|
HC FA STAIN PARAINFLUENZA
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
CPT 87279
|
| Hospital Charge Code |
900911783
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$66.40 |
| Max. Negotiated Rate |
$282.20 |
| Rate for Payer: Adventist Health Commercial |
$66.40
|
| Rate for Payer: Cash Price |
$182.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$132.80
|
| Rate for Payer: EPIC Health Plan Senior |
$132.80
|
| Rate for Payer: Galaxy Health WC |
$282.20
|
| Rate for Payer: Global Benefits Group Commercial |
$199.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$221.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$126.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$205.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.68
|
| Rate for Payer: Multiplan Commercial |
$265.60
|
| Rate for Payer: Networks By Design Commercial |
$215.80
|
| Rate for Payer: Prime Health Services Commercial |
$282.20
|
|
|
HC FEEDER HABERMAN MINI
|
Facility
|
OP
|
$84.82
|
|
| Hospital Charge Code |
901603839
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.96 |
| Max. Negotiated Rate |
$72.10 |
| Rate for Payer: Adventist Health Commercial |
$16.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$55.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$46.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$63.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52.09
|
| Rate for Payer: Cash Price |
$46.65
|
| Rate for Payer: Cigna of CA HMO |
$54.28
|
| Rate for Payer: Cigna of CA PPO |
$62.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$72.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$72.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.93
|
| Rate for Payer: EPIC Health Plan Senior |
$33.93
|
| Rate for Payer: Galaxy Health WC |
$72.10
|
| Rate for Payer: Global Benefits Group Commercial |
$50.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$52.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$59.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$59.37
|
| Rate for Payer: Multiplan Commercial |
$67.86
|
| Rate for Payer: Networks By Design Commercial |
$55.13
|
| Rate for Payer: Prime Health Services Commercial |
$72.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$50.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$50.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$42.41
|
| Rate for Payer: United Healthcare All Other HMO |
$42.41
|
| Rate for Payer: United Healthcare HMO Rider |
$42.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$42.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$72.10
|
| Rate for Payer: Vantage Medical Group Senior |
$72.10
|
|
|
HC FEEDER HABERMAN MINI
|
Facility
|
IP
|
$84.82
|
|
| Hospital Charge Code |
901603839
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.96 |
| Max. Negotiated Rate |
$72.10 |
| Rate for Payer: Adventist Health Commercial |
$16.96
|
| Rate for Payer: Cash Price |
$46.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.93
|
| Rate for Payer: EPIC Health Plan Senior |
$33.93
|
| Rate for Payer: Galaxy Health WC |
$72.10
|
| Rate for Payer: Global Benefits Group Commercial |
$50.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$52.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.36
|
| Rate for Payer: Multiplan Commercial |
$67.86
|
| Rate for Payer: Networks By Design Commercial |
$55.13
|
| Rate for Payer: Prime Health Services Commercial |
$72.10
|
|
|
HC FEEDER HABERMAN REGULAR
|
Facility
|
OP
|
$82.00
|
|
| Hospital Charge Code |
901603250
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$69.70 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.36
|
| Rate for Payer: Cash Price |
$45.10
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$69.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.40
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.00
|
| Rate for Payer: United Healthcare All Other HMO |
$41.00
|
| Rate for Payer: United Healthcare HMO Rider |
$41.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.70
|
| Rate for Payer: Vantage Medical Group Senior |
$69.70
|
|
|
HC FEEDER HABERMAN REGULAR
|
Facility
|
IP
|
$82.00
|
|
| Hospital Charge Code |
901603250
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$69.70 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Cash Price |
$45.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.68
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
|
|
HC FEET BOTH 1 VIEW
|
Facility
|
IP
|
$600.00
|
|
|
Service Code
|
CPT 73620 50
|
| Hospital Charge Code |
909001641
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$510.00 |
| Rate for Payer: Adventist Health Commercial |
$120.00
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$240.00
|
| Rate for Payer: EPIC Health Plan Senior |
$240.00
|
| Rate for Payer: Galaxy Health WC |
$510.00
|
| Rate for Payer: Global Benefits Group Commercial |
$360.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$400.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$228.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$371.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$144.00
|
| Rate for Payer: Multiplan Commercial |
$480.00
|
| Rate for Payer: Networks By Design Commercial |
$390.00
|
| Rate for Payer: Prime Health Services Commercial |
$510.00
|
|
|
HC FEET BOTH 1 VIEW
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
CPT 73620 50
|
| Hospital Charge Code |
909001641
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$29.06 |
| Max. Negotiated Rate |
$510.00 |
| Rate for Payer: Adventist Health Commercial |
$120.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$393.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$510.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$330.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$450.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$139.38
|
| Rate for Payer: Blue Shield of California Commercial |
$367.20
|
| Rate for Payer: Blue Shield of California EPN |
$242.40
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cigna of CA HMO |
$384.00
|
| Rate for Payer: Cigna of CA PPO |
$444.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$510.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$510.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$510.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$240.00
|
| Rate for Payer: EPIC Health Plan Senior |
$240.00
|
| Rate for Payer: Galaxy Health WC |
$510.00
|
| Rate for Payer: Global Benefits Group Commercial |
$360.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$29.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$400.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$371.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$144.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$420.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$420.00
|
| Rate for Payer: Multiplan Commercial |
$480.00
|
| Rate for Payer: Networks By Design Commercial |
$390.00
|
| Rate for Payer: Prime Health Services Commercial |
$510.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$360.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$360.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$510.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$510.00
|
| Rate for Payer: Vantage Medical Group Senior |
$510.00
|
|
|
HC FEMALE GENITAL SYTM PROC UNLST
|
Facility
|
IP
|
$858.00
|
|
|
Service Code
|
CPT 58999
|
| Hospital Charge Code |
900501441
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$171.60 |
| Max. Negotiated Rate |
$729.30 |
| Rate for Payer: Adventist Health Commercial |
$171.60
|
| Rate for Payer: Cash Price |
$471.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$343.20
|
| Rate for Payer: EPIC Health Plan Senior |
$343.20
|
| Rate for Payer: Galaxy Health WC |
$729.30
|
| Rate for Payer: Global Benefits Group Commercial |
$514.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$572.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$326.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$531.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$205.92
|
| Rate for Payer: Multiplan Commercial |
$686.40
|
| Rate for Payer: Networks By Design Commercial |
$557.70
|
| Rate for Payer: Prime Health Services Commercial |
$729.30
|
|
|
HC FEMALE GENITAL SYTM PROC UNLST
|
Facility
|
IP
|
$858.00
|
|
|
Service Code
|
CPT 58999
|
| Hospital Charge Code |
900501441
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$171.60 |
| Max. Negotiated Rate |
$729.30 |
| Rate for Payer: Adventist Health Commercial |
$171.60
|
| Rate for Payer: Cash Price |
$471.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$343.20
|
| Rate for Payer: EPIC Health Plan Senior |
$343.20
|
| Rate for Payer: Galaxy Health WC |
$729.30
|
| Rate for Payer: Global Benefits Group Commercial |
$514.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$572.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$326.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$531.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$205.92
|
| Rate for Payer: Multiplan Commercial |
$686.40
|
| Rate for Payer: Networks By Design Commercial |
$557.70
|
| Rate for Payer: Prime Health Services Commercial |
$729.30
|
|
|
HC FEMALE GENITAL SYTM PROC UNLST
|
Facility
|
OP
|
$858.00
|
|
|
Service Code
|
CPT 58999
|
| Hospital Charge Code |
900501441
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$171.60 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$171.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$383.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$281.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$255.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$526.90
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$471.90
|
| Rate for Payer: Cash Price |
$471.90
|
| Rate for Payer: Cash Price |
$471.90
|
| Rate for Payer: Cigna of CA HMO |
$549.12
|
| Rate for Payer: Cigna of CA PPO |
$634.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$383.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$281.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$255.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$345.07
|
| Rate for Payer: EPIC Health Plan Senior |
$255.61
|
| Rate for Payer: Galaxy Health WC |
$729.30
|
| Rate for Payer: Global Benefits Group Commercial |
$514.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$419.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$255.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$572.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$255.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$205.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$322.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$342.52
|
| Rate for Payer: Multiplan Commercial |
$686.40
|
| Rate for Payer: Multiplan WC |
$407.27
|
| Rate for Payer: Networks By Design Commercial |
$557.70
|
| Rate for Payer: Prime Health Services Commercial |
$729.30
|
| Rate for Payer: Prime Health Services WC |
$403.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$514.80
|
| 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: Upland Medical Group Pediatric |
$255.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$383.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$281.17
|
| Rate for Payer: Vantage Medical Group Senior |
$255.61
|
|
|
HC FEMALE GENITAL SYTM PROC UNLST
|
Facility
|
OP
|
$858.00
|
|
|
Service Code
|
CPT 58999
|
| Hospital Charge Code |
900501441
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$171.60 |
| Max. Negotiated Rate |
$3,429.00 |
| Rate for Payer: Adventist Health Commercial |
$171.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$383.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$281.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$255.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,489.00
|
| Rate for Payer: Cash Price |
$471.90
|
| Rate for Payer: Cash Price |
$471.90
|
| Rate for Payer: Cash Price |
$471.90
|
| Rate for Payer: Cigna of CA HMO |
$549.12
|
| Rate for Payer: Cigna of CA PPO |
$634.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$383.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$281.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$255.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$345.07
|
| Rate for Payer: EPIC Health Plan Senior |
$255.61
|
| Rate for Payer: Galaxy Health WC |
$729.30
|
| Rate for Payer: Global Benefits Group Commercial |
$514.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$419.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$255.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$572.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$255.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$205.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$322.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$342.52
|
| Rate for Payer: Multiplan Commercial |
$686.40
|
| Rate for Payer: Multiplan WC |
$407.27
|
| Rate for Payer: Networks By Design Commercial |
$557.70
|
| Rate for Payer: Prime Health Services Commercial |
$729.30
|
| Rate for Payer: Prime Health Services WC |
$403.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$514.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$429.00
|
| Rate for Payer: United Healthcare All Other HMO |
$429.00
|
| Rate for Payer: United Healthcare HMO Rider |
$429.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$429.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$255.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$383.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$281.17
|
| Rate for Payer: Vantage Medical Group Senior |
$255.61
|
|
|
HC FEMORAL LENGTH SOCK
|
Facility
|
OP
|
$224.00
|
|
|
Service Code
|
CPT L2850
|
| Hospital Charge Code |
915352850
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$41.40 |
| Max. Negotiated Rate |
$190.40 |
| Rate for Payer: Adventist Health Commercial |
$91.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$190.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$168.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$129.74
|
| Rate for Payer: Blue Shield of California Commercial |
$165.31
|
| Rate for Payer: Blue Shield of California EPN |
$108.86
|
| Rate for Payer: Cash Price |
$123.20
|
| Rate for Payer: Cash Price |
$123.20
|
| Rate for Payer: Cigna of CA HMO |
$156.80
|
| Rate for Payer: Cigna of CA PPO |
$156.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$190.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$190.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$190.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.60
|
| Rate for Payer: EPIC Health Plan Senior |
$89.60
|
| Rate for Payer: Galaxy Health WC |
$190.40
|
| Rate for Payer: Global Benefits Group Commercial |
$134.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$41.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$149.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$138.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$156.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$156.80
|
| Rate for Payer: Multiplan Commercial |
$179.20
|
| Rate for Payer: Networks By Design Commercial |
$112.00
|
| Rate for Payer: Prime Health Services Commercial |
$190.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$134.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$134.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$84.07
|
| Rate for Payer: United Healthcare All Other HMO |
$81.83
|
| Rate for Payer: United Healthcare HMO Rider |
$80.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$73.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$190.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$190.40
|
| Rate for Payer: Vantage Medical Group Senior |
$190.40
|
|
|
HC FEMORAL LENGTH SOCK
|
Facility
|
OP
|
$224.00
|
|
|
Service Code
|
CPT L2850
|
| Hospital Charge Code |
905352850
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$41.40 |
| Max. Negotiated Rate |
$190.40 |
| Rate for Payer: Adventist Health Commercial |
$91.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$190.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$168.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$129.74
|
| Rate for Payer: Blue Shield of California Commercial |
$165.31
|
| Rate for Payer: Blue Shield of California EPN |
$108.86
|
| Rate for Payer: Cash Price |
$123.20
|
| Rate for Payer: Cash Price |
$123.20
|
| Rate for Payer: Cigna of CA HMO |
$156.80
|
| Rate for Payer: Cigna of CA PPO |
$156.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$190.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$190.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$190.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.60
|
| Rate for Payer: EPIC Health Plan Senior |
$89.60
|
| Rate for Payer: Galaxy Health WC |
$190.40
|
| Rate for Payer: Global Benefits Group Commercial |
$134.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$41.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$149.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$138.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$156.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$156.80
|
| Rate for Payer: Multiplan Commercial |
$179.20
|
| Rate for Payer: Networks By Design Commercial |
$112.00
|
| Rate for Payer: Prime Health Services Commercial |
$190.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$134.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$134.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$84.07
|
| Rate for Payer: United Healthcare All Other HMO |
$81.83
|
| Rate for Payer: United Healthcare HMO Rider |
$80.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$73.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$190.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$190.40
|
| Rate for Payer: Vantage Medical Group Senior |
$190.40
|
|
|
HC FEMORAL LENGTH SOCK
|
Facility
|
IP
|
$224.00
|
|
|
Service Code
|
CPT L2850
|
| Hospital Charge Code |
905352850
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$44.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$44.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$123.20
|
| Rate for Payer: Cash Price |
$123.20
|
| Rate for Payer: Cigna of CA HMO |
$156.80
|
| Rate for Payer: Cigna of CA PPO |
$156.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.60
|
| Rate for Payer: EPIC Health Plan Senior |
$89.60
|
| Rate for Payer: Galaxy Health WC |
$190.40
|
| Rate for Payer: Global Benefits Group Commercial |
$134.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$149.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$138.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.76
|
| Rate for Payer: Multiplan Commercial |
$179.20
|
| Rate for Payer: Networks By Design Commercial |
$112.00
|
| Rate for Payer: Prime Health Services Commercial |
$190.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$84.07
|
| Rate for Payer: United Healthcare All Other HMO |
$81.83
|
| Rate for Payer: United Healthcare HMO Rider |
$80.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$73.36
|
|
|
HC FEMORAL LENGTH SOCK
|
Facility
|
IP
|
$224.00
|
|
|
Service Code
|
CPT L2850
|
| Hospital Charge Code |
915352850
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$44.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$44.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$123.20
|
| Rate for Payer: Cash Price |
$123.20
|
| Rate for Payer: Cigna of CA HMO |
$156.80
|
| Rate for Payer: Cigna of CA PPO |
$156.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.60
|
| Rate for Payer: EPIC Health Plan Senior |
$89.60
|
| Rate for Payer: Galaxy Health WC |
$190.40
|
| Rate for Payer: Global Benefits Group Commercial |
$134.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$149.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$138.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.76
|
| Rate for Payer: Multiplan Commercial |
$179.20
|
| Rate for Payer: Networks By Design Commercial |
$112.00
|
| Rate for Payer: Prime Health Services Commercial |
$190.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$84.07
|
| Rate for Payer: United Healthcare All Other HMO |
$81.83
|
| Rate for Payer: United Healthcare HMO Rider |
$80.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$73.36
|
|
|
HC FEMORAL NERVE BLOCK SINGLE
|
Facility
|
OP
|
$1,550.00
|
|
|
Service Code
|
CPT 64447
|
| Hospital Charge Code |
900501590
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$93.37 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$310.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$852.50
|
| Rate for Payer: Cash Price |
$852.50
|
| Rate for Payer: Cash Price |
$852.50
|
| Rate for Payer: Cigna of CA HMO |
$992.00
|
| Rate for Payer: Cigna of CA PPO |
$1,147.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$967.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$879.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,187.89
|
| Rate for Payer: EPIC Health Plan Senior |
$879.92
|
| Rate for Payer: Galaxy Health WC |
$1,317.50
|
| Rate for Payer: Global Benefits Group Commercial |
$930.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,443.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,033.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$372.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,108.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,179.09
|
| Rate for Payer: Multiplan Commercial |
$1,240.00
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: Networks By Design Commercial |
$1,007.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,317.50
|
| Rate for Payer: Prime Health Services WC |
$1,387.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$930.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$775.00
|
| Rate for Payer: United Healthcare All Other HMO |
$775.00
|
| Rate for Payer: United Healthcare HMO Rider |
$775.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$775.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$879.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Vantage Medical Group Senior |
$879.92
|
|
|
HC FEMORAL NERVE BLOCK SINGLE
|
Facility
|
IP
|
$1,550.00
|
|
|
Service Code
|
CPT 64447
|
| Hospital Charge Code |
900501590
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$310.00 |
| Max. Negotiated Rate |
$1,317.50 |
| Rate for Payer: Adventist Health Commercial |
$310.00
|
| Rate for Payer: Cash Price |
$852.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$620.00
|
| Rate for Payer: EPIC Health Plan Senior |
$620.00
|
| Rate for Payer: Galaxy Health WC |
$1,317.50
|
| Rate for Payer: Global Benefits Group Commercial |
$930.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,033.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$590.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$959.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$372.00
|
| Rate for Payer: Multiplan Commercial |
$1,240.00
|
| Rate for Payer: Networks By Design Commercial |
$1,007.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,317.50
|
|
|
HC FEMOSTOP GOLD STJ HEMOSTASIS
|
Facility
|
OP
|
$483.00
|
|
| Hospital Charge Code |
906812584
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$96.60 |
| Max. Negotiated Rate |
$410.55 |
| Rate for Payer: Adventist Health Commercial |
$96.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$316.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$410.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$265.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$362.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$296.61
|
| Rate for Payer: Cash Price |
$265.65
|
| Rate for Payer: Cigna of CA HMO |
$309.12
|
| Rate for Payer: Cigna of CA PPO |
$357.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$410.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$410.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$410.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$193.20
|
| Rate for Payer: EPIC Health Plan Senior |
$193.20
|
| Rate for Payer: Galaxy Health WC |
$410.55
|
| Rate for Payer: Global Benefits Group Commercial |
$289.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$322.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$184.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$298.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$338.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.10
|
| Rate for Payer: Multiplan Commercial |
$386.40
|
| Rate for Payer: Networks By Design Commercial |
$313.95
|
| Rate for Payer: Prime Health Services Commercial |
$410.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$289.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$289.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$241.50
|
| Rate for Payer: United Healthcare All Other HMO |
$241.50
|
| Rate for Payer: United Healthcare HMO Rider |
$241.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$241.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$410.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$410.55
|
| Rate for Payer: Vantage Medical Group Senior |
$410.55
|
|
|
HC FEMOSTOP GOLD STJ HEMOSTASIS
|
Facility
|
IP
|
$483.00
|
|
| Hospital Charge Code |
906812584
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$96.60 |
| Max. Negotiated Rate |
$410.55 |
| Rate for Payer: Adventist Health Commercial |
$96.60
|
| Rate for Payer: Cash Price |
$265.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$193.20
|
| Rate for Payer: EPIC Health Plan Senior |
$193.20
|
| Rate for Payer: Galaxy Health WC |
$410.55
|
| Rate for Payer: Global Benefits Group Commercial |
$289.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$322.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$184.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$298.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.92
|
| Rate for Payer: Multiplan Commercial |
$386.40
|
| Rate for Payer: Networks By Design Commercial |
$313.95
|
| Rate for Payer: Prime Health Services Commercial |
$410.55
|
|
|
HC FERN TEST
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
CPT 82120
|
| Hospital Charge Code |
910400132
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.20 |
| Max. Negotiated Rate |
$102.85 |
| Rate for Payer: Adventist Health Commercial |
$24.20
|
| Rate for Payer: Cash Price |
$66.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.40
|
| Rate for Payer: EPIC Health Plan Senior |
$48.40
|
| Rate for Payer: Galaxy Health WC |
$102.85
|
| Rate for Payer: Global Benefits Group Commercial |
$72.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$74.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.04
|
| Rate for Payer: Multiplan Commercial |
$96.80
|
| Rate for Payer: Networks By Design Commercial |
$78.65
|
| Rate for Payer: Prime Health Services Commercial |
$102.85
|
|
|
HC FERN TEST
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
CPT 82120
|
| Hospital Charge Code |
910400132
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.85 |
| Max. Negotiated Rate |
$102.85 |
| Rate for Payer: Adventist Health Commercial |
$24.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$79.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.30
|
| Rate for Payer: Blue Shield of California Commercial |
$80.95
|
| Rate for Payer: Blue Shield of California EPN |
$53.48
|
| Rate for Payer: Cash Price |
$66.55
|
| Rate for Payer: Cash Price |
$66.55
|
| Rate for Payer: Cigna of CA HMO |
$77.44
|
| Rate for Payer: Cigna of CA PPO |
$89.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.09
|
| Rate for Payer: EPIC Health Plan Senior |
$5.99
|
| Rate for Payer: Galaxy Health WC |
$102.85
|
| Rate for Payer: Global Benefits Group Commercial |
$72.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.03
|
| Rate for Payer: Multiplan Commercial |
$96.80
|
| Rate for Payer: Networks By Design Commercial |
$78.65
|
| Rate for Payer: Prime Health Services Commercial |
$102.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.85
|
| Rate for Payer: United Healthcare All Other HMO |
$4.85
|
| Rate for Payer: United Healthcare HMO Rider |
$4.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.85
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.59
|
| Rate for Payer: Vantage Medical Group Senior |
$5.99
|
|
|
HC FERRITIN
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
CPT 82728
|
| Hospital Charge Code |
900910819
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$54.00 |
| Max. Negotiated Rate |
$229.50 |
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.00
|
| Rate for Payer: EPIC Health Plan Senior |
$108.00
|
| Rate for Payer: Galaxy Health WC |
$229.50
|
| Rate for Payer: Global Benefits Group Commercial |
$162.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$180.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$167.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.80
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: Networks By Design Commercial |
$175.50
|
| Rate for Payer: Prime Health Services Commercial |
$229.50
|
|
|
HC FERRITIN
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
CPT 82728
|
| Hospital Charge Code |
900910819
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.04 |
| Max. Negotiated Rate |
$229.50 |
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$177.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$134.59
|
| Rate for Payer: Blue Shield of California Commercial |
$180.63
|
| Rate for Payer: Blue Shield of California EPN |
$119.34
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cigna of CA HMO |
$172.80
|
| Rate for Payer: Cigna of CA PPO |
$199.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.40
|
| Rate for Payer: EPIC Health Plan Senior |
$13.63
|
| Rate for Payer: Galaxy Health WC |
$229.50
|
| Rate for Payer: Global Benefits Group Commercial |
$162.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$180.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.26
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: Networks By Design Commercial |
$175.50
|
| Rate for Payer: Prime Health Services Commercial |
$229.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$162.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$162.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.04
|
| Rate for Payer: United Healthcare All Other HMO |
$11.04
|
| Rate for Payer: United Healthcare HMO Rider |
$11.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.04
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.99
|
| Rate for Payer: Vantage Medical Group Senior |
$13.63
|
|
|
HC FETAL BLEED SCREEN
|
Facility
|
OP
|
$296.00
|
|
|
Service Code
|
CPT 85461
|
| Hospital Charge Code |
900904562
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.01 |
| Max. Negotiated Rate |
$251.60 |
| Rate for Payer: Adventist Health Commercial |
$59.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$194.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$151.08
|
| Rate for Payer: Blue Shield of California Commercial |
$198.02
|
| Rate for Payer: Blue Shield of California EPN |
$130.83
|
| Rate for Payer: Cash Price |
$162.80
|
| Rate for Payer: Cash Price |
$162.80
|
| Rate for Payer: Cigna of CA HMO |
$189.44
|
| Rate for Payer: Cigna of CA PPO |
$219.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.64
|
| Rate for Payer: EPIC Health Plan Senior |
$9.36
|
| Rate for Payer: Galaxy Health WC |
$251.60
|
| Rate for Payer: Global Benefits Group Commercial |
$177.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$197.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.54
|
| 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
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$177.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$177.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.58
|
| Rate for Payer: United Healthcare All Other HMO |
$7.58
|
| Rate for Payer: United Healthcare HMO Rider |
$7.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.58
|
| Rate for Payer: Upland Medical Group Pediatric |
$9.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.30
|
| Rate for Payer: Vantage Medical Group Senior |
$9.36
|
|
|
HC FETAL BLEED SCREEN
|
Facility
|
IP
|
$296.00
|
|
|
Service Code
|
CPT 85461
|
| Hospital Charge Code |
900904562
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$59.20 |
| Max. Negotiated Rate |
$251.60 |
| Rate for Payer: Adventist Health Commercial |
$59.20
|
| Rate for Payer: Cash Price |
$162.80
|
| 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
|
|
