|
HC POSITIONING GEL-E DONUT MED
|
Facility
|
IP
|
$70.93
|
|
| Hospital Charge Code |
901604725
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.19 |
| Max. Negotiated Rate |
$60.29 |
| Rate for Payer: Adventist Health Commercial |
$14.19
|
| Rate for Payer: Cash Price |
$31.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.37
|
| Rate for Payer: EPIC Health Plan Senior |
$28.37
|
| Rate for Payer: Galaxy Health WC |
$60.29
|
| Rate for Payer: Global Benefits Group Commercial |
$42.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.02
|
| Rate for Payer: Multiplan Commercial |
$56.74
|
| Rate for Payer: Networks By Design Commercial |
$46.10
|
| Rate for Payer: Prime Health Services Commercial |
$60.29
|
|
|
HC POSITIONING GEL-E DONUT MED
|
Facility
|
OP
|
$70.93
|
|
| Hospital Charge Code |
901604725
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.19 |
| Max. Negotiated Rate |
$60.29 |
| Rate for Payer: Adventist Health Commercial |
$14.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$46.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$60.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$53.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.56
|
| Rate for Payer: Cash Price |
$31.92
|
| Rate for Payer: Cigna of CA HMO |
$45.40
|
| Rate for Payer: Cigna of CA PPO |
$52.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$60.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$60.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$60.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.37
|
| Rate for Payer: EPIC Health Plan Senior |
$28.37
|
| Rate for Payer: Galaxy Health WC |
$60.29
|
| Rate for Payer: Global Benefits Group Commercial |
$42.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$49.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.65
|
| Rate for Payer: Multiplan Commercial |
$56.74
|
| Rate for Payer: Networks By Design Commercial |
$46.10
|
| Rate for Payer: Prime Health Services Commercial |
$60.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.47
|
| Rate for Payer: United Healthcare All Other HMO |
$35.47
|
| Rate for Payer: United Healthcare HMO Rider |
$35.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$60.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$60.29
|
| Rate for Payer: Vantage Medical Group Senior |
$60.29
|
|
|
HC POSITIONING GEL-E DONUT SMALL
|
Facility
|
OP
|
$70.93
|
|
| Hospital Charge Code |
901604727
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.19 |
| Max. Negotiated Rate |
$60.29 |
| Rate for Payer: Adventist Health Commercial |
$14.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$46.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$60.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$53.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.56
|
| Rate for Payer: Cash Price |
$31.92
|
| Rate for Payer: Cigna of CA HMO |
$45.40
|
| Rate for Payer: Cigna of CA PPO |
$52.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$60.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$60.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$60.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.37
|
| Rate for Payer: EPIC Health Plan Senior |
$28.37
|
| Rate for Payer: Galaxy Health WC |
$60.29
|
| Rate for Payer: Global Benefits Group Commercial |
$42.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$49.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.65
|
| Rate for Payer: Multiplan Commercial |
$56.74
|
| Rate for Payer: Networks By Design Commercial |
$46.10
|
| Rate for Payer: Prime Health Services Commercial |
$60.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.47
|
| Rate for Payer: United Healthcare All Other HMO |
$35.47
|
| Rate for Payer: United Healthcare HMO Rider |
$35.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$60.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$60.29
|
| Rate for Payer: Vantage Medical Group Senior |
$60.29
|
|
|
HC POSITIONING GEL-E DONUT SMALL
|
Facility
|
IP
|
$70.93
|
|
| Hospital Charge Code |
901604727
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.19 |
| Max. Negotiated Rate |
$60.29 |
| Rate for Payer: Adventist Health Commercial |
$14.19
|
| Rate for Payer: Cash Price |
$31.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.37
|
| Rate for Payer: EPIC Health Plan Senior |
$28.37
|
| Rate for Payer: Galaxy Health WC |
$60.29
|
| Rate for Payer: Global Benefits Group Commercial |
$42.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.02
|
| Rate for Payer: Multiplan Commercial |
$56.74
|
| Rate for Payer: Networks By Design Commercial |
$46.10
|
| Rate for Payer: Prime Health Services Commercial |
$60.29
|
|
|
HC POSITIONING GEL-E DONUT X-SM
|
Facility
|
IP
|
$63.55
|
|
| Hospital Charge Code |
901698581
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.71 |
| Max. Negotiated Rate |
$54.02 |
| Rate for Payer: Adventist Health Commercial |
$12.71
|
| Rate for Payer: Cash Price |
$28.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.42
|
| Rate for Payer: EPIC Health Plan Senior |
$25.42
|
| Rate for Payer: Galaxy Health WC |
$54.02
|
| Rate for Payer: Global Benefits Group Commercial |
$38.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$39.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.25
|
| Rate for Payer: Multiplan Commercial |
$50.84
|
| Rate for Payer: Networks By Design Commercial |
$41.31
|
| Rate for Payer: Prime Health Services Commercial |
$54.02
|
|
|
HC POSITIONING GEL-E DONUT X-SM
|
Facility
|
OP
|
$63.55
|
|
| Hospital Charge Code |
901698581
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.71 |
| Max. Negotiated Rate |
$54.02 |
| Rate for Payer: Adventist Health Commercial |
$12.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$41.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$54.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$47.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.03
|
| Rate for Payer: Cash Price |
$28.60
|
| Rate for Payer: Cigna of CA HMO |
$40.67
|
| Rate for Payer: Cigna of CA PPO |
$47.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$54.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$54.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$54.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.42
|
| Rate for Payer: EPIC Health Plan Senior |
$25.42
|
| Rate for Payer: Galaxy Health WC |
$54.02
|
| Rate for Payer: Global Benefits Group Commercial |
$38.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$39.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44.48
|
| Rate for Payer: Multiplan Commercial |
$50.84
|
| Rate for Payer: Networks By Design Commercial |
$41.31
|
| Rate for Payer: Prime Health Services Commercial |
$54.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$38.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$38.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.77
|
| Rate for Payer: United Healthcare All Other HMO |
$31.77
|
| Rate for Payer: United Healthcare HMO Rider |
$31.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$54.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$54.02
|
| Rate for Payer: Vantage Medical Group Senior |
$54.02
|
|
|
HC POST FLUIDIZED ZFLO MED
|
Facility
|
OP
|
$788.49
|
|
| Hospital Charge Code |
901605553
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$157.70 |
| Max. Negotiated Rate |
$670.22 |
| Rate for Payer: Adventist Health Commercial |
$157.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$517.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$670.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$433.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$591.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$484.21
|
| Rate for Payer: Cash Price |
$354.82
|
| Rate for Payer: Cigna of CA HMO |
$504.63
|
| Rate for Payer: Cigna of CA PPO |
$583.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$670.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$670.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$670.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$315.40
|
| Rate for Payer: EPIC Health Plan Senior |
$315.40
|
| Rate for Payer: Galaxy Health WC |
$670.22
|
| Rate for Payer: Global Benefits Group Commercial |
$473.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$525.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$300.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$488.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$189.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$551.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$551.94
|
| Rate for Payer: Multiplan Commercial |
$630.79
|
| Rate for Payer: Networks By Design Commercial |
$512.52
|
| Rate for Payer: Prime Health Services Commercial |
$670.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$473.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$473.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$394.25
|
| Rate for Payer: United Healthcare All Other HMO |
$394.25
|
| Rate for Payer: United Healthcare HMO Rider |
$394.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$394.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$670.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$670.22
|
| Rate for Payer: Vantage Medical Group Senior |
$670.22
|
|
|
HC POST FLUIDIZED ZFLO MED
|
Facility
|
IP
|
$788.49
|
|
| Hospital Charge Code |
901605553
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$157.70 |
| Max. Negotiated Rate |
$670.22 |
| Rate for Payer: Adventist Health Commercial |
$157.70
|
| Rate for Payer: Cash Price |
$354.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$315.40
|
| Rate for Payer: EPIC Health Plan Senior |
$315.40
|
| Rate for Payer: Galaxy Health WC |
$670.22
|
| Rate for Payer: Global Benefits Group Commercial |
$473.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$525.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$300.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$488.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$189.24
|
| Rate for Payer: Multiplan Commercial |
$630.79
|
| Rate for Payer: Networks By Design Commercial |
$512.52
|
| Rate for Payer: Prime Health Services Commercial |
$670.22
|
|
|
HC POST MASTECTOMY BRA
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
CPT L8000
|
| Hospital Charge Code |
915358000
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$34.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$34.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: Cigna of CA HMO |
$119.70
|
| Rate for Payer: Cigna of CA PPO |
$119.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.40
|
| Rate for Payer: EPIC Health Plan Senior |
$68.40
|
| Rate for Payer: Galaxy Health WC |
$145.35
|
| Rate for Payer: Global Benefits Group Commercial |
$102.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$114.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$105.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.04
|
| Rate for Payer: Multiplan Commercial |
$136.80
|
| Rate for Payer: Networks By Design Commercial |
$85.50
|
| Rate for Payer: Prime Health Services Commercial |
$145.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$64.18
|
| Rate for Payer: United Healthcare All Other HMO |
$62.47
|
| Rate for Payer: United Healthcare HMO Rider |
$61.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$56.00
|
|
|
HC POST MASTECTOMY BRA
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
CPT L8000
|
| Hospital Charge Code |
905358000
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$41.04 |
| Max. Negotiated Rate |
$145.35 |
| Rate for Payer: Adventist Health Commercial |
$70.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$145.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$94.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$128.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$99.04
|
| Rate for Payer: Blue Shield of California Commercial |
$126.20
|
| Rate for Payer: Blue Shield of California EPN |
$83.11
|
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: Cigna of CA HMO |
$119.70
|
| Rate for Payer: Cigna of CA PPO |
$119.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$145.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$145.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$145.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.40
|
| Rate for Payer: EPIC Health Plan Senior |
$68.40
|
| Rate for Payer: Galaxy Health WC |
$145.35
|
| Rate for Payer: Global Benefits Group Commercial |
$102.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$51.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$114.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$105.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$119.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$119.70
|
| Rate for Payer: Multiplan Commercial |
$136.80
|
| Rate for Payer: Networks By Design Commercial |
$85.50
|
| Rate for Payer: Prime Health Services Commercial |
$145.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$102.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$102.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$64.18
|
| Rate for Payer: United Healthcare All Other HMO |
$62.47
|
| Rate for Payer: United Healthcare HMO Rider |
$61.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$56.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$145.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$145.35
|
| Rate for Payer: Vantage Medical Group Senior |
$145.35
|
|
|
HC POST MASTECTOMY BRA
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
CPT L8000
|
| Hospital Charge Code |
915358000
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$41.04 |
| Max. Negotiated Rate |
$145.35 |
| Rate for Payer: Adventist Health Commercial |
$70.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$145.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$94.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$128.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$99.04
|
| Rate for Payer: Blue Shield of California Commercial |
$126.20
|
| Rate for Payer: Blue Shield of California EPN |
$83.11
|
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: Cigna of CA HMO |
$119.70
|
| Rate for Payer: Cigna of CA PPO |
$119.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$145.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$145.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$145.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.40
|
| Rate for Payer: EPIC Health Plan Senior |
$68.40
|
| Rate for Payer: Galaxy Health WC |
$145.35
|
| Rate for Payer: Global Benefits Group Commercial |
$102.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$51.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$114.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$105.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$119.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$119.70
|
| Rate for Payer: Multiplan Commercial |
$136.80
|
| Rate for Payer: Networks By Design Commercial |
$85.50
|
| Rate for Payer: Prime Health Services Commercial |
$145.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$102.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$102.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$64.18
|
| Rate for Payer: United Healthcare All Other HMO |
$62.47
|
| Rate for Payer: United Healthcare HMO Rider |
$61.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$56.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$145.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$145.35
|
| Rate for Payer: Vantage Medical Group Senior |
$145.35
|
|
|
HC POST MASTECTOMY BRA
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
CPT L8000
|
| Hospital Charge Code |
905358000
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$34.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$34.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: Cigna of CA HMO |
$119.70
|
| Rate for Payer: Cigna of CA PPO |
$119.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.40
|
| Rate for Payer: EPIC Health Plan Senior |
$68.40
|
| Rate for Payer: Galaxy Health WC |
$145.35
|
| Rate for Payer: Global Benefits Group Commercial |
$102.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$114.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$105.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.04
|
| Rate for Payer: Multiplan Commercial |
$136.80
|
| Rate for Payer: Networks By Design Commercial |
$85.50
|
| Rate for Payer: Prime Health Services Commercial |
$145.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$64.18
|
| Rate for Payer: United Healthcare All Other HMO |
$62.47
|
| Rate for Payer: United Healthcare HMO Rider |
$61.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$56.00
|
|
|
HC POST PARTUM PERINEAL LAC RPR
|
Facility
|
OP
|
$4,834.00
|
|
|
Service Code
|
CPT 56810
|
| Hospital Charge Code |
902400754
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$417.11 |
| Max. Negotiated Rate |
$13,086.00 |
| Rate for Payer: Adventist Health Commercial |
$966.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13,086.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,039.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,922.00
|
| Rate for Payer: Cash Price |
$2,175.30
|
| Rate for Payer: Cash Price |
$2,175.30
|
| Rate for Payer: Cash Price |
$2,175.30
|
| Rate for Payer: Cigna of CA HMO |
$3,093.76
|
| Rate for Payer: Cigna of CA PPO |
$3,577.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,443.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,039.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,453.88
|
| Rate for Payer: EPIC Health Plan Senior |
$4,039.91
|
| Rate for Payer: Galaxy Health WC |
$4,108.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,900.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,625.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$417.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,039.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,224.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$471.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,039.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,160.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,090.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,413.48
|
| Rate for Payer: Multiplan Commercial |
$3,867.20
|
| Rate for Payer: Networks By Design Commercial |
$3,142.10
|
| Rate for Payer: Prime Health Services Commercial |
$4,108.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,900.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,900.40
|
| 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 |
$4,039.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Vantage Medical Group Senior |
$4,039.91
|
|
|
HC POST PARTUM PERINEAL LAC RPR
|
Facility
|
IP
|
$4,834.00
|
|
|
Service Code
|
CPT 56810
|
| Hospital Charge Code |
902400754
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$966.80 |
| Max. Negotiated Rate |
$4,108.90 |
| Rate for Payer: Adventist Health Commercial |
$966.80
|
| Rate for Payer: Cash Price |
$2,175.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,933.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,933.60
|
| Rate for Payer: Galaxy Health WC |
$4,108.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,900.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,224.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,841.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,992.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,160.16
|
| Rate for Payer: Multiplan Commercial |
$3,867.20
|
| Rate for Payer: Networks By Design Commercial |
$3,142.10
|
| Rate for Payer: Prime Health Services Commercial |
$4,108.90
|
|
|
HC POST TRANSFUSION INVESTIGATION
|
Facility
|
OP
|
$402.00
|
|
|
Service Code
|
CPT 86078
|
| Hospital Charge Code |
900904761
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$73.67 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Adventist Health Commercial |
$80.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$263.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$246.87
|
| Rate for Payer: Cash Price |
$180.90
|
| Rate for Payer: Cash Price |
$180.90
|
| Rate for Payer: Cash Price |
$180.90
|
| Rate for Payer: Cigna of CA HMO |
$257.28
|
| Rate for Payer: Cigna of CA PPO |
$297.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$326.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$217.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$293.94
|
| Rate for Payer: EPIC Health Plan Senior |
$217.73
|
| Rate for Payer: Galaxy Health WC |
$341.70
|
| Rate for Payer: Global Benefits Group Commercial |
$241.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$357.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$73.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$217.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$268.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$217.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$274.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$291.76
|
| Rate for Payer: Multiplan Commercial |
$321.60
|
| Rate for Payer: Networks By Design Commercial |
$261.30
|
| Rate for Payer: Prime Health Services Commercial |
$341.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$241.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$241.20
|
| 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 |
$217.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Vantage Medical Group Senior |
$217.73
|
|
|
HC POST TRANSFUSION INVESTIGATION
|
Facility
|
IP
|
$402.00
|
|
|
Service Code
|
CPT 86078
|
| Hospital Charge Code |
900904761
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$80.40 |
| Max. Negotiated Rate |
$341.70 |
| Rate for Payer: Adventist Health Commercial |
$80.40
|
| Rate for Payer: Cash Price |
$180.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.80
|
| Rate for Payer: EPIC Health Plan Senior |
$160.80
|
| Rate for Payer: Galaxy Health WC |
$341.70
|
| Rate for Payer: Global Benefits Group Commercial |
$241.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$268.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$153.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$248.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.48
|
| Rate for Payer: Multiplan Commercial |
$321.60
|
| Rate for Payer: Networks By Design Commercial |
$261.30
|
| Rate for Payer: Prime Health Services Commercial |
$341.70
|
|
|
HC POTASSIUM
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
900910488
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$45.82 |
| Rate for Payer: Adventist Health Commercial |
$6.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22.30
|
| 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 |
$45.82
|
| Rate for Payer: Blue Shield of California Commercial |
$22.75
|
| Rate for Payer: Blue Shield of California EPN |
$15.03
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cigna of CA HMO |
$21.76
|
| Rate for Payer: Cigna of CA PPO |
$25.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.43
|
| Rate for Payer: EPIC Health Plan Senior |
$4.76
|
| Rate for Payer: Galaxy Health WC |
$28.90
|
| Rate for Payer: Global Benefits Group Commercial |
$20.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.68
|
| 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 |
$8.16
|
| 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 |
$27.20
|
| Rate for Payer: Networks By Design Commercial |
$22.10
|
| Rate for Payer: Prime Health Services Commercial |
$28.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.40
|
| 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: Upland Medical Group Pediatric |
$4.76
|
| 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
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
900910488
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$83.30 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.20
|
| Rate for Payer: EPIC Health Plan Senior |
$39.20
|
| Rate for Payer: Galaxy Health WC |
$83.30
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$60.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.52
|
| Rate for Payer: Multiplan Commercial |
$78.40
|
| Rate for Payer: Networks By Design Commercial |
$63.70
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
|
|
HC POTASSIUM
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
900910266
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$83.30 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.20
|
| Rate for Payer: EPIC Health Plan Senior |
$39.20
|
| Rate for Payer: Galaxy Health WC |
$83.30
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$60.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.52
|
| Rate for Payer: Multiplan Commercial |
$78.40
|
| Rate for Payer: Networks By Design Commercial |
$63.70
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
|
|
HC POTASSIUM
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
900910266
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$45.82 |
| Rate for Payer: Adventist Health Commercial |
$6.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22.30
|
| 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 |
$45.82
|
| Rate for Payer: Blue Shield of California Commercial |
$22.75
|
| Rate for Payer: Blue Shield of California EPN |
$15.03
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cigna of CA HMO |
$21.76
|
| Rate for Payer: Cigna of CA PPO |
$25.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.43
|
| Rate for Payer: EPIC Health Plan Senior |
$4.76
|
| Rate for Payer: Galaxy Health WC |
$28.90
|
| Rate for Payer: Global Benefits Group Commercial |
$20.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.68
|
| 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 |
$8.16
|
| 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 |
$27.20
|
| Rate for Payer: Networks By Design Commercial |
$22.10
|
| Rate for Payer: Prime Health Services Commercial |
$28.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.40
|
| 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: Upland Medical Group Pediatric |
$4.76
|
| 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
|
$27.00
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
900912245
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.40 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Adventist Health Commercial |
$5.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.58
|
| Rate for Payer: Blue Shield of California Commercial |
$18.06
|
| Rate for Payer: Blue Shield of California EPN |
$11.93
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cigna of CA HMO |
$17.28
|
| Rate for Payer: Cigna of CA PPO |
$19.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.80
|
| Rate for Payer: EPIC Health Plan Senior |
$10.80
|
| Rate for Payer: Galaxy Health WC |
$22.95
|
| Rate for Payer: Global Benefits Group Commercial |
$16.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.90
|
| Rate for Payer: Multiplan Commercial |
$21.60
|
| Rate for Payer: Networks By Design Commercial |
$17.55
|
| Rate for Payer: Prime Health Services Commercial |
$22.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.50
|
| Rate for Payer: United Healthcare All Other HMO |
$13.50
|
| Rate for Payer: United Healthcare HMO Rider |
$13.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.95
|
| Rate for Payer: Vantage Medical Group Senior |
$22.95
|
|
|
HC POTASSIUM BODY FLUID
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
900912245
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$23.80 |
| Rate for Payer: Adventist Health Commercial |
$5.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.20
|
| Rate for Payer: EPIC Health Plan Senior |
$11.20
|
| Rate for Payer: Galaxy Health WC |
$23.80
|
| Rate for Payer: Global Benefits Group Commercial |
$16.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.72
|
| Rate for Payer: Multiplan Commercial |
$22.40
|
| Rate for Payer: Networks By Design Commercial |
$18.20
|
| Rate for Payer: Prime Health Services Commercial |
$23.80
|
|
|
HC POTASSIUM CH
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
900912185
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$72.25 |
| Rate for Payer: Adventist Health Commercial |
$17.00
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.00
|
| Rate for Payer: EPIC Health Plan Senior |
$34.00
|
| Rate for Payer: Galaxy Health WC |
$72.25
|
| Rate for Payer: Global Benefits Group Commercial |
$51.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$52.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.40
|
| Rate for Payer: Multiplan Commercial |
$68.00
|
| Rate for Payer: Networks By Design Commercial |
$55.25
|
| Rate for Payer: Prime Health Services Commercial |
$72.25
|
|
|
HC POTASSIUM CH
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
900912185
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$72.25 |
| Rate for Payer: Adventist Health Commercial |
$17.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$55.75
|
| 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 |
$45.82
|
| Rate for Payer: Blue Shield of California Commercial |
$56.87
|
| Rate for Payer: Blue Shield of California EPN |
$37.57
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cigna of CA HMO |
$54.40
|
| Rate for Payer: Cigna of CA PPO |
$62.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.43
|
| Rate for Payer: EPIC Health Plan Senior |
$4.76
|
| Rate for Payer: Galaxy Health WC |
$72.25
|
| Rate for Payer: Global Benefits Group Commercial |
$51.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.70
|
| 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 |
$20.40
|
| 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 |
$68.00
|
| Rate for Payer: Networks By Design Commercial |
$55.25
|
| Rate for Payer: Prime Health Services Commercial |
$72.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.00
|
| 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: Upland Medical Group Pediatric |
$4.76
|
| 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 POC
|
Facility
|
OP
|
$91.00
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
900912117
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$77.35 |
| Rate for Payer: Adventist Health Commercial |
$18.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.69
|
| 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 |
$45.82
|
| Rate for Payer: Blue Shield of California Commercial |
$60.88
|
| Rate for Payer: Blue Shield of California EPN |
$40.22
|
| Rate for Payer: Cash Price |
$40.95
|
| Rate for Payer: Cash Price |
$40.95
|
| Rate for Payer: Cigna of CA HMO |
$58.24
|
| Rate for Payer: Cigna of CA PPO |
$67.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.43
|
| Rate for Payer: EPIC Health Plan Senior |
$4.76
|
| Rate for Payer: Galaxy Health WC |
$77.35
|
| Rate for Payer: Global Benefits Group Commercial |
$54.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.70
|
| 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 |
$21.84
|
| 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 |
$72.80
|
| Rate for Payer: Networks By Design Commercial |
$59.15
|
| Rate for Payer: Prime Health Services Commercial |
$77.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$54.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$54.60
|
| 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: Upland Medical Group Pediatric |
$4.76
|
| 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
|
|
