|
HC VALVULOPLASTY, MITRAL
|
Facility
|
OP
|
$10,305.00
|
|
|
Service Code
|
CPT 92987
|
| Hospital Charge Code |
906811138
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$359.08 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$2,061.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$14,847.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,847.76
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,877.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,562.00
|
| Rate for Payer: Blue Shield of California Commercial |
$13,231.02
|
| Rate for Payer: Blue Shield of California EPN |
$8,315.83
|
| Rate for Payer: Cash Price |
$4,637.25
|
| Rate for Payer: Cash Price |
$4,637.25
|
| Rate for Payer: Cash Price |
$4,637.25
|
| Rate for Payer: Central Health Plan Commercial |
$8,244.00
|
| Rate for Payer: Cigna of CA HMO |
$6,698.25
|
| Rate for Payer: Cigna of CA PPO |
$7,625.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,332.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,847.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,213.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$24,498.80
|
| Rate for Payer: EPIC Health Plan Senior |
$16,332.54
|
| Rate for Payer: Galaxy Health WC |
$8,759.25
|
| Rate for Payer: Global Benefits Group Commercial |
$6,183.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,274.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24,350.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$359.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,543.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$396.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20,786.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,061.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19,896.00
|
| Rate for Payer: Multiplan Commercial |
$7,728.75
|
| Rate for Payer: Networks By Design Commercial |
$6,698.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Prime Health Services Commercial |
$8,759.25
|
| Rate for Payer: Prime Health Services Medicare |
$15,738.63
|
| Rate for Payer: Riverside University Health System MISP |
$16,332.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,183.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,183.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,152.50
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,847.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Vantage Medical Group Senior |
$14,847.76
|
|
|
HC VALVULOPLASTY, PULMONARY
|
Facility
|
OP
|
$11,391.00
|
|
|
Service Code
|
CPT 92990
|
| Hospital Charge Code |
906811137
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,408.71 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$2,278.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$14,847.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,847.76
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,933.00
|
| Rate for Payer: Blue Shield of California Commercial |
$13,231.02
|
| Rate for Payer: Blue Shield of California EPN |
$8,315.83
|
| Rate for Payer: Cash Price |
$5,125.95
|
| Rate for Payer: Cash Price |
$5,125.95
|
| Rate for Payer: Cash Price |
$5,125.95
|
| Rate for Payer: Central Health Plan Commercial |
$9,112.80
|
| Rate for Payer: Cigna of CA HMO |
$7,404.15
|
| Rate for Payer: Cigna of CA PPO |
$8,429.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,332.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,847.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,973.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$24,498.80
|
| Rate for Payer: EPIC Health Plan Senior |
$16,332.54
|
| Rate for Payer: Galaxy Health WC |
$9,682.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6,834.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,251.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24,350.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,408.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,233.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,556.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20,786.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,278.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19,896.00
|
| Rate for Payer: Multiplan Commercial |
$8,543.25
|
| Rate for Payer: Networks By Design Commercial |
$7,404.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Prime Health Services Commercial |
$9,682.35
|
| Rate for Payer: Prime Health Services Medicare |
$15,738.63
|
| Rate for Payer: Riverside University Health System MISP |
$16,332.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,834.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,834.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,695.50
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,847.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Vantage Medical Group Senior |
$14,847.76
|
|
|
HC VALVULOPLASTY, PULMONARY
|
Facility
|
IP
|
$11,391.00
|
|
|
Service Code
|
CPT 92990
|
| Hospital Charge Code |
906811137
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,278.20 |
| Max. Negotiated Rate |
$10,251.90 |
| Rate for Payer: Adventist Health Commercial |
$2,278.20
|
| Rate for Payer: Cash Price |
$5,125.95
|
| Rate for Payer: Central Health Plan Commercial |
$9,112.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,973.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,556.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,556.40
|
| Rate for Payer: Galaxy Health WC |
$9,682.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6,834.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,251.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,233.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,720.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,278.20
|
| Rate for Payer: Multiplan Commercial |
$8,543.25
|
| Rate for Payer: Networks By Design Commercial |
$7,404.15
|
| Rate for Payer: Prime Health Services Commercial |
$9,682.35
|
|
|
HC VANCOMYCIN
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
900910934
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.00 |
| Max. Negotiated Rate |
$220.50 |
| Rate for Payer: Adventist Health Commercial |
$49.00
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: Central Health Plan Commercial |
$196.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$171.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.00
|
| Rate for Payer: EPIC Health Plan Senior |
$98.00
|
| Rate for Payer: Galaxy Health WC |
$208.25
|
| Rate for Payer: Global Benefits Group Commercial |
$147.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$220.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$155.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$144.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.00
|
| Rate for Payer: Multiplan Commercial |
$183.75
|
| Rate for Payer: Networks By Design Commercial |
$159.25
|
| Rate for Payer: Prime Health Services Commercial |
$208.25
|
|
|
HC VANCOMYCIN
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
900910934
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.97 |
| Max. Negotiated Rate |
$220.50 |
| Rate for Payer: Adventist Health Commercial |
$49.00
|
| Rate for Payer: Adventist Health Commercial |
$10.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.54
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$99.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$99.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$98.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$98.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$137.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$137.00
|
| Rate for Payer: Blue Shield of California Commercial |
$32.13
|
| Rate for Payer: Blue Shield of California Commercial |
$154.35
|
| Rate for Payer: Blue Shield of California EPN |
$20.25
|
| Rate for Payer: Blue Shield of California EPN |
$97.27
|
| Rate for Payer: Cash Price |
$22.95
|
| Rate for Payer: Cash Price |
$22.95
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: Central Health Plan Commercial |
$196.00
|
| Rate for Payer: Central Health Plan Commercial |
$40.80
|
| Rate for Payer: Cigna of CA HMO |
$32.64
|
| Rate for Payer: Cigna of CA HMO |
$156.80
|
| Rate for Payer: Cigna of CA PPO |
$37.74
|
| Rate for Payer: Cigna of CA PPO |
$181.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.54
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$171.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.34
|
| Rate for Payer: EPIC Health Plan Senior |
$14.89
|
| Rate for Payer: EPIC Health Plan Senior |
$14.89
|
| Rate for Payer: Galaxy Health WC |
$43.35
|
| Rate for Payer: Galaxy Health WC |
$208.25
|
| Rate for Payer: Global Benefits Group Commercial |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$147.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$220.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.21
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$155.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$32.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.14
|
| Rate for Payer: Multiplan Commercial |
$38.25
|
| Rate for Payer: Multiplan Commercial |
$183.75
|
| Rate for Payer: Networks By Design Commercial |
$159.25
|
| Rate for Payer: Networks By Design Commercial |
$33.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.54
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.54
|
| Rate for Payer: Prime Health Services Commercial |
$43.35
|
| Rate for Payer: Prime Health Services Commercial |
$208.25
|
| Rate for Payer: Prime Health Services Medicare |
$14.35
|
| Rate for Payer: Prime Health Services Medicare |
$14.35
|
| Rate for Payer: Riverside University Health System MISP |
$14.89
|
| Rate for Payer: Riverside University Health System MISP |
$14.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$147.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$147.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.97
|
| Rate for Payer: United Healthcare All Other HMO |
$10.97
|
| Rate for Payer: United Healthcare All Other HMO |
$10.97
|
| Rate for Payer: United Healthcare HMO Rider |
$10.97
|
| Rate for Payer: United Healthcare HMO Rider |
$10.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.97
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.89
|
| Rate for Payer: Vantage Medical Group Senior |
$13.54
|
| Rate for Payer: Vantage Medical Group Senior |
$13.54
|
|
|
HC VANCOMYCIN PEAK
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
900912232
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.00 |
| Max. Negotiated Rate |
$220.50 |
| Rate for Payer: Adventist Health Commercial |
$49.00
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: Central Health Plan Commercial |
$196.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$171.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.00
|
| Rate for Payer: EPIC Health Plan Senior |
$98.00
|
| Rate for Payer: Galaxy Health WC |
$208.25
|
| Rate for Payer: Global Benefits Group Commercial |
$147.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$220.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$155.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$144.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.00
|
| Rate for Payer: Multiplan Commercial |
$183.75
|
| Rate for Payer: Networks By Design Commercial |
$159.25
|
| Rate for Payer: Prime Health Services Commercial |
$208.25
|
|
|
HC VANCOMYCIN PEAK
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
900912232
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.97 |
| Max. Negotiated Rate |
$220.50 |
| Rate for Payer: Adventist Health Commercial |
$49.00
|
| Rate for Payer: Adventist Health Commercial |
$10.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.54
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$99.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$99.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$98.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$98.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$137.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$137.00
|
| Rate for Payer: Blue Shield of California Commercial |
$32.13
|
| Rate for Payer: Blue Shield of California Commercial |
$154.35
|
| Rate for Payer: Blue Shield of California EPN |
$20.25
|
| Rate for Payer: Blue Shield of California EPN |
$97.27
|
| Rate for Payer: Cash Price |
$22.95
|
| Rate for Payer: Cash Price |
$22.95
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: Central Health Plan Commercial |
$196.00
|
| Rate for Payer: Central Health Plan Commercial |
$40.80
|
| Rate for Payer: Cigna of CA HMO |
$32.64
|
| Rate for Payer: Cigna of CA HMO |
$156.80
|
| Rate for Payer: Cigna of CA PPO |
$37.74
|
| Rate for Payer: Cigna of CA PPO |
$181.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.54
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$171.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.34
|
| Rate for Payer: EPIC Health Plan Senior |
$14.89
|
| Rate for Payer: EPIC Health Plan Senior |
$14.89
|
| Rate for Payer: Galaxy Health WC |
$43.35
|
| Rate for Payer: Galaxy Health WC |
$208.25
|
| Rate for Payer: Global Benefits Group Commercial |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$147.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$220.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.21
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$155.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$32.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.14
|
| Rate for Payer: Multiplan Commercial |
$38.25
|
| Rate for Payer: Multiplan Commercial |
$183.75
|
| Rate for Payer: Networks By Design Commercial |
$159.25
|
| Rate for Payer: Networks By Design Commercial |
$33.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.54
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.54
|
| Rate for Payer: Prime Health Services Commercial |
$43.35
|
| Rate for Payer: Prime Health Services Commercial |
$208.25
|
| Rate for Payer: Prime Health Services Medicare |
$14.35
|
| Rate for Payer: Prime Health Services Medicare |
$14.35
|
| Rate for Payer: Riverside University Health System MISP |
$14.89
|
| Rate for Payer: Riverside University Health System MISP |
$14.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$147.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$147.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.97
|
| Rate for Payer: United Healthcare All Other HMO |
$10.97
|
| Rate for Payer: United Healthcare All Other HMO |
$10.97
|
| Rate for Payer: United Healthcare HMO Rider |
$10.97
|
| Rate for Payer: United Healthcare HMO Rider |
$10.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.97
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.89
|
| Rate for Payer: Vantage Medical Group Senior |
$13.54
|
| Rate for Payer: Vantage Medical Group Senior |
$13.54
|
|
|
HC VANILLYLMANDELIC ACID URINE 24 HOURS
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT 84585
|
| Hospital Charge Code |
900912225
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$156.81 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$15.50
|
| Rate for Payer: Adventist Health Medi-Cal |
$15.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$113.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$113.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$112.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$112.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.81
|
| Rate for Payer: Blue Shield of California Commercial |
$25.20
|
| Rate for Payer: Blue Shield of California Commercial |
$22.68
|
| Rate for Payer: Blue Shield of California EPN |
$15.88
|
| Rate for Payer: Blue Shield of California EPN |
$14.29
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Central Health Plan Commercial |
$28.80
|
| Rate for Payer: Central Health Plan Commercial |
$32.00
|
| Rate for Payer: Cigna of CA HMO |
$25.60
|
| Rate for Payer: Cigna of CA HMO |
$23.04
|
| Rate for Payer: Cigna of CA PPO |
$29.60
|
| Rate for Payer: Cigna of CA PPO |
$26.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.57
|
| Rate for Payer: EPIC Health Plan Senior |
$17.05
|
| Rate for Payer: EPIC Health Plan Senior |
$17.05
|
| Rate for Payer: Galaxy Health WC |
$34.00
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$24.00
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$25.42
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$25.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.77
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
| Rate for Payer: Networks By Design Commercial |
$23.40
|
| Rate for Payer: Networks By Design Commercial |
$26.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$15.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$15.50
|
| Rate for Payer: Prime Health Services Commercial |
$34.00
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
| Rate for Payer: Prime Health Services Medicare |
$16.43
|
| Rate for Payer: Prime Health Services Medicare |
$16.43
|
| Rate for Payer: Riverside University Health System MISP |
$17.05
|
| Rate for Payer: Riverside University Health System MISP |
$17.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.55
|
| Rate for Payer: United Healthcare All Other HMO |
$12.55
|
| Rate for Payer: United Healthcare All Other HMO |
$12.55
|
| Rate for Payer: United Healthcare HMO Rider |
$12.55
|
| Rate for Payer: United Healthcare HMO Rider |
$12.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.55
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.05
|
| Rate for Payer: Vantage Medical Group Senior |
$15.50
|
| Rate for Payer: Vantage Medical Group Senior |
$15.50
|
|
|
HC VANILLYLMANDELIC ACID URINE 24 HOURS
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 84585
|
| Hospital Charge Code |
900912225
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Central Health Plan Commercial |
$32.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.00
|
| Rate for Payer: EPIC Health Plan Senior |
$16.00
|
| Rate for Payer: Galaxy Health WC |
$34.00
|
| Rate for Payer: Global Benefits Group Commercial |
$24.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.00
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
| Rate for Payer: Networks By Design Commercial |
$26.00
|
| Rate for Payer: Prime Health Services Commercial |
$34.00
|
|
|
HC VANILLYLMANDELIC ACID URINE RANDOM
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 84585
|
| Hospital Charge Code |
900912224
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Central Health Plan Commercial |
$32.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.00
|
| Rate for Payer: EPIC Health Plan Senior |
$16.00
|
| Rate for Payer: Galaxy Health WC |
$34.00
|
| Rate for Payer: Global Benefits Group Commercial |
$24.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.00
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
| Rate for Payer: Networks By Design Commercial |
$26.00
|
| Rate for Payer: Prime Health Services Commercial |
$34.00
|
|
|
HC VANILLYLMANDELIC ACID URINE RANDOM
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT 84585
|
| Hospital Charge Code |
900912224
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$156.81 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$15.50
|
| Rate for Payer: Adventist Health Medi-Cal |
$15.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$113.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$113.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$112.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$112.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.81
|
| Rate for Payer: Blue Shield of California Commercial |
$25.20
|
| Rate for Payer: Blue Shield of California Commercial |
$22.68
|
| Rate for Payer: Blue Shield of California EPN |
$15.88
|
| Rate for Payer: Blue Shield of California EPN |
$14.29
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Central Health Plan Commercial |
$28.80
|
| Rate for Payer: Central Health Plan Commercial |
$32.00
|
| Rate for Payer: Cigna of CA HMO |
$25.60
|
| Rate for Payer: Cigna of CA HMO |
$23.04
|
| Rate for Payer: Cigna of CA PPO |
$29.60
|
| Rate for Payer: Cigna of CA PPO |
$26.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.57
|
| Rate for Payer: EPIC Health Plan Senior |
$17.05
|
| Rate for Payer: EPIC Health Plan Senior |
$17.05
|
| Rate for Payer: Galaxy Health WC |
$34.00
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$24.00
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$25.42
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$25.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.77
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
| Rate for Payer: Networks By Design Commercial |
$23.40
|
| Rate for Payer: Networks By Design Commercial |
$26.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$15.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$15.50
|
| Rate for Payer: Prime Health Services Commercial |
$34.00
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
| Rate for Payer: Prime Health Services Medicare |
$16.43
|
| Rate for Payer: Prime Health Services Medicare |
$16.43
|
| Rate for Payer: Riverside University Health System MISP |
$17.05
|
| Rate for Payer: Riverside University Health System MISP |
$17.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.55
|
| Rate for Payer: United Healthcare All Other HMO |
$12.55
|
| Rate for Payer: United Healthcare All Other HMO |
$12.55
|
| Rate for Payer: United Healthcare HMO Rider |
$12.55
|
| Rate for Payer: United Healthcare HMO Rider |
$12.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.55
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.05
|
| Rate for Payer: Vantage Medical Group Senior |
$15.50
|
| Rate for Payer: Vantage Medical Group Senior |
$15.50
|
|
|
HC VANILMANDELIC ACID
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 84585
|
| Hospital Charge Code |
900910531
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Central Health Plan Commercial |
$32.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.00
|
| Rate for Payer: EPIC Health Plan Senior |
$16.00
|
| Rate for Payer: Galaxy Health WC |
$34.00
|
| Rate for Payer: Global Benefits Group Commercial |
$24.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.00
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
| Rate for Payer: Networks By Design Commercial |
$26.00
|
| Rate for Payer: Prime Health Services Commercial |
$34.00
|
|
|
HC VANILMANDELIC ACID
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT 84585
|
| Hospital Charge Code |
900910531
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$156.81 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$15.50
|
| Rate for Payer: Adventist Health Medi-Cal |
$15.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$113.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$113.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$112.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$112.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.81
|
| Rate for Payer: Blue Shield of California Commercial |
$25.20
|
| Rate for Payer: Blue Shield of California Commercial |
$22.68
|
| Rate for Payer: Blue Shield of California EPN |
$15.88
|
| Rate for Payer: Blue Shield of California EPN |
$14.29
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Central Health Plan Commercial |
$28.80
|
| Rate for Payer: Central Health Plan Commercial |
$32.00
|
| Rate for Payer: Cigna of CA HMO |
$25.60
|
| Rate for Payer: Cigna of CA HMO |
$23.04
|
| Rate for Payer: Cigna of CA PPO |
$29.60
|
| Rate for Payer: Cigna of CA PPO |
$26.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.57
|
| Rate for Payer: EPIC Health Plan Senior |
$17.05
|
| Rate for Payer: EPIC Health Plan Senior |
$17.05
|
| Rate for Payer: Galaxy Health WC |
$34.00
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$24.00
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$25.42
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$25.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.77
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
| Rate for Payer: Networks By Design Commercial |
$23.40
|
| Rate for Payer: Networks By Design Commercial |
$26.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$15.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$15.50
|
| Rate for Payer: Prime Health Services Commercial |
$34.00
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
| Rate for Payer: Prime Health Services Medicare |
$16.43
|
| Rate for Payer: Prime Health Services Medicare |
$16.43
|
| Rate for Payer: Riverside University Health System MISP |
$17.05
|
| Rate for Payer: Riverside University Health System MISP |
$17.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.55
|
| Rate for Payer: United Healthcare All Other HMO |
$12.55
|
| Rate for Payer: United Healthcare All Other HMO |
$12.55
|
| Rate for Payer: United Healthcare HMO Rider |
$12.55
|
| Rate for Payer: United Healthcare HMO Rider |
$12.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.55
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.05
|
| Rate for Payer: Vantage Medical Group Senior |
$15.50
|
| Rate for Payer: Vantage Medical Group Senior |
$15.50
|
|
|
HC VAN SONNENBERG SUMP (COOK)
|
Facility
|
IP
|
$454.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
909001067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$90.80 |
| Max. Negotiated Rate |
$408.60 |
| Rate for Payer: Adventist Health Commercial |
$90.80
|
| Rate for Payer: Blue Shield of California Commercial |
$364.11
|
| Rate for Payer: Blue Shield of California EPN |
$228.82
|
| Rate for Payer: Cash Price |
$204.30
|
| Rate for Payer: Central Health Plan Commercial |
$363.20
|
| Rate for Payer: Cigna of CA HMO |
$317.80
|
| Rate for Payer: Cigna of CA PPO |
$317.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$317.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$181.60
|
| Rate for Payer: EPIC Health Plan Senior |
$181.60
|
| Rate for Payer: Galaxy Health WC |
$385.90
|
| Rate for Payer: Global Benefits Group Commercial |
$272.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$408.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$288.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$267.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.80
|
| Rate for Payer: Multiplan Commercial |
$340.50
|
| Rate for Payer: Networks By Design Commercial |
$227.00
|
| Rate for Payer: Prime Health Services Commercial |
$385.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$170.39
|
| Rate for Payer: United Healthcare All Other HMO |
$165.85
|
| Rate for Payer: United Healthcare HMO Rider |
$162.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$148.69
|
|
|
HC VAN SONNENBERG SUMP (COOK)
|
Facility
|
OP
|
$454.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
909001067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$90.80 |
| Max. Negotiated Rate |
$408.60 |
| Rate for Payer: Adventist Health Commercial |
$90.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$385.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$249.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$340.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$207.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$248.97
|
| Rate for Payer: Blue Shield of California Commercial |
$364.11
|
| Rate for Payer: Blue Shield of California EPN |
$228.82
|
| Rate for Payer: Cash Price |
$204.30
|
| Rate for Payer: Central Health Plan Commercial |
$363.20
|
| Rate for Payer: Cigna of CA HMO |
$317.80
|
| Rate for Payer: Cigna of CA PPO |
$317.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$385.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$385.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$385.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$317.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$181.60
|
| Rate for Payer: EPIC Health Plan Senior |
$181.60
|
| Rate for Payer: Galaxy Health WC |
$385.90
|
| Rate for Payer: Global Benefits Group Commercial |
$272.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$408.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$288.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$164.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$267.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$317.80
|
| Rate for Payer: Multiplan Commercial |
$340.50
|
| Rate for Payer: Networks By Design Commercial |
$227.00
|
| Rate for Payer: Prime Health Services Commercial |
$385.90
|
| Rate for Payer: Riverside University Health System MISP |
$181.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$272.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$272.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$170.39
|
| Rate for Payer: United Healthcare All Other HMO |
$165.85
|
| Rate for Payer: United Healthcare HMO Rider |
$162.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$148.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$385.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$385.90
|
| Rate for Payer: Vantage Medical Group Senior |
$385.90
|
|
|
HC VARICELLA ADMINISTRATION
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 90716
|
| Hospital Charge Code |
902890228
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Central Health Plan Commercial |
$24.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
|
|
HC VARICELLA ADMINISTRATION
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 90716
|
| Hospital Charge Code |
902890228
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$1,833.00 |
| Rate for Payer: Adventist Health Commercial |
$12.30
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,144.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$159.53
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Central Health Plan Commercial |
$24.00
|
| Rate for Payer: Cigna of CA HMO |
$19.20
|
| Rate for Payer: Cigna of CA PPO |
$22.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$372.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21.00
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
| Rate for Payer: Riverside University Health System MISP |
$12.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.50
|
| Rate for Payer: Vantage Medical Group Senior |
$25.50
|
|
|
HC VARICELLA ZOSTER ANTIBODY
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
900913671
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.43 |
| Max. Negotiated Rate |
$130.32 |
| Rate for Payer: Adventist Health Commercial |
$25.80
|
| Rate for Payer: Adventist Health Commercial |
$28.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.88
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$93.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$93.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.32
|
| Rate for Payer: Blue Shield of California Commercial |
$89.46
|
| Rate for Payer: Blue Shield of California Commercial |
$81.27
|
| Rate for Payer: Blue Shield of California EPN |
$56.37
|
| Rate for Payer: Blue Shield of California EPN |
$51.21
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cash Price |
$58.05
|
| Rate for Payer: Cash Price |
$58.05
|
| Rate for Payer: Central Health Plan Commercial |
$103.20
|
| Rate for Payer: Central Health Plan Commercial |
$113.60
|
| Rate for Payer: Cigna of CA HMO |
$90.88
|
| Rate for Payer: Cigna of CA HMO |
$82.56
|
| Rate for Payer: Cigna of CA PPO |
$105.08
|
| Rate for Payer: Cigna of CA PPO |
$95.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$90.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$99.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.25
|
| Rate for Payer: EPIC Health Plan Senior |
$14.17
|
| Rate for Payer: EPIC Health Plan Senior |
$14.17
|
| Rate for Payer: Galaxy Health WC |
$120.70
|
| Rate for Payer: Galaxy Health WC |
$109.65
|
| Rate for Payer: Global Benefits Group Commercial |
$85.20
|
| Rate for Payer: Global Benefits Group Commercial |
$77.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$127.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$116.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.12
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$81.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$90.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.26
|
| Rate for Payer: Multiplan Commercial |
$106.50
|
| Rate for Payer: Multiplan Commercial |
$96.75
|
| Rate for Payer: Networks By Design Commercial |
$83.85
|
| Rate for Payer: Networks By Design Commercial |
$92.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.88
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.88
|
| Rate for Payer: Prime Health Services Commercial |
$120.70
|
| Rate for Payer: Prime Health Services Commercial |
$109.65
|
| Rate for Payer: Prime Health Services Medicare |
$13.65
|
| Rate for Payer: Prime Health Services Medicare |
$13.65
|
| Rate for Payer: Riverside University Health System MISP |
$14.17
|
| Rate for Payer: Riverside University Health System MISP |
$14.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$77.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$85.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$85.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$77.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.43
|
| Rate for Payer: United Healthcare All Other HMO |
$10.43
|
| Rate for Payer: United Healthcare All Other HMO |
$10.43
|
| Rate for Payer: United Healthcare HMO Rider |
$10.43
|
| Rate for Payer: United Healthcare HMO Rider |
$10.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.43
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.88
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Vantage Medical Group Senior |
$12.88
|
| Rate for Payer: Vantage Medical Group Senior |
$12.88
|
|
|
HC VARICELLA ZOSTER ANTIBODY
|
Facility
|
IP
|
$142.00
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
900913671
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$28.40 |
| Max. Negotiated Rate |
$127.80 |
| Rate for Payer: Adventist Health Commercial |
$28.40
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Central Health Plan Commercial |
$113.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$99.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.80
|
| Rate for Payer: EPIC Health Plan Senior |
$56.80
|
| Rate for Payer: Galaxy Health WC |
$120.70
|
| Rate for Payer: Global Benefits Group Commercial |
$85.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$127.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$90.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$83.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.40
|
| Rate for Payer: Multiplan Commercial |
$106.50
|
| Rate for Payer: Networks By Design Commercial |
$92.30
|
| Rate for Payer: Prime Health Services Commercial |
$120.70
|
|
|
HC VAR/VALGUS CORRECTION MODIFICA ADDITON LE
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
CPT L2275
|
| Hospital Charge Code |
915352275
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$76.96 |
| Max. Negotiated Rate |
$211.50 |
| Rate for Payer: Adventist Health Commercial |
$96.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$199.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$129.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$176.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.70
|
| Rate for Payer: Blue Shield of California Commercial |
$188.47
|
| Rate for Payer: Blue Shield of California EPN |
$118.44
|
| Rate for Payer: Cash Price |
$105.75
|
| Rate for Payer: Cash Price |
$105.75
|
| Rate for Payer: Central Health Plan Commercial |
$188.00
|
| Rate for Payer: Cigna of CA HMO |
$164.50
|
| Rate for Payer: Cigna of CA PPO |
$164.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$199.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$199.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$199.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$164.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.00
|
| Rate for Payer: EPIC Health Plan Senior |
$94.00
|
| Rate for Payer: Galaxy Health WC |
$199.75
|
| Rate for Payer: Global Benefits Group Commercial |
$141.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$211.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$124.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$149.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$137.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$138.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$164.50
|
| Rate for Payer: Multiplan Commercial |
$176.25
|
| Rate for Payer: Networks By Design Commercial |
$117.50
|
| Rate for Payer: Prime Health Services Commercial |
$199.75
|
| Rate for Payer: Riverside University Health System MISP |
$94.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$141.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$141.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$88.20
|
| Rate for Payer: United Healthcare All Other HMO |
$85.85
|
| Rate for Payer: United Healthcare HMO Rider |
$83.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$76.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$199.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$199.75
|
| Rate for Payer: Vantage Medical Group Senior |
$199.75
|
|
|
HC VAR/VALGUS CORRECTION MODIFICA ADDITON LE
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
CPT L2275
|
| Hospital Charge Code |
905352275
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$47.00 |
| Max. Negotiated Rate |
$211.50 |
| Rate for Payer: Adventist Health Commercial |
$47.00
|
| Rate for Payer: Blue Shield of California Commercial |
$188.47
|
| Rate for Payer: Blue Shield of California EPN |
$118.44
|
| Rate for Payer: Cash Price |
$105.75
|
| Rate for Payer: Central Health Plan Commercial |
$188.00
|
| Rate for Payer: Cigna of CA HMO |
$164.50
|
| Rate for Payer: Cigna of CA PPO |
$164.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$164.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.00
|
| Rate for Payer: EPIC Health Plan Senior |
$94.00
|
| Rate for Payer: Galaxy Health WC |
$199.75
|
| Rate for Payer: Global Benefits Group Commercial |
$141.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$211.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$149.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$138.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.00
|
| Rate for Payer: Multiplan Commercial |
$176.25
|
| Rate for Payer: Networks By Design Commercial |
$152.75
|
| Rate for Payer: Prime Health Services Commercial |
$199.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$88.20
|
| Rate for Payer: United Healthcare All Other HMO |
$85.85
|
| Rate for Payer: United Healthcare HMO Rider |
$83.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$76.96
|
|
|
HC VAR/VALGUS CORRECTION MODIFICA ADDITON LE
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
CPT L2275
|
| Hospital Charge Code |
915352275
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$47.00 |
| Max. Negotiated Rate |
$211.50 |
| Rate for Payer: Adventist Health Commercial |
$47.00
|
| Rate for Payer: Blue Shield of California Commercial |
$188.47
|
| Rate for Payer: Blue Shield of California EPN |
$118.44
|
| Rate for Payer: Cash Price |
$105.75
|
| Rate for Payer: Central Health Plan Commercial |
$188.00
|
| Rate for Payer: Cigna of CA HMO |
$164.50
|
| Rate for Payer: Cigna of CA PPO |
$164.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$164.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.00
|
| Rate for Payer: EPIC Health Plan Senior |
$94.00
|
| Rate for Payer: Galaxy Health WC |
$199.75
|
| Rate for Payer: Global Benefits Group Commercial |
$141.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$211.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$149.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$138.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.00
|
| Rate for Payer: Multiplan Commercial |
$176.25
|
| Rate for Payer: Networks By Design Commercial |
$152.75
|
| Rate for Payer: Prime Health Services Commercial |
$199.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$88.20
|
| Rate for Payer: United Healthcare All Other HMO |
$85.85
|
| Rate for Payer: United Healthcare HMO Rider |
$83.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$76.96
|
|
|
HC VAR/VALGUS CORRECTION MODIFICA ADDITON LE
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
CPT L2275
|
| Hospital Charge Code |
905352275
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$76.96 |
| Max. Negotiated Rate |
$211.50 |
| Rate for Payer: Adventist Health Commercial |
$96.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$199.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$129.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$176.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.70
|
| Rate for Payer: Blue Shield of California Commercial |
$188.47
|
| Rate for Payer: Blue Shield of California EPN |
$118.44
|
| Rate for Payer: Cash Price |
$105.75
|
| Rate for Payer: Cash Price |
$105.75
|
| Rate for Payer: Central Health Plan Commercial |
$188.00
|
| Rate for Payer: Cigna of CA HMO |
$164.50
|
| Rate for Payer: Cigna of CA PPO |
$164.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$199.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$199.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$199.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$164.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.00
|
| Rate for Payer: EPIC Health Plan Senior |
$94.00
|
| Rate for Payer: Galaxy Health WC |
$199.75
|
| Rate for Payer: Global Benefits Group Commercial |
$141.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$211.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$124.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$149.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$137.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$138.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$164.50
|
| Rate for Payer: Multiplan Commercial |
$176.25
|
| Rate for Payer: Networks By Design Commercial |
$117.50
|
| Rate for Payer: Prime Health Services Commercial |
$199.75
|
| Rate for Payer: Riverside University Health System MISP |
$94.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$141.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$141.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$88.20
|
| Rate for Payer: United Healthcare All Other HMO |
$85.85
|
| Rate for Payer: United Healthcare HMO Rider |
$83.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$76.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$199.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$199.75
|
| Rate for Payer: Vantage Medical Group Senior |
$199.75
|
|
|
HC VASC EMBOLIZATION, VENOUS, TUMORS, ORG ISCHEM, INFARC
|
Facility
|
OP
|
$44,324.00
|
|
|
Service Code
|
CPT 37243
|
| Hospital Charge Code |
900100013
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$639.21 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$8,864.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$14,847.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,847.76
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,138.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$22,958.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$19,945.80
|
| Rate for Payer: Cash Price |
$19,945.80
|
| Rate for Payer: Cash Price |
$19,945.80
|
| Rate for Payer: Central Health Plan Commercial |
$35,459.20
|
| Rate for Payer: Cigna of CA HMO |
$28,367.36
|
| Rate for Payer: Cigna of CA PPO |
$32,799.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,332.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,847.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$31,026.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$24,498.80
|
| Rate for Payer: EPIC Health Plan Senior |
$16,332.54
|
| Rate for Payer: Galaxy Health WC |
$37,675.40
|
| Rate for Payer: Global Benefits Group Commercial |
$26,594.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$39,891.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24,350.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$877.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28,145.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$969.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20,786.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,864.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19,896.00
|
| Rate for Payer: Multiplan Commercial |
$33,243.00
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: Networks By Design Commercial |
$28,810.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Preferred Health Network WC |
$23,427.23
|
| Rate for Payer: Prime Health Services Commercial |
$37,675.40
|
| Rate for Payer: Prime Health Services Medicare |
$15,738.63
|
| Rate for Payer: Prime Health Services WC |
$22,724.41
|
| Rate for Payer: Riverside University Health System MISP |
$16,332.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26,594.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$22,162.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,847.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Vantage Medical Group Senior |
$14,847.76
|
|
|
HC VASC EMBOLIZATION, VENOUS, TUMORS, ORG ISCHEM, INFARC
|
Facility
|
IP
|
$44,324.00
|
|
|
Service Code
|
CPT 37243
|
| Hospital Charge Code |
900100013
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8,864.80 |
| Max. Negotiated Rate |
$39,891.60 |
| Rate for Payer: Adventist Health Commercial |
$8,864.80
|
| Rate for Payer: Cash Price |
$19,945.80
|
| Rate for Payer: Central Health Plan Commercial |
$35,459.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$31,026.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$17,729.60
|
| Rate for Payer: EPIC Health Plan Senior |
$17,729.60
|
| Rate for Payer: Galaxy Health WC |
$37,675.40
|
| Rate for Payer: Global Benefits Group Commercial |
$26,594.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$39,891.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28,145.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26,151.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,864.80
|
| Rate for Payer: Multiplan Commercial |
$33,243.00
|
| Rate for Payer: Networks By Design Commercial |
$28,810.60
|
| Rate for Payer: Prime Health Services Commercial |
$37,675.40
|
|
