|
IP
|
$44.94
|
|
| Hospital Charge Code |
901604267
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.99 |
| Max. Negotiated Rate |
$38.20 |
| Rate for Payer: Adventist Health Commercial |
$8.99
|
| Rate for Payer: Cash Price |
$20.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$31.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.98
|
| Rate for Payer: EPIC Health Plan Senior |
$17.98
|
| Rate for Payer: Galaxy Health WC |
$38.20
|
| Rate for Payer: Global Benefits Group Commercial |
$26.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.79
|
| Rate for Payer: Multiplan Commercial |
$35.95
|
| Rate for Payer: Networks By Design Commercial |
$29.21
|
| Rate for Payer: Prime Health Services Commercial |
$38.20
|
|
|
HC BULB RESERVOIR JACKSON PRATT
|
Facility
|
OP
|
$44.94
|
|
| Hospital Charge Code |
901604267
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.99 |
| Max. Negotiated Rate |
$38.20 |
| Rate for Payer: Adventist Health Commercial |
$8.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$29.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.84
|
| Rate for Payer: Cash Price |
$20.22
|
| Rate for Payer: Cigna of CA HMO |
$28.76
|
| Rate for Payer: Cigna of CA PPO |
$33.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$38.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$31.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.98
|
| Rate for Payer: EPIC Health Plan Senior |
$17.98
|
| Rate for Payer: Galaxy Health WC |
$38.20
|
| Rate for Payer: Global Benefits Group Commercial |
$26.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31.46
|
| Rate for Payer: Multiplan Commercial |
$35.95
|
| Rate for Payer: Networks By Design Commercial |
$29.21
|
| Rate for Payer: Prime Health Services Commercial |
$38.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.47
|
| Rate for Payer: United Healthcare All Other HMO |
$22.47
|
| Rate for Payer: United Healthcare HMO Rider |
$22.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.20
|
| Rate for Payer: Vantage Medical Group Senior |
$38.20
|
|
|
HC BUN
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
900910253
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$83.30 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$68.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.20
|
| Rate for Payer: EPIC Health Plan Senior |
$39.20
|
| Rate for Payer: Galaxy Health WC |
$83.30
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$62.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$57.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.52
|
| Rate for Payer: Multiplan Commercial |
$78.40
|
| Rate for Payer: Networks By Design Commercial |
$63.70
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
|
|
HC BUN
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
900910253
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$40.72 |
| Rate for Payer: Adventist Health Commercial |
$6.80
|
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.72
|
| Rate for Payer: Blue Shield of California Commercial |
$45.18
|
| Rate for Payer: Blue Shield of California Commercial |
$15.67
|
| Rate for Payer: Blue Shield of California Commercial |
$68.31
|
| Rate for Payer: Blue Shield of California Commercial |
$23.70
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cigna of CA HMO |
$62.72
|
| Rate for Payer: Cigna of CA HMO |
$21.76
|
| Rate for Payer: Cigna of CA PPO |
$25.16
|
| Rate for Payer: Cigna of CA PPO |
$72.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$68.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.52
|
| Rate for Payer: EPIC Health Plan Senior |
$4.34
|
| Rate for Payer: EPIC Health Plan Senior |
$4.34
|
| Rate for Payer: Galaxy Health WC |
$28.90
|
| Rate for Payer: Galaxy Health WC |
$83.30
|
| Rate for Payer: Global Benefits Group Commercial |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6.48
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$62.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.29
|
| Rate for Payer: Multiplan Commercial |
$78.40
|
| Rate for Payer: Multiplan Commercial |
$27.20
|
| Rate for Payer: Networks By Design Commercial |
$63.70
|
| Rate for Payer: Networks By Design Commercial |
$22.10
|
| Rate for Payer: Prime Health Services Commercial |
$28.90
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.20
|
| Rate for Payer: United Healthcare All Other HMO |
$3.20
|
| Rate for Payer: United Healthcare All Other HMO |
$3.20
|
| Rate for Payer: United Healthcare HMO Rider |
$3.20
|
| Rate for Payer: United Healthcare HMO Rider |
$3.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.20
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.95
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.34
|
| Rate for Payer: Vantage Medical Group Senior |
$3.95
|
| Rate for Payer: Vantage Medical Group Senior |
$3.95
|
|
|
HC BUN BODY FLUID
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
900912241
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$35.70 |
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.80
|
| Rate for Payer: EPIC Health Plan Senior |
$16.80
|
| Rate for Payer: Galaxy Health WC |
$35.70
|
| Rate for Payer: Global Benefits Group Commercial |
$25.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.08
|
| Rate for Payer: Multiplan Commercial |
$33.60
|
| Rate for Payer: Networks By Design Commercial |
$27.30
|
| Rate for Payer: Prime Health Services Commercial |
$35.70
|
|
|
HC BUN BODY FLUID
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
900912241
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$40.72 |
| Rate for Payer: Adventist Health Commercial |
$7.60
|
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.72
|
| Rate for Payer: Blue Shield of California Commercial |
$19.36
|
| Rate for Payer: Blue Shield of California Commercial |
$17.52
|
| Rate for Payer: Blue Shield of California Commercial |
$29.27
|
| Rate for Payer: Blue Shield of California Commercial |
$26.49
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cigna of CA HMO |
$26.88
|
| Rate for Payer: Cigna of CA HMO |
$24.32
|
| Rate for Payer: Cigna of CA PPO |
$28.12
|
| Rate for Payer: Cigna of CA PPO |
$31.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.52
|
| Rate for Payer: EPIC Health Plan Senior |
$4.34
|
| Rate for Payer: EPIC Health Plan Senior |
$4.34
|
| Rate for Payer: Galaxy Health WC |
$32.30
|
| Rate for Payer: Galaxy Health WC |
$35.70
|
| Rate for Payer: Global Benefits Group Commercial |
$22.80
|
| Rate for Payer: Global Benefits Group Commercial |
$25.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6.48
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.29
|
| Rate for Payer: Multiplan Commercial |
$33.60
|
| Rate for Payer: Multiplan Commercial |
$30.40
|
| Rate for Payer: Networks By Design Commercial |
$27.30
|
| Rate for Payer: Networks By Design Commercial |
$24.70
|
| Rate for Payer: Prime Health Services Commercial |
$32.30
|
| Rate for Payer: Prime Health Services Commercial |
$35.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.20
|
| Rate for Payer: United Healthcare All Other HMO |
$3.20
|
| Rate for Payer: United Healthcare All Other HMO |
$3.20
|
| Rate for Payer: United Healthcare HMO Rider |
$3.20
|
| Rate for Payer: United Healthcare HMO Rider |
$3.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.20
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.95
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.34
|
| Rate for Payer: Vantage Medical Group Senior |
$3.95
|
| Rate for Payer: Vantage Medical Group Senior |
$3.95
|
|
|
HC BUN INDIVIDUAL
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
900910492
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$42.50 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
|
|
HC BUN INDIVIDUAL
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
900910492
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$42.50 |
| Rate for Payer: EPIC Health Plan Commercial |
$6.52
|
| Rate for Payer: EPIC Health Plan Senior |
$4.34
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.72
|
| Rate for Payer: Blue Shield of California Commercial |
$23.05
|
| Rate for Payer: Blue Shield of California Commercial |
$34.85
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna of CA HMO |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.00
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.29
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.20
|
| Rate for Payer: United Healthcare All Other HMO |
$3.20
|
| Rate for Payer: United Healthcare HMO Rider |
$3.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.20
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.34
|
| Rate for Payer: Vantage Medical Group Senior |
$3.95
|
|
|
HC BURR HOLES/ICP
|
Facility
|
IP
|
$702.00
|
|
|
Service Code
|
CPT 61105
|
| Hospital Charge Code |
988161105
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$140.40 |
| Max. Negotiated Rate |
$596.70 |
| Rate for Payer: Adventist Health Commercial |
$140.40
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$491.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$280.80
|
| Rate for Payer: EPIC Health Plan Senior |
$280.80
|
| Rate for Payer: Galaxy Health WC |
$596.70
|
| Rate for Payer: Global Benefits Group Commercial |
$421.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$445.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$414.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.48
|
| Rate for Payer: Multiplan Commercial |
$561.60
|
| Rate for Payer: Networks By Design Commercial |
$456.30
|
| Rate for Payer: Prime Health Services Commercial |
$596.70
|
|
|
HC BURR HOLES/ICP
|
Facility
|
OP
|
$702.00
|
|
|
Service Code
|
CPT 61105
|
| Hospital Charge Code |
988161105
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$140.40 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$140.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$596.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$386.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$526.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Cigna of CA HMO |
$449.28
|
| Rate for Payer: Cigna of CA PPO |
$519.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$596.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$596.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$596.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$491.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$280.80
|
| Rate for Payer: EPIC Health Plan Senior |
$280.80
|
| Rate for Payer: Galaxy Health WC |
$596.70
|
| Rate for Payer: Global Benefits Group Commercial |
$421.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$495.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$445.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$560.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$414.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$491.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$491.40
|
| Rate for Payer: Multiplan Commercial |
$561.60
|
| Rate for Payer: Networks By Design Commercial |
$456.30
|
| Rate for Payer: Prime Health Services Commercial |
$596.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$421.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$351.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$596.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$596.70
|
| Rate for Payer: Vantage Medical Group Senior |
$596.70
|
|
|
HC BX BONE OPEN SUPERFICIAL
|
Facility
|
IP
|
$8,616.00
|
|
|
Service Code
|
CPT 20240
|
| Hospital Charge Code |
902320240
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,723.20 |
| Max. Negotiated Rate |
$7,323.60 |
| Rate for Payer: Adventist Health Commercial |
$1,723.20
|
| Rate for Payer: Cash Price |
$3,877.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,031.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,446.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,446.40
|
| Rate for Payer: Galaxy Health WC |
$7,323.60
|
| Rate for Payer: Global Benefits Group Commercial |
$5,169.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,471.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,083.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,067.84
|
| Rate for Payer: Multiplan Commercial |
$6,892.80
|
| Rate for Payer: Networks By Design Commercial |
$5,600.40
|
| Rate for Payer: Prime Health Services Commercial |
$7,323.60
|
|
|
HC BX BONE OPEN SUPERFICIAL
|
Facility
|
OP
|
$8,616.00
|
|
|
Service Code
|
CPT 20240
|
| Hospital Charge Code |
902320240
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$212.65 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,723.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,603.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,109.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,735.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,574.78
|
| Rate for Payer: Blue Shield of California Commercial |
$3,897.87
|
| Rate for Payer: Cash Price |
$3,877.20
|
| Rate for Payer: Cash Price |
$3,877.20
|
| Rate for Payer: Cash Price |
$3,877.20
|
| Rate for Payer: Cigna of CA HMO |
$5,514.24
|
| Rate for Payer: Cigna of CA PPO |
$6,375.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,603.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,109.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,735.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,031.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,164.32
|
| Rate for Payer: EPIC Health Plan Senior |
$4,109.55
|
| Rate for Payer: Galaxy Health WC |
$7,323.60
|
| Rate for Payer: Global Benefits Group Commercial |
$5,169.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,126.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$212.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,735.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,471.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$240.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,230.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,067.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,707.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,006.17
|
| Rate for Payer: Multiplan Commercial |
$6,892.80
|
| Rate for Payer: Multiplan WC |
$5,794.14
|
| Rate for Payer: Networks By Design Commercial |
$5,600.40
|
| Rate for Payer: Prime Health Services Commercial |
$7,323.60
|
| Rate for Payer: Prime Health Services WC |
$5,735.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,169.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,308.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,735.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,603.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,109.55
|
| Rate for Payer: Vantage Medical Group Senior |
$3,735.95
|
|
|
HC BX BREAST 1ST LESION MR IMAG
|
Facility
|
OP
|
$3,063.00
|
|
|
Service Code
|
CPT 19085
|
| Hospital Charge Code |
900100008
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$279.59 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$612.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,574.78
|
| Rate for Payer: Blue Shield of California Commercial |
$3,897.87
|
| Rate for Payer: Cash Price |
$1,378.35
|
| Rate for Payer: Cash Price |
$1,378.35
|
| Rate for Payer: Cash Price |
$1,378.35
|
| Rate for Payer: Cigna of CA HMO |
$1,960.32
|
| Rate for Payer: Cigna of CA PPO |
$2,266.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,144.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,504.98
|
| Rate for Payer: EPIC Health Plan Senior |
$2,336.65
|
| Rate for Payer: Galaxy Health WC |
$2,603.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,837.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,483.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$279.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,945.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$316.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,973.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$735.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,676.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,846.47
|
| Rate for Payer: Multiplan Commercial |
$2,450.40
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$1,990.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,603.55
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,837.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,531.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,124.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
