|
HC CORONARY STENT SINGLE VESSEL
|
Facility
|
IP
|
$23,492.00
|
|
|
Service Code
|
CPT 92928
|
| Hospital Charge Code |
906820239
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,698.40 |
| Max. Negotiated Rate |
$19,968.20 |
| Rate for Payer: Adventist Health Commercial |
$4,698.40
|
| Rate for Payer: Cash Price |
$10,571.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,396.80
|
| Rate for Payer: EPIC Health Plan Senior |
$9,396.80
|
| Rate for Payer: Galaxy Health WC |
$19,968.20
|
| Rate for Payer: Global Benefits Group Commercial |
$14,095.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,669.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,950.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,541.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,638.08
|
| Rate for Payer: Multiplan Commercial |
$18,793.60
|
| Rate for Payer: Networks By Design Commercial |
$15,269.80
|
| Rate for Payer: Prime Health Services Commercial |
$19,968.20
|
|
|
HC CORONARY THROMBECTOMY
|
Facility
|
IP
|
$7,778.00
|
|
|
Service Code
|
CPT 92973
|
| Hospital Charge Code |
906820083
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,555.60 |
| Max. Negotiated Rate |
$6,611.30 |
| Rate for Payer: Adventist Health Commercial |
$1,555.60
|
| Rate for Payer: Cash Price |
$3,500.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,111.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,111.20
|
| Rate for Payer: Galaxy Health WC |
$6,611.30
|
| Rate for Payer: Global Benefits Group Commercial |
$4,666.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,187.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,963.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,814.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,866.72
|
| Rate for Payer: Multiplan Commercial |
$6,222.40
|
| Rate for Payer: Networks By Design Commercial |
$5,055.70
|
| Rate for Payer: Prime Health Services Commercial |
$6,611.30
|
|
|
HC CORONARY THROMBECTOMY
|
Facility
|
OP
|
$8,003.00
|
|
|
Service Code
|
CPT 92973
|
| Hospital Charge Code |
906812217
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$246.47 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,600.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,802.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,401.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,002.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,922.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$3,601.35
|
| Rate for Payer: Cash Price |
$3,601.35
|
| Rate for Payer: Cash Price |
$3,601.35
|
| Rate for Payer: Cigna of CA HMO |
$5,201.95
|
| Rate for Payer: Cigna of CA PPO |
$5,922.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,802.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,802.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,802.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,201.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,201.20
|
| Rate for Payer: Galaxy Health WC |
$6,802.55
|
| Rate for Payer: Global Benefits Group Commercial |
$4,801.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$246.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,338.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$278.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,953.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,920.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,602.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,602.10
|
| Rate for Payer: Multiplan Commercial |
$6,402.40
|
| Rate for Payer: Networks By Design Commercial |
$5,201.95
|
| Rate for Payer: Prime Health Services Commercial |
$6,802.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,801.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,801.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,802.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,802.55
|
| Rate for Payer: Vantage Medical Group Senior |
$6,802.55
|
|
|
HC CORONARY THROMBECTOMY
|
Facility
|
OP
|
$7,778.00
|
|
|
Service Code
|
CPT 92973
|
| Hospital Charge Code |
906820083
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$246.47 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,555.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,611.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,277.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,833.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,922.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$3,500.10
|
| Rate for Payer: Cash Price |
$3,500.10
|
| Rate for Payer: Cash Price |
$3,500.10
|
| Rate for Payer: Cigna of CA HMO |
$5,055.70
|
| Rate for Payer: Cigna of CA PPO |
$5,755.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,611.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,611.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,611.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,111.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,111.20
|
| Rate for Payer: Galaxy Health WC |
$6,611.30
|
| Rate for Payer: Global Benefits Group Commercial |
$4,666.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$246.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,187.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$278.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,814.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,866.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,444.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,444.60
|
| Rate for Payer: Multiplan Commercial |
$6,222.40
|
| Rate for Payer: Networks By Design Commercial |
$5,055.70
|
| Rate for Payer: Prime Health Services Commercial |
$6,611.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,666.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,666.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,611.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,611.30
|
| Rate for Payer: Vantage Medical Group Senior |
$6,611.30
|
|
|
HC CORONARY THROMBECTOMY
|
Facility
|
IP
|
$8,003.00
|
|
|
Service Code
|
CPT 92973
|
| Hospital Charge Code |
906812217
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,600.60 |
| Max. Negotiated Rate |
$6,802.55 |
| Rate for Payer: Adventist Health Commercial |
$1,600.60
|
| Rate for Payer: Cash Price |
$3,601.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,201.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,201.20
|
| Rate for Payer: Galaxy Health WC |
$6,802.55
|
| Rate for Payer: Global Benefits Group Commercial |
$4,801.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,338.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,049.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,953.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,920.72
|
| Rate for Payer: Multiplan Commercial |
$6,402.40
|
| Rate for Payer: Networks By Design Commercial |
$5,201.95
|
| Rate for Payer: Prime Health Services Commercial |
$6,802.55
|
|
|
HC CORPORA CAVERNOSA-GLANS PENIS
|
Facility
|
OP
|
$7,274.00
|
|
|
Service Code
|
CPT 54435
|
| Hospital Charge Code |
900501751
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$164.10 |
| Max. Negotiated Rate |
$12,491.00 |
| Rate for Payer: Adventist Health Commercial |
$1,454.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,573.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,820.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,382.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,712.00
|
| Rate for Payer: Cash Price |
$3,273.30
|
| Rate for Payer: Cash Price |
$3,273.30
|
| Rate for Payer: Cash Price |
$3,273.30
|
| Rate for Payer: Cigna of CA HMO |
$4,655.36
|
| Rate for Payer: Cigna of CA PPO |
$5,382.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,573.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,820.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,382.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,916.05
|
| Rate for Payer: EPIC Health Plan Senior |
$4,382.26
|
| Rate for Payer: Galaxy Health WC |
$6,182.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,364.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,186.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,382.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,851.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$164.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,382.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,745.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,521.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,872.23
|
| Rate for Payer: Multiplan Commercial |
$5,819.20
|
| Rate for Payer: Multiplan WC |
$6,982.34
|
| Rate for Payer: Networks By Design Commercial |
$4,728.10
|
| Rate for Payer: Prime Health Services Commercial |
$6,182.90
|
| Rate for Payer: Prime Health Services WC |
$6,911.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,364.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,637.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,637.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,637.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,637.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,382.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,573.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,820.49
|
| Rate for Payer: Vantage Medical Group Senior |
$4,382.26
|
|
|
HC CORPORA CAVERNOSA-GLANS PENIS
|
Facility
|
IP
|
$7,274.00
|
|
|
Service Code
|
CPT 54435
|
| Hospital Charge Code |
900501751
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,454.80 |
| Max. Negotiated Rate |
$6,182.90 |
| Rate for Payer: Adventist Health Commercial |
$1,454.80
|
| Rate for Payer: Cash Price |
$3,273.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,909.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,909.60
|
| Rate for Payer: Galaxy Health WC |
$6,182.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,364.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,851.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,771.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,502.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,745.76
|
| Rate for Payer: Multiplan Commercial |
$5,819.20
|
| Rate for Payer: Networks By Design Commercial |
$4,728.10
|
| Rate for Payer: Prime Health Services Commercial |
$6,182.90
|
|
|
HC CORPORA CAVERNOSOGRAPHY
|
Facility
|
OP
|
$759.00
|
|
|
Service Code
|
CPT 74445
|
| Hospital Charge Code |
909080040
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$87.21 |
| Max. Negotiated Rate |
$645.15 |
| Rate for Payer: Adventist Health Commercial |
$151.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$497.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$320.72
|
| Rate for Payer: Blue Shield of California Commercial |
$464.51
|
| Rate for Payer: Blue Shield of California EPN |
$306.64
|
| Rate for Payer: Cash Price |
$341.55
|
| Rate for Payer: Cash Price |
$341.55
|
| Rate for Payer: Cigna of CA HMO |
$485.76
|
| Rate for Payer: Cigna of CA PPO |
$561.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$645.15
|
| Rate for Payer: Global Benefits Group Commercial |
$455.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$87.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$506.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$182.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$607.20
|
| Rate for Payer: Networks By Design Commercial |
$493.35
|
| Rate for Payer: Prime Health Services Commercial |
$645.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$455.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$455.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$470.69
|
| Rate for Payer: United Healthcare All Other HMO |
$470.69
|
| Rate for Payer: United Healthcare HMO Rider |
$470.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$470.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC CORPORA CAVERNOSOGRAPHY
|
Facility
|
IP
|
$759.00
|
|
|
Service Code
|
CPT 74445
|
| Hospital Charge Code |
909080040
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$151.80 |
| Max. Negotiated Rate |
$645.15 |
| Rate for Payer: Networks By Design Commercial |
$493.35
|
| Rate for Payer: Adventist Health Commercial |
$151.80
|
| Rate for Payer: Cash Price |
$341.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$303.60
|
| Rate for Payer: EPIC Health Plan Senior |
$303.60
|
| Rate for Payer: Galaxy Health WC |
$645.15
|
| Rate for Payer: Global Benefits Group Commercial |
$455.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$506.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$289.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$469.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$182.16
|
| Rate for Payer: Multiplan Commercial |
$607.20
|
| Rate for Payer: Prime Health Services Commercial |
$645.15
|
|
|
HC CORTISOL
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
900912125
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$161.19 |
| Rate for Payer: Adventist Health Commercial |
$25.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$83.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$161.19
|
| Rate for Payer: Blue Shield of California Commercial |
$85.63
|
| Rate for Payer: Blue Shield of California EPN |
$56.58
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna of CA HMO |
$81.92
|
| Rate for Payer: Cigna of CA PPO |
$94.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.00
|
| Rate for Payer: EPIC Health Plan Senior |
$16.30
|
| Rate for Payer: Galaxy Health WC |
$108.80
|
| Rate for Payer: Global Benefits Group Commercial |
$76.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$85.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.84
|
| Rate for Payer: Multiplan Commercial |
$102.40
|
| Rate for Payer: Networks By Design Commercial |
$83.20
|
| Rate for Payer: Prime Health Services Commercial |
$108.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$76.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$76.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.20
|
| Rate for Payer: United Healthcare All Other HMO |
$13.20
|
| Rate for Payer: United Healthcare HMO Rider |
$13.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.20
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.93
|
| Rate for Payer: Vantage Medical Group Senior |
$16.30
|
|
|
HC CORTISOL
|
Facility
|
IP
|
$296.00
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
900912125
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$59.20 |
| Max. Negotiated Rate |
$251.60 |
| Rate for Payer: Adventist Health Commercial |
$59.20
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.40
|
| Rate for Payer: EPIC Health Plan Senior |
$118.40
|
| Rate for Payer: Galaxy Health WC |
$251.60
|
| Rate for Payer: Global Benefits Group Commercial |
$177.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$197.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$183.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.04
|
| Rate for Payer: Multiplan Commercial |
$236.80
|
| Rate for Payer: Networks By Design Commercial |
$192.40
|
| Rate for Payer: Prime Health Services Commercial |
$251.60
|
|
|
HC COUGH ASSIST
|
Facility
|
IP
|
$499.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900801124
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$99.80 |
| Max. Negotiated Rate |
$424.15 |
| Rate for Payer: Adventist Health Commercial |
$99.80
|
| Rate for Payer: Cash Price |
$224.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$199.60
|
| Rate for Payer: EPIC Health Plan Senior |
$199.60
|
| Rate for Payer: Galaxy Health WC |
$424.15
|
| Rate for Payer: Global Benefits Group Commercial |
$299.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$332.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$190.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$308.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.76
|
| Rate for Payer: Multiplan Commercial |
$399.20
|
| Rate for Payer: Networks By Design Commercial |
$324.35
|
| Rate for Payer: Prime Health Services Commercial |
$424.15
|
|
|
HC COUGH ASSIST
|
Facility
|
OP
|
$499.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900801124
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$99.80 |
| Max. Negotiated Rate |
$764.00 |
| Rate for Payer: Adventist Health Commercial |
$99.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$327.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.44
|
| Rate for Payer: Blue Shield of California Commercial |
$305.39
|
| Rate for Payer: Blue Shield of California EPN |
$201.60
|
| Rate for Payer: Cash Price |
$224.55
|
| Rate for Payer: Cash Price |
$224.55
|
| Rate for Payer: Cash Price |
$224.55
|
| Rate for Payer: Cigna of CA HMO |
$319.36
|
| Rate for Payer: Cigna of CA PPO |
$369.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.38
|
| Rate for Payer: EPIC Health Plan Senior |
$198.80
|
| Rate for Payer: Galaxy Health WC |
$424.15
|
| Rate for Payer: Global Benefits Group Commercial |
$299.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$326.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$332.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$250.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$266.39
|
| Rate for Payer: Multiplan Commercial |
$399.20
|
| Rate for Payer: Networks By Design Commercial |
$324.35
|
| Rate for Payer: Prime Health Services Commercial |
$424.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$299.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$299.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$764.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$731.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$669.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$198.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Vantage Medical Group Senior |
$198.80
|
|
|
HC COVID19 CONVALESCENT PLASMA
|
Facility
|
OP
|
$1,295.00
|
|
|
Service Code
|
CPT C9507
|
| Hospital Charge Code |
900909507
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$259.00 |
| Max. Negotiated Rate |
$1,434.42 |
| Rate for Payer: Adventist Health Commercial |
$259.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$849.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$811.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$594.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$540.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$795.26
|
| Rate for Payer: Cash Price |
$582.75
|
| Rate for Payer: Cash Price |
$582.75
|
| Rate for Payer: Cash Price |
$582.75
|
| Rate for Payer: Cigna of CA HMO |
$828.80
|
| Rate for Payer: Cigna of CA PPO |
$958.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$811.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$594.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$540.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$730.07
|
| Rate for Payer: EPIC Health Plan Senior |
$540.79
|
| Rate for Payer: Galaxy Health WC |
$1,100.75
|
| Rate for Payer: Global Benefits Group Commercial |
$777.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$886.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,268.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$540.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$863.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,434.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$540.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$310.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$681.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$724.66
|
| Rate for Payer: Multiplan Commercial |
$1,036.00
|
| Rate for Payer: Networks By Design Commercial |
$841.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,100.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$777.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$777.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$540.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$811.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$594.87
|
| Rate for Payer: Vantage Medical Group Senior |
$540.79
|
|
|
HC COVID19 CONVALESCENT PLASMA
|
Facility
|
IP
|
$1,295.00
|
|
|
Service Code
|
CPT C9507
|
| Hospital Charge Code |
900909507
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$259.00 |
| Max. Negotiated Rate |
$1,100.75 |
| Rate for Payer: Adventist Health Commercial |
$259.00
|
| Rate for Payer: Cash Price |
$582.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$518.00
|
| Rate for Payer: EPIC Health Plan Senior |
$518.00
|
| Rate for Payer: Galaxy Health WC |
$1,100.75
|
| Rate for Payer: Global Benefits Group Commercial |
$777.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$863.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$493.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$801.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$310.80
|
| Rate for Payer: Multiplan Commercial |
$1,036.00
|
| Rate for Payer: Networks By Design Commercial |
$841.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,100.75
|
|
|
HC COVID19 CONVLESNT PLASMA, DIVIDED
|
Facility
|
OP
|
$1,218.00
|
|
|
Service Code
|
CPT P9011
|
| Hospital Charge Code |
900904011
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$180.17 |
| Max. Negotiated Rate |
$1,035.30 |
| Rate for Payer: Adventist Health Commercial |
$243.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$798.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$270.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$198.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$180.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$747.97
|
| Rate for Payer: Cash Price |
$548.10
|
| Rate for Payer: Cash Price |
$548.10
|
| Rate for Payer: Cash Price |
$548.10
|
| Rate for Payer: Cigna of CA HMO |
$779.52
|
| Rate for Payer: Cigna of CA PPO |
$901.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$270.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$198.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$180.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$243.23
|
| Rate for Payer: EPIC Health Plan Senior |
$180.17
|
| Rate for Payer: Galaxy Health WC |
$1,035.30
|
| Rate for Payer: Global Benefits Group Commercial |
$730.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$295.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$250.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$180.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$812.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$283.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$180.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$292.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$227.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$241.43
|
| Rate for Payer: Multiplan Commercial |
$974.40
|
| Rate for Payer: Networks By Design Commercial |
$791.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,035.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$730.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$730.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$180.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$270.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$198.19
|
| Rate for Payer: Vantage Medical Group Senior |
$180.17
|
|
|
HC COVID19 CONVLESNT PLASMA, DIVIDED
|
Facility
|
IP
|
$1,218.00
|
|
|
Service Code
|
CPT P9011
|
| Hospital Charge Code |
900904011
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$243.60 |
| Max. Negotiated Rate |
$1,035.30 |
| Rate for Payer: Adventist Health Commercial |
$243.60
|
| Rate for Payer: Cash Price |
$548.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$487.20
|
| Rate for Payer: EPIC Health Plan Senior |
$487.20
|
| Rate for Payer: Galaxy Health WC |
$1,035.30
|
| Rate for Payer: Global Benefits Group Commercial |
$730.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$812.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$464.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$753.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$292.32
|
| Rate for Payer: Multiplan Commercial |
$974.40
|
| Rate for Payer: Networks By Design Commercial |
$791.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,035.30
|
|
|
HC COVID 19 IGM IGG
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
CPT 86318
|
| Hospital Charge Code |
900912259
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$25.80 |
| Max. Negotiated Rate |
$109.65 |
| Rate for Payer: Adventist Health Commercial |
$25.80
|
| Rate for Payer: Cash Price |
$58.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.60
|
| Rate for Payer: EPIC Health Plan Senior |
$51.60
|
| Rate for Payer: Galaxy Health WC |
$109.65
|
| Rate for Payer: Global Benefits Group Commercial |
$77.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$86.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$79.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.96
|
| Rate for Payer: Multiplan Commercial |
$103.20
|
| Rate for Payer: Networks By Design Commercial |
$83.85
|
| Rate for Payer: Prime Health Services Commercial |
$109.65
|
|
|
HC COVID 19 IGM IGG
|
Facility
|
OP
|
$89.00
|
|
|
Service Code
|
CPT 86318
|
| Hospital Charge Code |
900912259
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$14.65 |
| Max. Negotiated Rate |
$127.87 |
| Rate for Payer: Adventist Health Commercial |
$17.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$58.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.87
|
| Rate for Payer: Blue Shield of California Commercial |
$59.54
|
| Rate for Payer: Blue Shield of California EPN |
$39.34
|
| Rate for Payer: Cash Price |
$40.05
|
| Rate for Payer: Cash Price |
$40.05
|
| Rate for Payer: Cigna of CA HMO |
$56.96
|
| Rate for Payer: Cigna of CA PPO |
$65.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.42
|
| Rate for Payer: EPIC Health Plan Senior |
$18.09
|
| Rate for Payer: Galaxy Health WC |
$75.65
|
| Rate for Payer: Global Benefits Group Commercial |
$53.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$59.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.24
|
| Rate for Payer: Multiplan Commercial |
$71.20
|
| Rate for Payer: Networks By Design Commercial |
$57.85
|
| Rate for Payer: Prime Health Services Commercial |
$75.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$53.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$53.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.65
|
| Rate for Payer: United Healthcare All Other HMO |
$14.65
|
| Rate for Payer: United Healthcare HMO Rider |
$14.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.65
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.90
|
| Rate for Payer: Vantage Medical Group Senior |
$18.09
|
|
|
HC COVID19 SCREEN POOL
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
900912262
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$356.36 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$62.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$356.36
|
| Rate for Payer: Blue Shield of California Commercial |
$13.38
|
| Rate for Payer: Blue Shield of California EPN |
$8.84
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna of CA HMO |
$12.80
|
| Rate for Payer: Cigna of CA PPO |
$14.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.27
|
| Rate for Payer: EPIC Health Plan Senior |
$51.31
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$84.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$86.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$51.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$64.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$68.76
|
| Rate for Payer: Multiplan Commercial |
$16.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.56
|
| Rate for Payer: United Healthcare All Other HMO |
$41.56
|
| Rate for Payer: United Healthcare HMO Rider |
$41.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$51.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.44
|
| Rate for Payer: Vantage Medical Group Senior |
$51.31
|
|
|
HC COVID19 SCREEN POOL
|
Facility
|
IP
|
$386.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
900912262
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$77.20 |
| Max. Negotiated Rate |
$328.10 |
| Rate for Payer: Adventist Health Commercial |
$77.20
|
| Rate for Payer: Cash Price |
$173.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$154.40
|
| Rate for Payer: EPIC Health Plan Senior |
$154.40
|
| Rate for Payer: Galaxy Health WC |
$328.10
|
| Rate for Payer: Global Benefits Group Commercial |
$231.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$257.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$147.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$238.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.64
|
| Rate for Payer: Multiplan Commercial |
$308.80
|
| Rate for Payer: Networks By Design Commercial |
$250.90
|
| Rate for Payer: Prime Health Services Commercial |
$328.10
|
|
|
HC COVID VENI OR SWAB W SPCMN
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
CPT C9803
|
| Hospital Charge Code |
900518903
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.40 |
| Max. Negotiated Rate |
$152.81 |
| Rate for Payer: Adventist Health Commercial |
$6.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$20.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$152.81
|
| Rate for Payer: Blue Shield of California Commercial |
$21.41
|
| Rate for Payer: Blue Shield of California EPN |
$14.14
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna of CA HMO |
$20.48
|
| Rate for Payer: Cigna of CA PPO |
$23.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.80
|
| Rate for Payer: EPIC Health Plan Senior |
$12.80
|
| Rate for Payer: Galaxy Health WC |
$27.20
|
| Rate for Payer: Global Benefits Group Commercial |
$19.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.40
|
| Rate for Payer: Multiplan Commercial |
$25.60
|
| Rate for Payer: Networks By Design Commercial |
$20.80
|
| Rate for Payer: Prime Health Services Commercial |
$27.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.44
|
| Rate for Payer: United Healthcare All Other HMO |
$20.44
|
| Rate for Payer: United Healthcare HMO Rider |
$20.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.20
|
| Rate for Payer: Vantage Medical Group Senior |
$27.20
|
|
|
HC COVID VENI OR SWAB W SPCMN
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
CPT C9803
|
| Hospital Charge Code |
900518903
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.40 |
| Max. Negotiated Rate |
$27.20 |
| Rate for Payer: Adventist Health Commercial |
$6.40
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.80
|
| Rate for Payer: EPIC Health Plan Senior |
$12.80
|
| Rate for Payer: Galaxy Health WC |
$27.20
|
| Rate for Payer: Global Benefits Group Commercial |
$19.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.68
|
| Rate for Payer: Multiplan Commercial |
$25.60
|
| Rate for Payer: Networks By Design Commercial |
$20.80
|
| Rate for Payer: Prime Health Services Commercial |
$27.20
|
|
|
HC CPAP/BIPAP/NIPPV - DAILY
|
Facility
|
IP
|
$5,391.00
|
|
|
Service Code
|
CPT 94660
|
| Hospital Charge Code |
900800110
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$1,078.20 |
| Max. Negotiated Rate |
$4,582.35 |
| Rate for Payer: Adventist Health Commercial |
$1,078.20
|
| Rate for Payer: Cash Price |
$2,425.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,156.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,156.40
|
| Rate for Payer: Galaxy Health WC |
$4,582.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,234.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,595.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,053.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,337.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,293.84
|
| Rate for Payer: Multiplan Commercial |
$4,312.80
|
| Rate for Payer: Networks By Design Commercial |
$3,504.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,582.35
|
|
|
HC CPAP/BIPAP/NIPPV - DAILY
|
Facility
|
OP
|
$5,391.00
|
|
|
Service Code
|
CPT 94660
|
| Hospital Charge Code |
900800110
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$68.54 |
| Max. Negotiated Rate |
$4,582.35 |
| Rate for Payer: Adventist Health Commercial |
$1,078.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,535.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$284.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$2,425.95
|
| Rate for Payer: Cash Price |
$2,425.95
|
| Rate for Payer: Cash Price |
$2,425.95
|
| Rate for Payer: Cash Price |
$2,425.95
|
| Rate for Payer: Cigna of CA HMO |
$3,450.24
|
| Rate for Payer: Cigna of CA PPO |
$3,989.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$284.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$348.88
|
| Rate for Payer: EPIC Health Plan Senior |
$258.43
|
| Rate for Payer: Galaxy Health WC |
$4,582.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,234.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$423.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$68.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,595.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$258.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,293.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$325.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$346.30
|
| Rate for Payer: Multiplan Commercial |
$4,312.80
|
| Rate for Payer: Networks By Design Commercial |
$3,504.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,582.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,234.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,234.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$284.27
|
| Rate for Payer: Vantage Medical Group Senior |
$258.43
|
|
