|
HC CAFFEINE SERUM
|
Facility
|
IP
|
$158.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900910538
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.60 |
| Max. Negotiated Rate |
$134.30 |
| Rate for Payer: Adventist Health Commercial |
$31.60
|
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$110.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.20
|
| Rate for Payer: EPIC Health Plan Senior |
$63.20
|
| Rate for Payer: Galaxy Health WC |
$134.30
|
| Rate for Payer: Global Benefits Group Commercial |
$94.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$100.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$93.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.92
|
| Rate for Payer: Multiplan Commercial |
$126.40
|
| Rate for Payer: Networks By Design Commercial |
$102.70
|
| Rate for Payer: Prime Health Services Commercial |
$134.30
|
|
|
HC CAFFEINE SERUM
|
Facility
|
OP
|
$158.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900910538
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.10 |
| Max. Negotiated Rate |
$150.30 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Vantage Medical Group Senior |
$18.64
|
| Rate for Payer: Vantage Medical Group Senior |
$18.64
|
| Rate for Payer: Adventist Health Commercial |
$31.60
|
| Rate for Payer: Adventist Health Commercial |
$9.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$110.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$110.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.30
|
| Rate for Payer: Blue Shield of California Commercial |
$21.21
|
| Rate for Payer: Blue Shield of California Commercial |
$110.13
|
| Rate for Payer: Blue Shield of California Commercial |
$32.06
|
| Rate for Payer: Blue Shield of California Commercial |
$72.84
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Cigna of CA HMO |
$29.44
|
| Rate for Payer: Cigna of CA HMO |
$101.12
|
| Rate for Payer: Cigna of CA PPO |
$116.92
|
| Rate for Payer: Cigna of CA PPO |
$34.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$110.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$32.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.76
|
| Rate for Payer: EPIC Health Plan Senior |
$20.50
|
| Rate for Payer: EPIC Health Plan Senior |
$20.50
|
| Rate for Payer: Galaxy Health WC |
$134.30
|
| Rate for Payer: Galaxy Health WC |
$39.10
|
| Rate for Payer: Global Benefits Group Commercial |
$94.80
|
| Rate for Payer: Global Benefits Group Commercial |
$27.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.57
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$100.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$29.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.98
|
| Rate for Payer: Multiplan Commercial |
$36.80
|
| Rate for Payer: Multiplan Commercial |
$126.40
|
| Rate for Payer: Networks By Design Commercial |
$29.90
|
| Rate for Payer: Networks By Design Commercial |
$102.70
|
| Rate for Payer: Prime Health Services Commercial |
$134.30
|
| Rate for Payer: Prime Health Services Commercial |
$39.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$94.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$94.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.10
|
| Rate for Payer: United Healthcare All Other HMO |
$15.10
|
| Rate for Payer: United Healthcare All Other HMO |
$15.10
|
| Rate for Payer: United Healthcare HMO Rider |
$15.10
|
| Rate for Payer: United Healthcare HMO Rider |
$15.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.10
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.64
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.96
|
|
|
HC CA IONIZED (POC)
|
Facility
|
OP
|
$323.00
|
|
|
Service Code
|
CPT 82330
|
| Hospital Charge Code |
900912118
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$274.55 |
| Rate for Payer: Adventist Health Commercial |
$64.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$113.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$141.06
|
| Rate for Payer: Blue Shield of California Commercial |
$148.90
|
| Rate for Payer: Blue Shield of California Commercial |
$225.13
|
| Rate for Payer: Cash Price |
$145.35
|
| Rate for Payer: Cash Price |
$145.35
|
| Rate for Payer: Cigna of CA HMO |
$206.72
|
| Rate for Payer: Cigna of CA PPO |
$239.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$226.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.57
|
| Rate for Payer: EPIC Health Plan Senior |
$15.05
|
| Rate for Payer: Galaxy Health WC |
$274.55
|
| Rate for Payer: Global Benefits Group Commercial |
$193.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$205.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.33
|
| Rate for Payer: Multiplan Commercial |
$258.40
|
| Rate for Payer: Networks By Design Commercial |
$209.95
|
| Rate for Payer: Prime Health Services Commercial |
$274.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$193.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$193.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.08
|
| Rate for Payer: United Healthcare All Other HMO |
$11.08
|
| Rate for Payer: United Healthcare HMO Rider |
$11.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.08
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.05
|
| Rate for Payer: Vantage Medical Group Senior |
$13.68
|
|
|
HC CA IONIZED (POC)
|
Facility
|
IP
|
$323.00
|
|
|
Service Code
|
CPT 82330
|
| Hospital Charge Code |
900912118
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$64.60 |
| Max. Negotiated Rate |
$274.55 |
| Rate for Payer: Adventist Health Commercial |
$64.60
|
| Rate for Payer: Cash Price |
$145.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$226.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$129.20
|
| Rate for Payer: EPIC Health Plan Senior |
$129.20
|
| Rate for Payer: Galaxy Health WC |
$274.55
|
| Rate for Payer: Global Benefits Group Commercial |
$193.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$205.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$190.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.52
|
| Rate for Payer: Multiplan Commercial |
$258.40
|
| Rate for Payer: Networks By Design Commercial |
$209.95
|
| Rate for Payer: Prime Health Services Commercial |
$274.55
|
|
|
HC C ALBICANS OR C TROPICALIS NAT
|
Facility
|
OP
|
$106.00
|
|
|
Service Code
|
CPT 87481
|
| Hospital Charge Code |
900912492
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$21.20 |
| Max. Negotiated Rate |
$350.50 |
| Rate for Payer: Adventist Health Commercial |
$21.20
|
| Rate for Payer: Adventist Health Commercial |
$15.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$291.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$291.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$350.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$350.50
|
| Rate for Payer: Blue Shield of California Commercial |
$35.04
|
| Rate for Payer: Blue Shield of California Commercial |
$48.87
|
| Rate for Payer: Blue Shield of California Commercial |
$52.97
|
| Rate for Payer: Blue Shield of California Commercial |
$73.88
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cigna of CA HMO |
$48.64
|
| Rate for Payer: Cigna of CA HMO |
$67.84
|
| Rate for Payer: Cigna of CA PPO |
$78.44
|
| Rate for Payer: Cigna of CA PPO |
$56.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$74.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$53.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.90
|
| Rate for Payer: EPIC Health Plan Senior |
$38.60
|
| Rate for Payer: EPIC Health Plan Senior |
$38.60
|
| Rate for Payer: Galaxy Health WC |
$90.10
|
| Rate for Payer: Galaxy Health WC |
$64.60
|
| Rate for Payer: Global Benefits Group Commercial |
$63.60
|
| Rate for Payer: Global Benefits Group Commercial |
$45.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.55
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$52.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$52.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$67.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$48.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$59.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$59.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$60.80
|
| Rate for Payer: Multiplan Commercial |
$84.80
|
| Rate for Payer: Networks By Design Commercial |
$49.40
|
| Rate for Payer: Networks By Design Commercial |
$68.90
|
| Rate for Payer: Prime Health Services Commercial |
$90.10
|
| Rate for Payer: Prime Health Services Commercial |
$64.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$63.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$63.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$35.09
|
| Rate for Payer: Upland Medical Group Pediatric |
$35.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC C ALBICANS OR C TROPICALIS NAT
|
Facility
|
IP
|
$106.00
|
|
|
Service Code
|
CPT 87481
|
| Hospital Charge Code |
900912492
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$21.20 |
| Max. Negotiated Rate |
$90.10 |
| Rate for Payer: Adventist Health Commercial |
$21.20
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$74.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.40
|
| Rate for Payer: EPIC Health Plan Senior |
$42.40
|
| Rate for Payer: Galaxy Health WC |
$90.10
|
| Rate for Payer: Global Benefits Group Commercial |
$63.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$67.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$62.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.44
|
| Rate for Payer: Multiplan Commercial |
$84.80
|
| Rate for Payer: Networks By Design Commercial |
$68.90
|
| Rate for Payer: Prime Health Services Commercial |
$90.10
|
|
|
HC CALCIUM IONIZED CH
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 82330
|
| Hospital Charge Code |
900912178
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$141.06 |
| Rate for Payer: Adventist Health Commercial |
$11.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$113.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$141.06
|
| Rate for Payer: Blue Shield of California Commercial |
$25.82
|
| Rate for Payer: Blue Shield of California Commercial |
$39.03
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna of CA HMO |
$35.84
|
| Rate for Payer: Cigna of CA PPO |
$41.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$39.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.57
|
| Rate for Payer: EPIC Health Plan Senior |
$15.05
|
| Rate for Payer: Galaxy Health WC |
$47.60
|
| Rate for Payer: Global Benefits Group Commercial |
$33.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$35.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.33
|
| Rate for Payer: Multiplan Commercial |
$44.80
|
| Rate for Payer: Networks By Design Commercial |
$36.40
|
| Rate for Payer: Prime Health Services Commercial |
$47.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.08
|
| Rate for Payer: United Healthcare All Other HMO |
$11.08
|
| Rate for Payer: United Healthcare HMO Rider |
$11.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.08
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.05
|
| Rate for Payer: Vantage Medical Group Senior |
$13.68
|
|
|
HC CALCIUM IONIZED CH
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 82330
|
| Hospital Charge Code |
900912178
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$47.60 |
| Rate for Payer: Networks By Design Commercial |
$36.40
|
| Rate for Payer: Adventist Health Commercial |
$11.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$39.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.40
|
| Rate for Payer: EPIC Health Plan Senior |
$22.40
|
| Rate for Payer: Galaxy Health WC |
$47.60
|
| Rate for Payer: Global Benefits Group Commercial |
$33.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$35.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.44
|
| Rate for Payer: Multiplan Commercial |
$44.80
|
| Rate for Payer: Prime Health Services Commercial |
$47.60
|
|
|
HC CALCIUM TOTAL
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 82310
|
| Hospital Charge Code |
900910239
|
|
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 CALCIUM TOTAL
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
CPT 82310
|
| Hospital Charge Code |
900910239
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.18 |
| Max. Negotiated Rate |
$53.09 |
| Rate for Payer: Adventist Health Commercial |
$6.80
|
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$42.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$42.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.09
|
| 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 |
$7.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.16
|
| 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 |
$8.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.51
|
| Rate for Payer: EPIC Health Plan Senior |
$5.68
|
| Rate for Payer: EPIC Health Plan Senior |
$5.68
|
| 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 |
$8.46
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.16
|
| 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 |
$7.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.22
|
| 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 |
$6.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.91
|
| 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 |
$4.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.18
|
| Rate for Payer: United Healthcare All Other HMO |
$4.18
|
| Rate for Payer: United Healthcare All Other HMO |
$4.18
|
| Rate for Payer: United Healthcare HMO Rider |
$4.18
|
| Rate for Payer: United Healthcare HMO Rider |
$4.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.18
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.16
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.68
|
| Rate for Payer: Vantage Medical Group Senior |
$5.16
|
| Rate for Payer: Vantage Medical Group Senior |
$5.16
|
|
|
HC CALCIUM TOTAL INDIVIDUAL
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 82310
|
| Hospital Charge Code |
900910494
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.18 |
| Max. Negotiated Rate |
$53.09 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$42.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.09
|
| 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 |
$7.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.51
|
| Rate for Payer: EPIC Health Plan Senior |
$5.68
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.91
|
| 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 |
$4.18
|
| Rate for Payer: United Healthcare All Other HMO |
$4.18
|
| Rate for Payer: United Healthcare HMO Rider |
$4.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.18
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.68
|
| Rate for Payer: Vantage Medical Group Senior |
$5.16
|
|
|
HC CALCIUM TOTAL INDIVIDUAL
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 82310
|
| Hospital Charge Code |
900910494
|
|
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 CANDIDA AURIS PCR
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT 87481
|
| Hospital Charge Code |
900913697
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$350.50 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$291.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$291.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$350.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$350.50
|
| Rate for Payer: Blue Shield of California Commercial |
$24.89
|
| Rate for Payer: Blue Shield of California Commercial |
$20.75
|
| Rate for Payer: Blue Shield of California Commercial |
$37.64
|
| Rate for Payer: Blue Shield of California Commercial |
$31.36
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cigna of CA HMO |
$34.56
|
| Rate for Payer: Cigna of CA HMO |
$28.80
|
| Rate for Payer: Cigna of CA PPO |
$33.30
|
| Rate for Payer: Cigna of CA PPO |
$39.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$31.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.90
|
| Rate for Payer: EPIC Health Plan Senior |
$38.60
|
| Rate for Payer: EPIC Health Plan Senior |
$38.60
|
| Rate for Payer: Galaxy Health WC |
$38.25
|
| Rate for Payer: Galaxy Health WC |
$45.90
|
| Rate for Payer: Global Benefits Group Commercial |
$27.00
|
| Rate for Payer: Global Benefits Group Commercial |
$32.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.55
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$52.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$52.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$59.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$59.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$43.20
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: Networks By Design Commercial |
$35.10
|
| Rate for Payer: Networks By Design Commercial |
$29.25
|
| Rate for Payer: Prime Health Services Commercial |
$38.25
|
| Rate for Payer: Prime Health Services Commercial |
$45.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$35.09
|
| Rate for Payer: Upland Medical Group Pediatric |
$35.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC CANDIDA AURIS PCR
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
CPT 87481
|
| Hospital Charge Code |
900913697
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.60
|
| Rate for Payer: EPIC Health Plan Senior |
$21.60
|
| Rate for Payer: Galaxy Health WC |
$45.90
|
| Rate for Payer: Global Benefits Group Commercial |
$32.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.96
|
| Rate for Payer: Multiplan Commercial |
$43.20
|
| Rate for Payer: Networks By Design Commercial |
$35.10
|
| Rate for Payer: Prime Health Services Commercial |
$45.90
|
|
|
HC CANNABINOIDS SEMI-QUANTITATIVE
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900910380
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.10 |
| Max. Negotiated Rate |
$150.30 |
| Rate for Payer: Adventist Health Commercial |
$23.80
|
| Rate for Payer: Adventist Health Commercial |
$19.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$110.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$110.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.30
|
| Rate for Payer: Blue Shield of California Commercial |
$45.64
|
| Rate for Payer: Blue Shield of California Commercial |
$54.86
|
| Rate for Payer: Blue Shield of California Commercial |
$69.00
|
| Rate for Payer: Blue Shield of California Commercial |
$82.94
|
| Rate for Payer: Cash Price |
$44.55
|
| Rate for Payer: Cash Price |
$44.55
|
| Rate for Payer: Cash Price |
$53.55
|
| Rate for Payer: Cash Price |
$53.55
|
| Rate for Payer: Cigna of CA HMO |
$63.36
|
| Rate for Payer: Cigna of CA HMO |
$76.16
|
| Rate for Payer: Cigna of CA PPO |
$88.06
|
| Rate for Payer: Cigna of CA PPO |
$73.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$83.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$69.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.76
|
| Rate for Payer: EPIC Health Plan Senior |
$20.50
|
| Rate for Payer: EPIC Health Plan Senior |
$20.50
|
| Rate for Payer: Galaxy Health WC |
$101.15
|
| Rate for Payer: Galaxy Health WC |
$84.15
|
| Rate for Payer: Global Benefits Group Commercial |
$71.40
|
| Rate for Payer: Global Benefits Group Commercial |
$59.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.57
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$75.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$62.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.98
|
| Rate for Payer: Multiplan Commercial |
$79.20
|
| Rate for Payer: Multiplan Commercial |
$95.20
|
| Rate for Payer: Networks By Design Commercial |
$64.35
|
| Rate for Payer: Networks By Design Commercial |
$77.35
|
| Rate for Payer: Prime Health Services Commercial |
$101.15
|
| Rate for Payer: Prime Health Services Commercial |
$84.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$71.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$59.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$71.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$59.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.10
|
| Rate for Payer: United Healthcare All Other HMO |
$15.10
|
| Rate for Payer: United Healthcare All Other HMO |
$15.10
|
| Rate for Payer: United Healthcare HMO Rider |
$15.10
|
| Rate for Payer: United Healthcare HMO Rider |
$15.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.10
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.64
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Vantage Medical Group Senior |
$18.64
|
| Rate for Payer: Vantage Medical Group Senior |
$18.64
|
|
|
HC CANNABINOIDS SEMI-QUANTITATIVE
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900910380
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.80 |
| Max. Negotiated Rate |
$101.15 |
| Rate for Payer: Adventist Health Commercial |
$23.80
|
| Rate for Payer: Cash Price |
$53.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$83.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.60
|
| Rate for Payer: EPIC Health Plan Senior |
$47.60
|
| Rate for Payer: Galaxy Health WC |
$101.15
|
| Rate for Payer: Global Benefits Group Commercial |
$71.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$75.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$70.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.56
|
| Rate for Payer: Multiplan Commercial |
$95.20
|
| Rate for Payer: Networks By Design Commercial |
$77.35
|
| Rate for Payer: Prime Health Services Commercial |
$101.15
|
|
|
HC CANN INNER #6 EXT LENGTH
|
Facility
|
IP
|
$54.12
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
901604685
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$46.00 |
| Rate for Payer: Adventist Health Commercial |
$10.82
|
| Rate for Payer: Cash Price |
$24.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.65
|
| Rate for Payer: EPIC Health Plan Senior |
$21.65
|
| Rate for Payer: Galaxy Health WC |
$46.00
|
| Rate for Payer: Global Benefits Group Commercial |
$32.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.99
|
| Rate for Payer: Multiplan Commercial |
$43.30
|
| Rate for Payer: Networks By Design Commercial |
$35.18
|
| Rate for Payer: Prime Health Services Commercial |
$46.00
|
|
|
HC CANN INNER #6 EXT LENGTH
|
Facility
|
OP
|
$54.12
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
901604685
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$46.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$18.70
|
| Rate for Payer: Adventist Health Commercial |
$10.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.73
|
| Rate for Payer: Cash Price |
$24.35
|
| Rate for Payer: Cash Price |
$24.35
|
| Rate for Payer: Cigna of CA HMO |
$34.64
|
| Rate for Payer: Cigna of CA PPO |
$40.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$46.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$46.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.65
|
| Rate for Payer: EPIC Health Plan Senior |
$21.65
|
| Rate for Payer: Galaxy Health WC |
$46.00
|
| Rate for Payer: Global Benefits Group Commercial |
$32.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37.88
|
| Rate for Payer: Multiplan Commercial |
$43.30
|
| Rate for Payer: Networks By Design Commercial |
$35.18
|
| Rate for Payer: Prime Health Services Commercial |
$46.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.06
|
| Rate for Payer: United Healthcare All Other HMO |
$27.06
|
| Rate for Payer: United Healthcare HMO Rider |
$27.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$46.00
|
| Rate for Payer: Vantage Medical Group Senior |
$46.00
|
|
|
HC CANN INNER #7 EXT LENGTH
|
Facility
|
IP
|
$54.12
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
901604683
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$46.00 |
| Rate for Payer: Adventist Health Commercial |
$10.82
|
| Rate for Payer: Cash Price |
$24.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.65
|
| Rate for Payer: EPIC Health Plan Senior |
$21.65
|
| Rate for Payer: Galaxy Health WC |
$46.00
|
| Rate for Payer: Global Benefits Group Commercial |
$32.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.99
|
| Rate for Payer: Multiplan Commercial |
$43.30
|
| Rate for Payer: Networks By Design Commercial |
$35.18
|
| Rate for Payer: Prime Health Services Commercial |
$46.00
|
|
|
HC CANN INNER #7 EXT LENGTH
|
Facility
|
OP
|
$54.12
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
901604683
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$46.00 |
| Rate for Payer: Adventist Health Commercial |
$10.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.73
|
| Rate for Payer: Cash Price |
$24.35
|
| Rate for Payer: Cash Price |
$24.35
|
| Rate for Payer: Cigna of CA HMO |
$34.64
|
| Rate for Payer: Cigna of CA PPO |
$40.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$46.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$46.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.65
|
| Rate for Payer: EPIC Health Plan Senior |
$21.65
|
| Rate for Payer: Galaxy Health WC |
$46.00
|
| Rate for Payer: Global Benefits Group Commercial |
$32.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37.88
|
| Rate for Payer: Multiplan Commercial |
$43.30
|
| Rate for Payer: Networks By Design Commercial |
$35.18
|
| Rate for Payer: Prime Health Services Commercial |
$46.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.06
|
| Rate for Payer: United Healthcare All Other HMO |
$27.06
|
| Rate for Payer: United Healthcare HMO Rider |
$27.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$46.00
|
| Rate for Payer: Vantage Medical Group Senior |
$46.00
|
|
|
HC CANN INNER #8 EXT LENGTH
|
Facility
|
IP
|
$54.12
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
901604682
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$46.00 |
| Rate for Payer: Adventist Health Commercial |
$10.82
|
| Rate for Payer: Cash Price |
$24.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.65
|
| Rate for Payer: EPIC Health Plan Senior |
$21.65
|
| Rate for Payer: Galaxy Health WC |
$46.00
|
| Rate for Payer: Global Benefits Group Commercial |
$32.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.99
|
| Rate for Payer: Multiplan Commercial |
$43.30
|
| Rate for Payer: Networks By Design Commercial |
$35.18
|
| Rate for Payer: Prime Health Services Commercial |
$46.00
|
|
|
HC CANN INNER #8 EXT LENGTH
|
Facility
|
OP
|
$54.12
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
901604682
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$46.00 |
| Rate for Payer: Adventist Health Commercial |
$10.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.73
|
| Rate for Payer: Cash Price |
$24.35
|
| Rate for Payer: Cash Price |
$24.35
|
| Rate for Payer: Cigna of CA HMO |
$34.64
|
| Rate for Payer: Cigna of CA PPO |
$40.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$46.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$46.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.65
|
| Rate for Payer: EPIC Health Plan Senior |
$21.65
|
| Rate for Payer: Galaxy Health WC |
$46.00
|
| Rate for Payer: Global Benefits Group Commercial |
$32.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37.88
|
| Rate for Payer: Multiplan Commercial |
$43.30
|
| Rate for Payer: Networks By Design Commercial |
$35.18
|
| Rate for Payer: Prime Health Services Commercial |
$46.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.06
|
| Rate for Payer: United Healthcare All Other HMO |
$27.06
|
| Rate for Payer: United Healthcare HMO Rider |
$27.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$46.00
|
| Rate for Payer: Vantage Medical Group Senior |
$46.00
|
|
|
HC CANN TRACH SHILEY SIZE 4
|
Facility
|
IP
|
$24.93
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
901600953
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.99 |
| Max. Negotiated Rate |
$21.19 |
| Rate for Payer: Adventist Health Commercial |
$4.99
|
| Rate for Payer: Cash Price |
$11.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.97
|
| Rate for Payer: EPIC Health Plan Senior |
$9.97
|
| Rate for Payer: Galaxy Health WC |
$21.19
|
| Rate for Payer: Global Benefits Group Commercial |
$14.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.98
|
| Rate for Payer: Multiplan Commercial |
$19.94
|
| Rate for Payer: Networks By Design Commercial |
$16.20
|
| Rate for Payer: Prime Health Services Commercial |
$21.19
|
|
|
HC CANN TRACH SHILEY SIZE 4
|
Facility
|
OP
|
$24.93
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
901600953
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.99 |
| Max. Negotiated Rate |
$21.19 |
| Rate for Payer: Adventist Health Commercial |
$4.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.00
|
| Rate for Payer: Cash Price |
$11.22
|
| Rate for Payer: Cash Price |
$11.22
|
| Rate for Payer: Cigna of CA HMO |
$15.96
|
| Rate for Payer: Cigna of CA PPO |
$18.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.97
|
| Rate for Payer: EPIC Health Plan Senior |
$9.97
|
| Rate for Payer: Galaxy Health WC |
$21.19
|
| Rate for Payer: Global Benefits Group Commercial |
$14.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.45
|
| Rate for Payer: Multiplan Commercial |
$19.94
|
| Rate for Payer: Networks By Design Commercial |
$16.20
|
| Rate for Payer: Prime Health Services Commercial |
$21.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.46
|
| Rate for Payer: United Healthcare All Other HMO |
$12.46
|
| Rate for Payer: United Healthcare HMO Rider |
$12.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.19
|
| Rate for Payer: Vantage Medical Group Senior |
$21.19
|
|
|
HC CANN TRACH SHILEY SIZE 6
|
Facility
|
IP
|
$24.93
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
901600966
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.99 |
| Max. Negotiated Rate |
$21.19 |
| Rate for Payer: Adventist Health Commercial |
$4.99
|
| Rate for Payer: Cash Price |
$11.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.97
|
| Rate for Payer: EPIC Health Plan Senior |
$9.97
|
| Rate for Payer: Galaxy Health WC |
$21.19
|
| Rate for Payer: Global Benefits Group Commercial |
$14.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.98
|
| Rate for Payer: Multiplan Commercial |
$19.94
|
| Rate for Payer: Networks By Design Commercial |
$16.20
|
| Rate for Payer: Prime Health Services Commercial |
$21.19
|
|
