|
HC FETAL LUNG MATURITY (FLM)
|
Facility
|
IP
|
$538.00
|
|
|
Service Code
|
CPT 83663
|
| Hospital Charge Code |
900910962
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$107.60 |
| Max. Negotiated Rate |
$457.30 |
| Rate for Payer: Adventist Health Commercial |
$107.60
|
| Rate for Payer: Cash Price |
$242.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.20
|
| Rate for Payer: EPIC Health Plan Senior |
$215.20
|
| Rate for Payer: Galaxy Health WC |
$457.30
|
| Rate for Payer: Global Benefits Group Commercial |
$322.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$358.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$204.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$333.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.12
|
| Rate for Payer: Multiplan Commercial |
$430.40
|
| Rate for Payer: Networks By Design Commercial |
$349.70
|
| Rate for Payer: Prime Health Services Commercial |
$457.30
|
|
|
HC FETAL LUNG MATURITY (FLM)
|
Facility
|
OP
|
$538.00
|
|
|
Service Code
|
CPT 83663
|
| Hospital Charge Code |
900910962
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.32 |
| Max. Negotiated Rate |
$457.30 |
| Rate for Payer: Adventist Health Commercial |
$107.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$352.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$93.36
|
| Rate for Payer: Blue Shield of California Commercial |
$359.92
|
| Rate for Payer: Blue Shield of California EPN |
$237.80
|
| Rate for Payer: Cash Price |
$242.10
|
| Rate for Payer: Cash Price |
$242.10
|
| Rate for Payer: Cigna of CA HMO |
$344.32
|
| Rate for Payer: Cigna of CA PPO |
$398.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.53
|
| Rate for Payer: EPIC Health Plan Senior |
$18.91
|
| Rate for Payer: Galaxy Health WC |
$457.30
|
| Rate for Payer: Global Benefits Group Commercial |
$322.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$31.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$358.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.34
|
| Rate for Payer: Multiplan Commercial |
$430.40
|
| Rate for Payer: Networks By Design Commercial |
$349.70
|
| Rate for Payer: Prime Health Services Commercial |
$457.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$322.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$322.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.32
|
| Rate for Payer: United Healthcare All Other HMO |
$15.32
|
| Rate for Payer: United Healthcare HMO Rider |
$15.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.32
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.80
|
| Rate for Payer: Vantage Medical Group Senior |
$18.91
|
|
|
HC FETAL MONITOR CONT HRLY
|
Facility
|
IP
|
$41.00
|
|
| Hospital Charge Code |
902400355
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$34.85 |
| Rate for Payer: Adventist Health Commercial |
$8.20
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.40
|
| Rate for Payer: EPIC Health Plan Senior |
$16.40
|
| Rate for Payer: Galaxy Health WC |
$34.85
|
| Rate for Payer: Global Benefits Group Commercial |
$24.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.84
|
| Rate for Payer: Multiplan Commercial |
$32.80
|
| Rate for Payer: Networks By Design Commercial |
$26.65
|
| Rate for Payer: Prime Health Services Commercial |
$34.85
|
|
|
HC FETAL MONITOR CONT HRLY
|
Facility
|
OP
|
$41.00
|
|
| Hospital Charge Code |
902400355
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$1,091.00 |
| Rate for Payer: Adventist Health Commercial |
$8.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.18
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Cigna of CA HMO |
$26.24
|
| Rate for Payer: Cigna of CA PPO |
$30.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$34.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.40
|
| Rate for Payer: EPIC Health Plan Senior |
$16.40
|
| Rate for Payer: Galaxy Health WC |
$34.85
|
| Rate for Payer: Global Benefits Group Commercial |
$24.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.70
|
| Rate for Payer: Multiplan Commercial |
$32.80
|
| Rate for Payer: Networks By Design Commercial |
$26.65
|
| Rate for Payer: Prime Health Services Commercial |
$34.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,091.00
|
| Rate for Payer: United Healthcare All Other HMO |
$839.00
|
| Rate for Payer: United Healthcare HMO Rider |
$635.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$581.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.85
|
| Rate for Payer: Vantage Medical Group Senior |
$34.85
|
|
|
HC FETAL NON-STRESS TEST
|
Facility
|
OP
|
$1,360.00
|
|
|
Service Code
|
CPT 59025
|
| Hospital Charge Code |
902400362
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$38.30 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$272.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$892.02
|
| 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 |
$5,398.00
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cigna of CA HMO |
$870.40
|
| Rate for Payer: Cigna of CA PPO |
$1,006.40
|
| 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 |
$1,156.00
|
| Rate for Payer: Global Benefits Group Commercial |
$816.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$419.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$38.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$255.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$907.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$255.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$326.40
|
| 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 |
$1,088.00
|
| Rate for Payer: Networks By Design Commercial |
$884.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,156.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$816.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$816.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,091.00
|
| Rate for Payer: United Healthcare All Other HMO |
$839.00
|
| Rate for Payer: United Healthcare HMO Rider |
$635.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$581.00
|
| 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 FETAL NON-STRESS TEST
|
Facility
|
IP
|
$1,360.00
|
|
|
Service Code
|
CPT 59025
|
| Hospital Charge Code |
902400362
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$272.00 |
| Max. Negotiated Rate |
$1,156.00 |
| Rate for Payer: Adventist Health Commercial |
$272.00
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$544.00
|
| Rate for Payer: EPIC Health Plan Senior |
$544.00
|
| Rate for Payer: Galaxy Health WC |
$1,156.00
|
| Rate for Payer: Global Benefits Group Commercial |
$816.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$907.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$518.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$841.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$326.40
|
| Rate for Payer: Multiplan Commercial |
$1,088.00
|
| Rate for Payer: Networks By Design Commercial |
$884.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,156.00
|
|
|
HC FETAL NON-STRESS TEST ADDL FETUS
|
Facility
|
OP
|
$1,360.00
|
|
|
Service Code
|
CPT 59025 59
|
| Hospital Charge Code |
910400087
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$73.70 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$272.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$892.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,156.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$748.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,020.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cigna of CA HMO |
$870.40
|
| Rate for Payer: Cigna of CA PPO |
$1,006.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,156.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,156.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,156.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$544.00
|
| Rate for Payer: EPIC Health Plan Senior |
$544.00
|
| Rate for Payer: Galaxy Health WC |
$1,156.00
|
| Rate for Payer: Global Benefits Group Commercial |
$816.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$73.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$907.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$841.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$326.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$952.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$952.00
|
| Rate for Payer: Multiplan Commercial |
$1,088.00
|
| Rate for Payer: Networks By Design Commercial |
$884.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,156.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$816.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$816.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$680.00
|
| Rate for Payer: United Healthcare All Other HMO |
$680.00
|
| Rate for Payer: United Healthcare HMO Rider |
$680.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$680.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,156.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,156.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,156.00
|
|
|
HC FETAL NON-STRESS TEST ADDL FETUS
|
Facility
|
IP
|
$1,360.00
|
|
|
Service Code
|
CPT 59025 59
|
| Hospital Charge Code |
910400087
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$272.00 |
| Max. Negotiated Rate |
$1,156.00 |
| Rate for Payer: Adventist Health Commercial |
$272.00
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$544.00
|
| Rate for Payer: EPIC Health Plan Senior |
$544.00
|
| Rate for Payer: Galaxy Health WC |
$1,156.00
|
| Rate for Payer: Global Benefits Group Commercial |
$816.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$907.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$518.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$841.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$326.40
|
| Rate for Payer: Multiplan Commercial |
$1,088.00
|
| Rate for Payer: Networks By Design Commercial |
$884.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,156.00
|
|
|
HC FETAL NON-STRESS TEST SINGLE FETUS
|
Facility
|
OP
|
$1,360.00
|
|
|
Service Code
|
CPT 59025
|
| Hospital Charge Code |
910400086
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$38.30 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$272.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$892.02
|
| 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 |
$5,398.00
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cigna of CA HMO |
$870.40
|
| Rate for Payer: Cigna of CA PPO |
$1,006.40
|
| 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 |
$1,156.00
|
| Rate for Payer: Global Benefits Group Commercial |
$816.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$419.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$38.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$255.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$907.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$255.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$326.40
|
| 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 |
$1,088.00
|
| Rate for Payer: Networks By Design Commercial |
$884.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,156.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$816.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$816.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$680.00
|
| Rate for Payer: United Healthcare All Other HMO |
$680.00
|
| Rate for Payer: United Healthcare HMO Rider |
$680.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$680.00
|
| 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 FETAL NON-STRESS TEST SINGLE FETUS
|
Facility
|
IP
|
$1,360.00
|
|
|
Service Code
|
CPT 59025
|
| Hospital Charge Code |
910400086
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$272.00 |
| Max. Negotiated Rate |
$1,156.00 |
| Rate for Payer: Adventist Health Commercial |
$272.00
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$544.00
|
| Rate for Payer: EPIC Health Plan Senior |
$544.00
|
| Rate for Payer: Galaxy Health WC |
$1,156.00
|
| Rate for Payer: Global Benefits Group Commercial |
$816.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$907.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$518.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$841.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$326.40
|
| Rate for Payer: Multiplan Commercial |
$1,088.00
|
| Rate for Payer: Networks By Design Commercial |
$884.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,156.00
|
|
|
HC FETAL SHUNT PLACEMENT
|
Facility
|
IP
|
$509.00
|
|
|
Service Code
|
CPT 59076
|
| Hospital Charge Code |
910400092
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$101.80 |
| Max. Negotiated Rate |
$432.65 |
| Rate for Payer: Adventist Health Commercial |
$101.80
|
| Rate for Payer: Cash Price |
$229.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$203.60
|
| Rate for Payer: EPIC Health Plan Senior |
$203.60
|
| Rate for Payer: Galaxy Health WC |
$432.65
|
| Rate for Payer: Global Benefits Group Commercial |
$305.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$339.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$193.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$315.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.16
|
| Rate for Payer: Multiplan Commercial |
$407.20
|
| Rate for Payer: Networks By Design Commercial |
$330.85
|
| Rate for Payer: Prime Health Services Commercial |
$432.65
|
|
|
HC FETAL SHUNT PLACEMENT
|
Facility
|
OP
|
$509.00
|
|
|
Service Code
|
CPT 59076
|
| Hospital Charge Code |
910400092
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$101.80 |
| Max. Negotiated Rate |
$6,427.00 |
| Rate for Payer: Adventist Health Commercial |
$101.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$386.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$229.05
|
| Rate for Payer: Cash Price |
$229.05
|
| Rate for Payer: Cash Price |
$229.05
|
| Rate for Payer: Cigna of CA HMO |
$325.76
|
| Rate for Payer: Cigna of CA PPO |
$376.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$579.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$425.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$386.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$521.77
|
| Rate for Payer: EPIC Health Plan Senior |
$386.50
|
| Rate for Payer: Galaxy Health WC |
$432.65
|
| Rate for Payer: Global Benefits Group Commercial |
$305.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$633.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$742.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$386.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$339.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$839.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$386.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$486.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$517.91
|
| Rate for Payer: Multiplan Commercial |
$407.20
|
| Rate for Payer: Networks By Design Commercial |
$330.85
|
| Rate for Payer: Prime Health Services Commercial |
$432.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$305.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$305.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,091.00
|
| Rate for Payer: United Healthcare All Other HMO |
$839.00
|
| Rate for Payer: United Healthcare HMO Rider |
$635.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$581.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$386.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Vantage Medical Group Senior |
$386.50
|
|
|
HC FETAL SHUNT PLACMNT ADDL FETUS
|
Facility
|
IP
|
$509.00
|
|
|
Service Code
|
CPT 59076
|
| Hospital Charge Code |
910400093
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$101.80 |
| Max. Negotiated Rate |
$432.65 |
| Rate for Payer: Adventist Health Commercial |
$101.80
|
| Rate for Payer: Cash Price |
$229.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$203.60
|
| Rate for Payer: EPIC Health Plan Senior |
$203.60
|
| Rate for Payer: Galaxy Health WC |
$432.65
|
| Rate for Payer: Global Benefits Group Commercial |
$305.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$339.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$193.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$315.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.16
|
| Rate for Payer: Multiplan Commercial |
$407.20
|
| Rate for Payer: Networks By Design Commercial |
$330.85
|
| Rate for Payer: Prime Health Services Commercial |
$432.65
|
|
|
HC FETAL SHUNT PLACMNT ADDL FETUS
|
Facility
|
OP
|
$509.00
|
|
|
Service Code
|
CPT 59076
|
| Hospital Charge Code |
910400093
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$101.80 |
| Max. Negotiated Rate |
$6,427.00 |
| Rate for Payer: Adventist Health Commercial |
$101.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$386.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$229.05
|
| Rate for Payer: Cash Price |
$229.05
|
| Rate for Payer: Cash Price |
$229.05
|
| Rate for Payer: Cigna of CA HMO |
$325.76
|
| Rate for Payer: Cigna of CA PPO |
$376.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$579.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$425.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$386.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$521.77
|
| Rate for Payer: EPIC Health Plan Senior |
$386.50
|
| Rate for Payer: Galaxy Health WC |
$432.65
|
| Rate for Payer: Global Benefits Group Commercial |
$305.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$633.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$742.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$386.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$339.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$839.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$386.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$486.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$517.91
|
| Rate for Payer: Multiplan Commercial |
$407.20
|
| Rate for Payer: Networks By Design Commercial |
$330.85
|
| Rate for Payer: Prime Health Services Commercial |
$432.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$305.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$305.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$254.50
|
| Rate for Payer: United Healthcare All Other HMO |
$254.50
|
| Rate for Payer: United Healthcare HMO Rider |
$254.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$254.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$386.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Vantage Medical Group Senior |
$386.50
|
|
|
HC FFP PED PAK ALIQUOT
|
Facility
|
OP
|
$695.00
|
|
|
Service Code
|
CPT P9011
|
| Hospital Charge Code |
900904530
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$139.00 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Adventist Health Commercial |
$139.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$455.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$270.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$198.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$180.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$426.80
|
| Rate for Payer: Cash Price |
$312.75
|
| Rate for Payer: Cash Price |
$312.75
|
| Rate for Payer: Cash Price |
$312.75
|
| Rate for Payer: Cigna of CA HMO |
$444.80
|
| Rate for Payer: Cigna of CA PPO |
$514.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$270.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$198.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$180.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$243.23
|
| Rate for Payer: EPIC Health Plan Senior |
$180.17
|
| Rate for Payer: Galaxy Health WC |
$590.75
|
| Rate for Payer: Global Benefits Group Commercial |
$417.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$295.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$250.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$180.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$463.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$283.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$180.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$227.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$241.43
|
| Rate for Payer: Multiplan Commercial |
$556.00
|
| Rate for Payer: Networks By Design Commercial |
$451.75
|
| Rate for Payer: Prime Health Services Commercial |
$590.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$417.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$417.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$180.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$270.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$198.19
|
| Rate for Payer: Vantage Medical Group Senior |
$180.17
|
|
|
HC FFP PED PAK ALIQUOT
|
Facility
|
IP
|
$695.00
|
|
|
Service Code
|
CPT P9011
|
| Hospital Charge Code |
900904530
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$139.00 |
| Max. Negotiated Rate |
$590.75 |
| Rate for Payer: Adventist Health Commercial |
$139.00
|
| Rate for Payer: Cash Price |
$312.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$278.00
|
| Rate for Payer: EPIC Health Plan Senior |
$278.00
|
| Rate for Payer: Galaxy Health WC |
$590.75
|
| Rate for Payer: Global Benefits Group Commercial |
$417.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$463.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$264.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$430.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.80
|
| Rate for Payer: Multiplan Commercial |
$556.00
|
| Rate for Payer: Networks By Design Commercial |
$451.75
|
| Rate for Payer: Prime Health Services Commercial |
$590.75
|
|
|
HC FFP SPLIT UNIT GT 150 ML
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
CPT P9011
|
| Hospital Charge Code |
900904533
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$66.20 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Adventist Health Commercial |
$66.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$217.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$270.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$198.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$180.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$203.27
|
| Rate for Payer: Cash Price |
$148.95
|
| Rate for Payer: Cash Price |
$148.95
|
| Rate for Payer: Cash Price |
$148.95
|
| Rate for Payer: Cigna of CA HMO |
$211.84
|
| Rate for Payer: Cigna of CA PPO |
$244.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$270.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$198.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$180.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$243.23
|
| Rate for Payer: EPIC Health Plan Senior |
$180.17
|
| Rate for Payer: Galaxy Health WC |
$281.35
|
| Rate for Payer: Global Benefits Group Commercial |
$198.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$295.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$250.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$180.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$220.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$283.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$180.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$227.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$241.43
|
| Rate for Payer: Multiplan Commercial |
$264.80
|
| Rate for Payer: Networks By Design Commercial |
$215.15
|
| Rate for Payer: Prime Health Services Commercial |
$281.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$198.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$198.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$180.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$270.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$198.19
|
| Rate for Payer: Vantage Medical Group Senior |
$180.17
|
|
|
HC FFP SPLIT UNIT GT 150 ML
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
CPT P9011
|
| Hospital Charge Code |
900904533
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$66.20 |
| Max. Negotiated Rate |
$281.35 |
| Rate for Payer: Adventist Health Commercial |
$66.20
|
| Rate for Payer: Cash Price |
$148.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$132.40
|
| Rate for Payer: EPIC Health Plan Senior |
$132.40
|
| Rate for Payer: Galaxy Health WC |
$281.35
|
| Rate for Payer: Global Benefits Group Commercial |
$198.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$220.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$126.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$204.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.44
|
| Rate for Payer: Multiplan Commercial |
$264.80
|
| Rate for Payer: Networks By Design Commercial |
$215.15
|
| Rate for Payer: Prime Health Services Commercial |
$281.35
|
|
|
HC FIBRIN DEGRAD SPLIT PRODUCTS
|
Facility
|
OP
|
$37.00
|
|
|
Service Code
|
CPT 85362
|
| Hospital Charge Code |
900910069
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.58 |
| Max. Negotiated Rate |
$67.96 |
| Rate for Payer: Adventist Health Commercial |
$7.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$67.96
|
| Rate for Payer: Blue Shield of California Commercial |
$24.75
|
| Rate for Payer: Blue Shield of California EPN |
$16.35
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cigna of CA HMO |
$23.68
|
| Rate for Payer: Cigna of CA PPO |
$27.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.30
|
| Rate for Payer: EPIC Health Plan Senior |
$6.89
|
| Rate for Payer: Galaxy Health WC |
$31.45
|
| Rate for Payer: Global Benefits Group Commercial |
$22.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.23
|
| Rate for Payer: Multiplan Commercial |
$29.60
|
| Rate for Payer: Networks By Design Commercial |
$24.05
|
| Rate for Payer: Prime Health Services Commercial |
$31.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.58
|
| Rate for Payer: United Healthcare All Other HMO |
$5.58
|
| Rate for Payer: United Healthcare HMO Rider |
$5.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.58
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.58
|
| Rate for Payer: Vantage Medical Group Senior |
$6.89
|
|
|
HC FIBRIN DEGRAD SPLIT PRODUCTS
|
Facility
|
IP
|
$262.00
|
|
|
Service Code
|
CPT 85362
|
| Hospital Charge Code |
900910069
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$52.40 |
| Max. Negotiated Rate |
$222.70 |
| Rate for Payer: Adventist Health Commercial |
$52.40
|
| Rate for Payer: Cash Price |
$117.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$104.80
|
| Rate for Payer: EPIC Health Plan Senior |
$104.80
|
| Rate for Payer: Galaxy Health WC |
$222.70
|
| Rate for Payer: Global Benefits Group Commercial |
$157.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$174.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$99.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.88
|
| Rate for Payer: Multiplan Commercial |
$209.60
|
| Rate for Payer: Networks By Design Commercial |
$170.30
|
| Rate for Payer: Prime Health Services Commercial |
$222.70
|
|
|
HC FIBRINOGEN ASSAY
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
CPT 85384
|
| Hospital Charge Code |
900910013
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.88 |
| Max. Negotiated Rate |
$83.39 |
| Rate for Payer: Adventist Health Commercial |
$16.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$55.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$83.39
|
| Rate for Payer: Blue Shield of California Commercial |
$56.20
|
| Rate for Payer: Blue Shield of California EPN |
$37.13
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cigna of CA HMO |
$53.76
|
| Rate for Payer: Cigna of CA PPO |
$62.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.12
|
| Rate for Payer: EPIC Health Plan Senior |
$9.72
|
| Rate for Payer: Galaxy Health WC |
$71.40
|
| Rate for Payer: Global Benefits Group Commercial |
$50.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.02
|
| Rate for Payer: Multiplan Commercial |
$67.20
|
| Rate for Payer: Networks By Design Commercial |
$54.60
|
| Rate for Payer: Prime Health Services Commercial |
$71.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$50.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$50.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.88
|
| Rate for Payer: United Healthcare All Other HMO |
$7.88
|
| Rate for Payer: United Healthcare HMO Rider |
$7.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.88
|
| Rate for Payer: Upland Medical Group Pediatric |
$9.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.69
|
| Rate for Payer: Vantage Medical Group Senior |
$9.72
|
|
|
HC FIBRINOGEN ASSAY
|
Facility
|
IP
|
$299.00
|
|
|
Service Code
|
CPT 85384
|
| Hospital Charge Code |
900910013
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$59.80 |
| Max. Negotiated Rate |
$254.15 |
| Rate for Payer: Adventist Health Commercial |
$59.80
|
| Rate for Payer: Cash Price |
$134.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$119.60
|
| Rate for Payer: EPIC Health Plan Senior |
$119.60
|
| Rate for Payer: Galaxy Health WC |
$254.15
|
| Rate for Payer: Global Benefits Group Commercial |
$179.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$199.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$185.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.76
|
| Rate for Payer: Multiplan Commercial |
$239.20
|
| Rate for Payer: Networks By Design Commercial |
$194.35
|
| Rate for Payer: Prime Health Services Commercial |
$254.15
|
|
|
HC FINE NDLE ASPIR W/GUIDANCE
|
Facility
|
OP
|
$2,540.00
|
|
|
Service Code
|
CPT 62267
|
| Hospital Charge Code |
909000240
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$195.77 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$508.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$893.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| 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 |
$1,143.00
|
| Rate for Payer: Cash Price |
$1,143.00
|
| Rate for Payer: Cash Price |
$1,143.00
|
| Rate for Payer: Cigna of CA HMO |
$1,625.60
|
| Rate for Payer: Cigna of CA PPO |
$1,879.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$983.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$893.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,206.87
|
| Rate for Payer: EPIC Health Plan Senior |
$893.98
|
| Rate for Payer: Galaxy Health WC |
$2,159.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,524.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,466.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$195.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$893.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,694.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$221.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$893.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$609.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,126.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,197.93
|
| Rate for Payer: Multiplan Commercial |
$2,032.00
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$1,651.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,159.00
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,524.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$893.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Vantage Medical Group Senior |
$893.98
|
|
|
HC FINE NDLE ASPIR W/GUIDANCE
|
Facility
|
IP
|
$2,540.00
|
|
|
Service Code
|
CPT 62267
|
| Hospital Charge Code |
909000240
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$508.00 |
| Max. Negotiated Rate |
$2,159.00 |
| Rate for Payer: Adventist Health Commercial |
$508.00
|
| Rate for Payer: Cash Price |
$1,143.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,016.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,016.00
|
| Rate for Payer: Galaxy Health WC |
$2,159.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,524.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,694.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$967.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,572.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$609.60
|
| Rate for Payer: Multiplan Commercial |
$2,032.00
|
| Rate for Payer: Networks By Design Commercial |
$1,651.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,159.00
|
|
|
HC FINE NEEDLE ASPIRATION
|
Facility
|
OP
|
$328.00
|
|
|
Service Code
|
CPT 88173
|
| Hospital Charge Code |
903800007
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$41.11 |
| Max. Negotiated Rate |
$278.80 |
| Rate for Payer: Adventist Health Commercial |
$65.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$215.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$101.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$107.99
|
| Rate for Payer: Blue Shield of California Commercial |
$219.43
|
| Rate for Payer: Blue Shield of California EPN |
$144.98
|
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Cigna of CA HMO |
$209.92
|
| Rate for Payer: Cigna of CA PPO |
$242.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$101.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.65
|
| Rate for Payer: EPIC Health Plan Senior |
$67.89
|
| Rate for Payer: Galaxy Health WC |
$278.80
|
| Rate for Payer: Global Benefits Group Commercial |
$196.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$111.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$87.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$218.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$85.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$90.97
|
| Rate for Payer: Multiplan Commercial |
$262.40
|
| Rate for Payer: Networks By Design Commercial |
$213.20
|
| Rate for Payer: Prime Health Services Commercial |
$278.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$196.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$196.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.11
|
| Rate for Payer: United Healthcare All Other HMO |
$41.11
|
| Rate for Payer: United Healthcare HMO Rider |
$41.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.11
|
| Rate for Payer: Upland Medical Group Pediatric |
$67.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$101.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.68
|
| Rate for Payer: Vantage Medical Group Senior |
$67.89
|
|
