|
HC PORPHOBILINOGEN QUAL
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 84106
|
| Hospital Charge Code |
900910297
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$39.07 |
| Rate for Payer: Aetna of CA HMO/PPO |
$35.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.07
|
| Rate for Payer: Blue Distinction Transplant |
$9.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9.69
|
| Rate for Payer: Blue Shield of California EPN |
$7.68
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cigna of CA HMO |
$9.60
|
| Rate for Payer: Cigna of CA PPO |
$11.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.73
|
| Rate for Payer: Dignity Health Media |
$5.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.86
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.82
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.54
|
| Rate for Payer: Heritage Provider Network Transplant |
$9.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$9.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.80
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.72
|
| Rate for Payer: United Healthcare All Other HMO |
$4.72
|
| Rate for Payer: United Healthcare HMO Rider |
$4.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.40
|
| Rate for Payer: Vantage Medical Group Senior |
$5.82
|
|
|
HC PORTAL VEIN CATHETER
|
Facility
|
OP
|
$605.00
|
|
|
Service Code
|
CPT 36481
|
| Hospital Charge Code |
909081327
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$145.20 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$514.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$332.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$332.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$363.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$272.25
|
| Rate for Payer: Cash Price |
$272.25
|
| Rate for Payer: Cash Price |
$272.25
|
| Rate for Payer: Cigna of CA PPO |
$447.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$514.25
|
| Rate for Payer: Dignity Health Media |
$514.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$514.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$242.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$242.00
|
| Rate for Payer: Galaxy Health WC |
$514.25
|
| Rate for Payer: Global Benefits Group Commercial |
$363.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$453.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$403.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$553.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.20
|
| Rate for Payer: Multiplan Commercial |
$484.00
|
| Rate for Payer: Networks By Design Commercial |
$393.25
|
| Rate for Payer: Prime Health Services Commercial |
$514.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$363.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$514.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$514.25
|
| Rate for Payer: Vantage Medical Group Senior |
$514.25
|
|
|
HC PORTAL VEIN CATHETER
|
Facility
|
IP
|
$605.00
|
|
|
Service Code
|
CPT 36481
|
| Hospital Charge Code |
909081327
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$145.20 |
| Max. Negotiated Rate |
$514.25 |
| Rate for Payer: Cash Price |
$272.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$242.00
|
| Rate for Payer: Galaxy Health WC |
$514.25
|
| Rate for Payer: Global Benefits Group Commercial |
$363.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$403.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$230.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.20
|
| Rate for Payer: Multiplan Commercial |
$484.00
|
| Rate for Payer: Networks By Design Commercial |
$393.25
|
| Rate for Payer: Prime Health Services Commercial |
$514.25
|
|
|
HC PORT IMAGE
|
Facility
|
OP
|
$871.00
|
|
|
Service Code
|
CPT 77417
|
| Hospital Charge Code |
904810803
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$18.66 |
| Max. Negotiated Rate |
$1,675.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$94.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$740.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$479.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$479.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$151.10
|
| Rate for Payer: Blue Distinction Transplant |
$522.60
|
| Rate for Payer: Blue Shield of California Commercial |
$514.76
|
| Rate for Payer: Blue Shield of California EPN |
$408.50
|
| Rate for Payer: Cash Price |
$391.95
|
| Rate for Payer: Cash Price |
$391.95
|
| Rate for Payer: Cash Price |
$391.95
|
| Rate for Payer: Cigna of CA HMO |
$557.44
|
| Rate for Payer: Cigna of CA PPO |
$644.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$740.35
|
| Rate for Payer: Dignity Health Media |
$740.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$740.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$348.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$348.40
|
| Rate for Payer: Galaxy Health WC |
$740.35
|
| Rate for Payer: Global Benefits Group Commercial |
$522.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$653.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$580.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$209.04
|
| Rate for Payer: Multiplan Commercial |
$696.80
|
| Rate for Payer: Networks By Design Commercial |
$566.15
|
| Rate for Payer: Prime Health Services Commercial |
$740.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$522.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,659.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,675.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,269.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,161.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$740.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$740.35
|
| Rate for Payer: Vantage Medical Group Senior |
$740.35
|
|
|
HC PORT IMAGE
|
Facility
|
IP
|
$871.00
|
|
|
Service Code
|
CPT 77417
|
| Hospital Charge Code |
904810803
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$209.04 |
| Max. Negotiated Rate |
$740.35 |
| Rate for Payer: Cash Price |
$391.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$348.40
|
| Rate for Payer: Galaxy Health WC |
$740.35
|
| Rate for Payer: Global Benefits Group Commercial |
$522.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$580.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$331.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$209.04
|
| Rate for Payer: Multiplan Commercial |
$696.80
|
| Rate for Payer: Networks By Design Commercial |
$566.15
|
| Rate for Payer: Prime Health Services Commercial |
$740.35
|
|
|
HC POS COMBO 43 PANEL ID
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900912490
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.28 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$67.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$73.65
|
| Rate for Payer: Blue Distinction Transplant |
$13.20
|
| Rate for Payer: Blue Shield of California Commercial |
$14.21
|
| Rate for Payer: Blue Shield of California EPN |
$11.26
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cigna of CA HMO |
$14.08
|
| Rate for Payer: Cigna of CA PPO |
$16.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: Dignity Health Media |
$8.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.08
|
| Rate for Payer: Galaxy Health WC |
$18.70
|
| Rate for Payer: Global Benefits Group Commercial |
$13.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$16.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.25
|
| Rate for Payer: Heritage Provider Network Transplant |
$13.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$13.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.83
|
| Rate for Payer: Multiplan Commercial |
$17.60
|
| Rate for Payer: Networks By Design Commercial |
$14.30
|
| Rate for Payer: Prime Health Services Commercial |
$18.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.54
|
| Rate for Payer: United Healthcare All Other HMO |
$6.54
|
| Rate for Payer: United Healthcare HMO Rider |
$6.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
HC POST PARTUM PERINEAL LAC RPR
|
Facility
|
OP
|
$5,987.00
|
|
|
Service Code
|
CPT 56810
|
| Hospital Charge Code |
902400754
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$471.73 |
| Max. Negotiated Rate |
$13,086.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13,086.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,906.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,241.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,592.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4,412.42
|
| Rate for Payer: Blue Shield of California EPN |
$3,496.41
|
| Rate for Payer: Cash Price |
$2,694.15
|
| Rate for Payer: Cash Price |
$2,694.15
|
| Rate for Payer: Cash Price |
$2,694.15
|
| Rate for Payer: Cigna of CA HMO |
$3,831.68
|
| Rate for Payer: Cigna of CA PPO |
$4,430.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Dignity Health Media |
$3,906.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,296.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,273.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,906.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,906.18
|
| Rate for Payer: Galaxy Health WC |
$5,088.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,592.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,490.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,406.14
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,406.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,328.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$6,328.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,906.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,993.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$471.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,906.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,436.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,921.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,234.28
|
| Rate for Payer: Multiplan Commercial |
$4,789.60
|
| Rate for Payer: Networks By Design Commercial |
$3,891.55
|
| Rate for Payer: Prime Health Services Commercial |
$5,088.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,592.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,592.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,036.00
|
| Rate for Payer: United Healthcare All Other HMO |
$799.00
|
| Rate for Payer: United Healthcare HMO Rider |
$605.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$552.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,906.18
|
|
|
HC POST PARTUM PERINEAL LAC RPR
|
Facility
|
IP
|
$5,987.00
|
|
|
Service Code
|
CPT 56810
|
| Hospital Charge Code |
902400754
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,436.88 |
| Max. Negotiated Rate |
$5,088.95 |
| Rate for Payer: Cash Price |
$2,694.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,394.80
|
| Rate for Payer: Galaxy Health WC |
$5,088.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,592.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,993.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,281.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,436.88
|
| Rate for Payer: Multiplan Commercial |
$4,789.60
|
| Rate for Payer: Networks By Design Commercial |
$3,891.55
|
| Rate for Payer: Prime Health Services Commercial |
$5,088.95
|
|
|
HC POST TRANSFUSION INVESTIGATION
|
Facility
|
OP
|
$304.00
|
|
|
Service Code
|
CPT 86078
|
| Hospital Charge Code |
900904761
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$72.96 |
| Max. Negotiated Rate |
$642.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$290.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$320.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$234.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$213.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$181.12
|
| Rate for Payer: Blue Distinction Transplant |
$182.40
|
| Rate for Payer: Blue Shield of California Commercial |
$224.05
|
| Rate for Payer: Blue Shield of California EPN |
$177.54
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cigna of CA HMO |
$194.56
|
| Rate for Payer: Cigna of CA PPO |
$224.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$320.12
|
| Rate for Payer: Dignity Health Media |
$213.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$234.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$288.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$213.41
|
| Rate for Payer: EPIC Health Plan Transplant |
$213.41
|
| Rate for Payer: Galaxy Health WC |
$258.40
|
| Rate for Payer: Global Benefits Group Commercial |
$182.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$228.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$349.99
|
| Rate for Payer: Heritage Provider Network Transplant |
$349.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$345.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$345.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$213.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$202.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$213.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$268.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$285.97
|
| Rate for Payer: Multiplan Commercial |
$243.20
|
| Rate for Payer: Networks By Design Commercial |
$197.60
|
| Rate for Payer: Prime Health Services Commercial |
$258.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$182.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$182.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$642.00
|
| Rate for Payer: United Healthcare All Other HMO |
$631.00
|
| Rate for Payer: United Healthcare HMO Rider |
$630.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$575.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$320.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$234.75
|
| Rate for Payer: Vantage Medical Group Senior |
$213.41
|
|
|
HC POST TRANSFUSION INVESTIGATION
|
Facility
|
IP
|
$304.00
|
|
|
Service Code
|
CPT 86078
|
| Hospital Charge Code |
900904761
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$72.96 |
| Max. Negotiated Rate |
$258.40 |
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.60
|
| Rate for Payer: Galaxy Health WC |
$258.40
|
| Rate for Payer: Global Benefits Group Commercial |
$182.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$202.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.96
|
| Rate for Payer: Multiplan Commercial |
$243.20
|
| Rate for Payer: Networks By Design Commercial |
$197.60
|
| Rate for Payer: Prime Health Services Commercial |
$258.40
|
|
|
HC POTASSIUM
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
900910488
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$42.32 |
| Rate for Payer: Aetna of CA HMO/PPO |
$38.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.32
|
| Rate for Payer: Blue Distinction Transplant |
$9.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9.69
|
| Rate for Payer: Blue Shield of California EPN |
$7.68
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cigna of CA HMO |
$9.60
|
| Rate for Payer: Cigna of CA PPO |
$11.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.14
|
| Rate for Payer: Dignity Health Media |
$4.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.76
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.81
|
| Rate for Payer: Heritage Provider Network Transplant |
$7.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$7.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.38
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.85
|
| Rate for Payer: United Healthcare All Other HMO |
$3.85
|
| Rate for Payer: United Healthcare HMO Rider |
$3.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.24
|
| Rate for Payer: Vantage Medical Group Senior |
$4.76
|
|
|
HC POTASSIUM
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
900910266
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$42.32 |
| Rate for Payer: Aetna of CA HMO/PPO |
$38.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.32
|
| Rate for Payer: Blue Distinction Transplant |
$9.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9.69
|
| Rate for Payer: Blue Shield of California EPN |
$7.68
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cigna of CA HMO |
$9.60
|
| Rate for Payer: Cigna of CA PPO |
$11.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.14
|
| Rate for Payer: Dignity Health Media |
$4.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.76
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.81
|
| Rate for Payer: Heritage Provider Network Transplant |
$7.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$7.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.38
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.85
|
| Rate for Payer: United Healthcare All Other HMO |
$3.85
|
| Rate for Payer: United Healthcare HMO Rider |
$3.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.24
|
| Rate for Payer: Vantage Medical Group Senior |
$4.76
|
|
|
HC POTASSIUM BODY FLUID
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
900912245
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$14.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$11.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.13
|
| Rate for Payer: Blue Distinction Transplant |
$10.20
|
| Rate for Payer: Blue Shield of California Commercial |
$10.98
|
| Rate for Payer: Blue Shield of California EPN |
$8.70
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cigna of CA HMO |
$10.88
|
| Rate for Payer: Cigna of CA PPO |
$12.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.45
|
| Rate for Payer: Dignity Health Media |
$14.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.80
|
| Rate for Payer: Galaxy Health WC |
$14.45
|
| Rate for Payer: Global Benefits Group Commercial |
$10.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.08
|
| Rate for Payer: Multiplan Commercial |
$13.60
|
| Rate for Payer: Networks By Design Commercial |
$11.05
|
| Rate for Payer: Prime Health Services Commercial |
$14.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.50
|
| Rate for Payer: United Healthcare All Other HMO |
$8.50
|
| Rate for Payer: United Healthcare HMO Rider |
$8.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.45
|
| Rate for Payer: Vantage Medical Group Senior |
$14.45
|
|
|
HC POTASSIUM STOOL
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
CPT 84133
|
| Hospital Charge Code |
900910416
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.83 |
| Max. Negotiated Rate |
$39.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$35.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.25
|
| Rate for Payer: Blue Distinction Transplant |
$9.60
|
| Rate for Payer: Blue Shield of California Commercial |
$10.34
|
| Rate for Payer: Blue Shield of California EPN |
$8.19
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna of CA HMO |
$10.24
|
| Rate for Payer: Cigna of CA PPO |
$11.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.10
|
| Rate for Payer: Dignity Health Media |
$4.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.39
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4.73
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.73
|
| Rate for Payer: Galaxy Health WC |
$13.60
|
| Rate for Payer: Global Benefits Group Commercial |
$9.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.76
|
| Rate for Payer: Heritage Provider Network Transplant |
$7.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$7.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.34
|
| Rate for Payer: Multiplan Commercial |
$12.80
|
| Rate for Payer: Networks By Design Commercial |
$10.40
|
| Rate for Payer: Prime Health Services Commercial |
$13.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.83
|
| Rate for Payer: United Healthcare All Other HMO |
$3.83
|
| Rate for Payer: United Healthcare HMO Rider |
$3.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.20
|
| Rate for Payer: Vantage Medical Group Senior |
$4.73
|
|
|
HC POTASSIUM URINE
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 84133
|
| Hospital Charge Code |
900910267
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$39.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$35.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.25
|
| Rate for Payer: Blue Distinction Transplant |
$9.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9.69
|
| Rate for Payer: Blue Shield of California EPN |
$7.68
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cigna of CA HMO |
$9.60
|
| Rate for Payer: Cigna of CA PPO |
$11.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.10
|
| Rate for Payer: Dignity Health Media |
$4.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.39
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4.73
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.73
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.76
|
| Rate for Payer: Heritage Provider Network Transplant |
$7.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$7.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.34
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.83
|
| Rate for Payer: United Healthcare All Other HMO |
$3.83
|
| Rate for Payer: United Healthcare HMO Rider |
$3.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.20
|
| Rate for Payer: Vantage Medical Group Senior |
$4.73
|
|
|
HC PRCD DRG GT 6YR W/O CGN CRDC ANM
|
Facility
|
IP
|
$1,644.00
|
|
|
Service Code
|
CPT 33017
|
| Hospital Charge Code |
900503017
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$394.56 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$739.80
|
| Rate for Payer: Cash Price |
$739.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$657.60
|
| Rate for Payer: Galaxy Health WC |
$1,397.40
|
| Rate for Payer: Global Benefits Group Commercial |
$986.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,096.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$626.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$394.56
|
| Rate for Payer: Multiplan Commercial |
$1,315.20
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,397.40
|
|
|
HC PRCD DRG GT 6YR W/O CGN CRDC ANM
|
Facility
|
OP
|
$1,644.00
|
|
|
Service Code
|
CPT 33017
|
| Hospital Charge Code |
900503017
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$394.56 |
| Max. Negotiated Rate |
$7,282.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,057.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,397.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$904.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$904.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$986.40
|
| Rate for Payer: Blue Shield of California Commercial |
$833.61
|
| Rate for Payer: Blue Shield of California EPN |
$542.56
|
| Rate for Payer: Cash Price |
$739.80
|
| Rate for Payer: Cash Price |
$739.80
|
| Rate for Payer: Cigna of CA PPO |
$1,216.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,397.40
|
| Rate for Payer: Dignity Health Media |
$1,397.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,397.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$657.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$657.60
|
| Rate for Payer: Galaxy Health WC |
$1,397.40
|
| Rate for Payer: Global Benefits Group Commercial |
$986.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,233.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,096.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$396.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$394.56
|
| Rate for Payer: Multiplan Commercial |
$1,315.20
|
| Rate for Payer: Networks By Design Commercial |
$1,068.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,397.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$986.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,397.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,397.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,397.40
|
|
|
HC PRCRD DRG LT 6YR/ANY AGE W/ANMLY
|
Facility
|
OP
|
$1,644.00
|
|
|
Service Code
|
CPT 33018
|
| Hospital Charge Code |
900503018
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$90.80 |
| Max. Negotiated Rate |
$7,282.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,057.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,397.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$904.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$904.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$986.40
|
| Rate for Payer: Blue Shield of California Commercial |
$833.61
|
| Rate for Payer: Blue Shield of California EPN |
$542.56
|
| Rate for Payer: Cash Price |
$739.80
|
| Rate for Payer: Cash Price |
$739.80
|
| Rate for Payer: Cigna of CA PPO |
$1,216.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,397.40
|
| Rate for Payer: Dignity Health Media |
$1,397.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,397.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$657.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$657.60
|
| Rate for Payer: Galaxy Health WC |
$1,397.40
|
| Rate for Payer: Global Benefits Group Commercial |
$986.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,233.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,096.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$90.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$394.56
|
| Rate for Payer: Multiplan Commercial |
$1,315.20
|
| Rate for Payer: Networks By Design Commercial |
$1,068.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,397.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$986.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,397.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,397.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,397.40
|
|
|
HC PRCRD DRG LT 6YR/ANY AGE W/ANMLY
|
Facility
|
IP
|
$1,644.00
|
|
|
Service Code
|
CPT 33018
|
| Hospital Charge Code |
900503018
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$394.56 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$739.80
|
| Rate for Payer: Cash Price |
$739.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$657.60
|
| Rate for Payer: Galaxy Health WC |
$1,397.40
|
| Rate for Payer: Global Benefits Group Commercial |
$986.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,096.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$626.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$394.56
|
| Rate for Payer: Multiplan Commercial |
$1,315.20
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,397.40
|
|
|
HC PREGNANCY TEST URINE
|
Facility
|
OP
|
$247.00
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
910400131
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.32 |
| Max. Negotiated Rate |
$209.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$19.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.56
|
| Rate for Payer: Blue Distinction Transplant |
$148.20
|
| Rate for Payer: Blue Shield of California Commercial |
$159.56
|
| Rate for Payer: Blue Shield of California EPN |
$126.46
|
| Rate for Payer: Cash Price |
$111.15
|
| Rate for Payer: Cash Price |
$111.15
|
| Rate for Payer: Cigna of CA HMO |
$158.08
|
| Rate for Payer: Cigna of CA PPO |
$182.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.92
|
| Rate for Payer: Dignity Health Media |
$8.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8.61
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.61
|
| Rate for Payer: Galaxy Health WC |
$209.95
|
| Rate for Payer: Global Benefits Group Commercial |
$148.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$185.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.12
|
| Rate for Payer: Heritage Provider Network Transplant |
$14.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$13.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$164.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.54
|
| Rate for Payer: Multiplan Commercial |
$197.60
|
| Rate for Payer: Networks By Design Commercial |
$160.55
|
| Rate for Payer: Prime Health Services Commercial |
$209.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$148.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$148.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.98
|
| Rate for Payer: United Healthcare All Other HMO |
$6.98
|
| Rate for Payer: United Healthcare HMO Rider |
$6.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.47
|
| Rate for Payer: Vantage Medical Group Senior |
$8.61
|
|
|
HC PREGNANCY TEST URINE
|
Facility
|
IP
|
$247.00
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
910400131
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$59.28 |
| Max. Negotiated Rate |
$209.95 |
| Rate for Payer: Cash Price |
$111.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.80
|
| Rate for Payer: Galaxy Health WC |
$209.95
|
| Rate for Payer: Global Benefits Group Commercial |
$148.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$164.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.28
|
| Rate for Payer: Multiplan Commercial |
$197.60
|
| Rate for Payer: Networks By Design Commercial |
$160.55
|
| Rate for Payer: Prime Health Services Commercial |
$209.95
|
|
|
HC PREPARE FACE/ORAL PROSTHESIS
|
Facility
|
OP
|
$7,704.00
|
|
|
Service Code
|
CPT 21085
|
| Hospital Charge Code |
900501350
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$305.19 |
| Max. Negotiated Rate |
$6,548.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$305.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,622.40
|
| Rate for Payer: Cash Price |
$3,466.80
|
| Rate for Payer: Cash Price |
$3,466.80
|
| Rate for Payer: Cash Price |
$3,466.80
|
| Rate for Payer: Cigna of CA PPO |
$5,700.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.78
|
| Rate for Payer: Dignity Health Media |
$305.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$412.01
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$305.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$305.19
|
| Rate for Payer: Galaxy Health WC |
$6,548.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,622.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,778.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$500.51
|
| Rate for Payer: Heritage Provider Network Transplant |
$500.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$305.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,138.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,935.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$305.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,848.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$384.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.95
|
| Rate for Payer: Multiplan Commercial |
$6,163.20
|
| Rate for Payer: Networks By Design Commercial |
$5,007.60
|
| Rate for Payer: Prime Health Services Commercial |
$6,548.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,622.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,852.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,852.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,852.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: Vantage Medical Group Senior |
$305.19
|
|
|
HC PREPARE FACE/ORAL PROSTHESIS
|
Facility
|
IP
|
$7,704.00
|
|
|
Service Code
|
CPT 21085
|
| Hospital Charge Code |
900501350
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,848.96 |
| Max. Negotiated Rate |
$6,548.40 |
| Rate for Payer: Cash Price |
$3,466.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,081.60
|
| Rate for Payer: Galaxy Health WC |
$6,548.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,622.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,138.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,935.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,848.96
|
| Rate for Payer: Multiplan Commercial |
$6,163.20
|
| Rate for Payer: Networks By Design Commercial |
$5,007.60
|
| Rate for Payer: Prime Health Services Commercial |
$6,548.40
|
|
|
HC PRE POST CHALLENGE SPIROMETRY
|
Facility
|
OP
|
$1,086.00
|
|
|
Service Code
|
CPT 94060
|
| Hospital Charge Code |
900801002
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$85.56 |
| Max. Negotiated Rate |
$923.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$317.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$647.04
|
| Rate for Payer: Blue Distinction Transplant |
$651.60
|
| Rate for Payer: Blue Shield of California Commercial |
$641.83
|
| Rate for Payer: Blue Shield of California EPN |
$509.33
|
| Rate for Payer: Cash Price |
$488.70
|
| Rate for Payer: Cash Price |
$488.70
|
| Rate for Payer: Cash Price |
$488.70
|
| Rate for Payer: Cigna of CA HMO |
$695.04
|
| Rate for Payer: Cigna of CA PPO |
$803.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$588.26
|
| Rate for Payer: Dignity Health Media |
$392.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$529.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$392.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$392.17
|
| Rate for Payer: Galaxy Health WC |
$923.10
|
| Rate for Payer: Global Benefits Group Commercial |
$651.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$814.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$643.16
|
| Rate for Payer: Heritage Provider Network Transplant |
$643.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$635.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$635.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$392.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$724.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$392.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$260.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$494.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$525.51
|
| Rate for Payer: Multiplan Commercial |
$868.80
|
| Rate for Payer: Networks By Design Commercial |
$705.90
|
| Rate for Payer: Prime Health Services Commercial |
$923.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$651.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$651.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$725.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$696.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$636.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Vantage Medical Group Senior |
$392.17
|
|
|
HC PRE POST CHALLENGE SPIROMETRY
|
Facility
|
IP
|
$1,086.00
|
|
|
Service Code
|
CPT 94060
|
| Hospital Charge Code |
900801002
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$260.64 |
| Max. Negotiated Rate |
$923.10 |
| Rate for Payer: Cash Price |
$488.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$434.40
|
| Rate for Payer: Galaxy Health WC |
$923.10
|
| Rate for Payer: Global Benefits Group Commercial |
$651.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$724.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$413.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$260.64
|
| Rate for Payer: Multiplan Commercial |
$868.80
|
| Rate for Payer: Networks By Design Commercial |
$705.90
|
| Rate for Payer: Prime Health Services Commercial |
$923.10
|
|
