|
HC VALVULOPLASTY, MITRAL
|
Facility
OP
|
$12,761.00
|
|
|
Service Code
|
CPT 92987
|
| Hospital Charge Code |
906811138
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,552.20 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$13,745.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,244.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13,745.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,877.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,389.00
|
| Rate for Payer: BCBS Transplant Transplant |
$7,656.60
|
| Rate for Payer: Blue Shield of California Commercial |
$12,373.72
|
| Rate for Payer: Blue Shield of California EPN |
$8,887.36
|
| Rate for Payer: Caremore Medicare Advantage |
$13,745.22
|
| Rate for Payer: Cash Price |
$5,742.45
|
| Rate for Payer: Cash Price |
$5,742.45
|
| Rate for Payer: Central Health Plan Commercial |
$10,208.80
|
| Rate for Payer: Cigna of CA PPO |
$9,443.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,617.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,556.05
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13,745.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$13,745.22
|
| Rate for Payer: Galaxy Health WC |
$10,846.85
|
| Rate for Payer: Global Benefits Group Commercial |
$7,656.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,484.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9,570.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22,542.16
|
| Rate for Payer: IEHP medi-cal |
$22,679.61
|
| Rate for Payer: IEHP Medicare Advantage |
$13,745.22
|
| Rate for Payer: Innovage PACE Commercial |
$20,617.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,511.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,745.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,552.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,418.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,418.59
|
| Rate for Payer: Multiplan Commercial |
$9,570.75
|
| Rate for Payer: Networks By Design Commercial |
$8,294.65
|
| Rate for Payer: Prime Health Services Commercial |
$10,846.85
|
| Rate for Payer: Prime Health Services Medicare |
$14,569.93
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$7,656.60
|
| Rate for Payer: Riverside University Health MISP |
$15,119.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,656.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,656.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: Vantage Medical Group Senior |
$13,745.22
|
|
|
HC VALVULOPLASTY, MITRAL
|
Facility
OP
|
$12,761.00
|
|
|
Service Code
|
CPT 92987
|
| Hospital Charge Code |
906820033
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,552.20 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$13,745.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,244.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13,745.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,877.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,389.00
|
| Rate for Payer: BCBS Transplant Transplant |
$7,656.60
|
| Rate for Payer: Blue Shield of California Commercial |
$12,373.72
|
| Rate for Payer: Blue Shield of California EPN |
$8,887.36
|
| Rate for Payer: Caremore Medicare Advantage |
$13,745.22
|
| Rate for Payer: Cash Price |
$5,742.45
|
| Rate for Payer: Cash Price |
$5,742.45
|
| Rate for Payer: Central Health Plan Commercial |
$10,208.80
|
| Rate for Payer: Cigna of CA PPO |
$9,443.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,617.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,556.05
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13,745.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$13,745.22
|
| Rate for Payer: Galaxy Health WC |
$10,846.85
|
| Rate for Payer: Global Benefits Group Commercial |
$7,656.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,484.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9,570.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22,542.16
|
| Rate for Payer: IEHP medi-cal |
$22,679.61
|
| Rate for Payer: IEHP Medicare Advantage |
$13,745.22
|
| Rate for Payer: Innovage PACE Commercial |
$20,617.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,511.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,745.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,552.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,418.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,418.59
|
| Rate for Payer: Multiplan Commercial |
$9,570.75
|
| Rate for Payer: Networks By Design Commercial |
$8,294.65
|
| Rate for Payer: Prime Health Services Commercial |
$10,846.85
|
| Rate for Payer: Prime Health Services Medicare |
$14,569.93
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$7,656.60
|
| Rate for Payer: Riverside University Health MISP |
$15,119.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,656.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,656.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: Vantage Medical Group Senior |
$13,745.22
|
|
|
HC VALVULOPLASTY, PULMONARY
|
Facility
OP
|
$14,106.00
|
|
|
Service Code
|
CPT 92990
|
| Hospital Charge Code |
906811137
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,821.20 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$13,745.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,417.57
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13,745.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,979.00
|
| Rate for Payer: BCBS Transplant Transplant |
$8,463.60
|
| Rate for Payer: Blue Shield of California Commercial |
$12,373.72
|
| Rate for Payer: Blue Shield of California EPN |
$8,887.36
|
| Rate for Payer: Caremore Medicare Advantage |
$13,745.22
|
| Rate for Payer: Cash Price |
$6,347.70
|
| Rate for Payer: Cash Price |
$6,347.70
|
| Rate for Payer: Central Health Plan Commercial |
$11,284.80
|
| Rate for Payer: Cigna of CA PPO |
$10,438.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,617.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,556.05
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13,745.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$13,745.22
|
| Rate for Payer: Galaxy Health WC |
$11,990.10
|
| Rate for Payer: Global Benefits Group Commercial |
$8,463.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,695.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$10,579.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22,542.16
|
| Rate for Payer: IEHP medi-cal |
$22,679.61
|
| Rate for Payer: IEHP Medicare Advantage |
$13,745.22
|
| Rate for Payer: Innovage PACE Commercial |
$20,617.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,408.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,745.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,821.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,418.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,418.59
|
| Rate for Payer: Multiplan Commercial |
$10,579.50
|
| Rate for Payer: Networks By Design Commercial |
$9,168.90
|
| Rate for Payer: Prime Health Services Commercial |
$11,990.10
|
| Rate for Payer: Prime Health Services Medicare |
$14,569.93
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$8,463.60
|
| Rate for Payer: Riverside University Health MISP |
$15,119.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,463.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,463.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: Vantage Medical Group Senior |
$13,745.22
|
|
|
HC VALVULOPLASTY, PULMONARY
|
Facility
OP
|
$14,106.00
|
|
|
Service Code
|
CPT 92990
|
| Hospital Charge Code |
906820032
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,821.20 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$13,745.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,417.57
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13,745.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,979.00
|
| Rate for Payer: BCBS Transplant Transplant |
$8,463.60
|
| Rate for Payer: Blue Shield of California Commercial |
$12,373.72
|
| Rate for Payer: Blue Shield of California EPN |
$8,887.36
|
| Rate for Payer: Caremore Medicare Advantage |
$13,745.22
|
| Rate for Payer: Cash Price |
$6,347.70
|
| Rate for Payer: Cash Price |
$6,347.70
|
| Rate for Payer: Central Health Plan Commercial |
$11,284.80
|
| Rate for Payer: Cigna of CA PPO |
$10,438.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,617.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,556.05
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13,745.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$13,745.22
|
| Rate for Payer: Galaxy Health WC |
$11,990.10
|
| Rate for Payer: Global Benefits Group Commercial |
$8,463.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,695.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$10,579.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22,542.16
|
| Rate for Payer: IEHP medi-cal |
$22,679.61
|
| Rate for Payer: IEHP Medicare Advantage |
$13,745.22
|
| Rate for Payer: Innovage PACE Commercial |
$20,617.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,408.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,745.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,821.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,418.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,418.59
|
| Rate for Payer: Multiplan Commercial |
$10,579.50
|
| Rate for Payer: Networks By Design Commercial |
$9,168.90
|
| Rate for Payer: Prime Health Services Commercial |
$11,990.10
|
| Rate for Payer: Prime Health Services Medicare |
$14,569.93
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$8,463.60
|
| Rate for Payer: Riverside University Health MISP |
$15,119.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,463.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,463.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: Vantage Medical Group Senior |
$13,745.22
|
|
|
HC VALVULOPLASTY, PULMONARY
|
Facility
IP
|
$14,106.00
|
|
|
Service Code
|
CPT 92990
|
| Hospital Charge Code |
906820032
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,821.20 |
| Max. Negotiated Rate |
$12,695.40 |
| Rate for Payer: Cash Price |
$6,347.70
|
| Rate for Payer: Central Health Plan Commercial |
$11,284.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,642.40
|
| Rate for Payer: Galaxy Health WC |
$11,990.10
|
| Rate for Payer: Global Benefits Group Commercial |
$8,463.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,695.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,408.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,821.20
|
| Rate for Payer: Multiplan Commercial |
$10,579.50
|
| Rate for Payer: Networks By Design Commercial |
$9,168.90
|
| Rate for Payer: Prime Health Services Commercial |
$11,990.10
|
|
|
HC VALVULOPLASTY, PULMONARY
|
Facility
IP
|
$14,106.00
|
|
|
Service Code
|
CPT 92990
|
| Hospital Charge Code |
906811137
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,821.20 |
| Max. Negotiated Rate |
$12,695.40 |
| Rate for Payer: Cash Price |
$6,347.70
|
| Rate for Payer: Central Health Plan Commercial |
$11,284.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,642.40
|
| Rate for Payer: Galaxy Health WC |
$11,990.10
|
| Rate for Payer: Global Benefits Group Commercial |
$8,463.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,695.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,408.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,821.20
|
| Rate for Payer: Multiplan Commercial |
$10,579.50
|
| Rate for Payer: Networks By Design Commercial |
$9,168.90
|
| Rate for Payer: Prime Health Services Commercial |
$11,990.10
|
|
|
HC VANCOMYCIN
|
Facility
OP
|
$50.00
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
900910934
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$120.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$13.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$99.40
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.89
|
| Rate for Payer: AlphaCare 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 HMO/PPO |
$120.20
|
| Rate for Payer: BCBS Transplant Transplant |
$30.00
|
| Rate for Payer: Blue Shield of California Commercial |
$30.90
|
| Rate for Payer: Blue Shield of California EPN |
$24.30
|
| Rate for Payer: Caremore Medicare Advantage |
$13.54
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: Cigna of CA HMO |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.54
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$37.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.21
|
| Rate for Payer: IEHP medi-cal |
$22.34
|
| Rate for Payer: IEHP Medicare Advantage |
$13.54
|
| Rate for Payer: Innovage PACE Commercial |
$20.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.14
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Prime Health Services Medicare |
$14.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: Riverside University Health MISP |
$14.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| 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 HMO Rider |
$10.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.97
|
| 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 Senior |
$13.54
|
|
|
HC VANCOMYCIN
|
Facility
IP
|
$250.00
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
900910934
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Central Health Plan Commercial |
$200.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.00
|
| Rate for Payer: Galaxy Health WC |
$212.50
|
| Rate for Payer: Global Benefits Group Commercial |
$150.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$225.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.00
|
| Rate for Payer: Multiplan Commercial |
$187.50
|
| Rate for Payer: Networks By Design Commercial |
$162.50
|
| Rate for Payer: Prime Health Services Commercial |
$212.50
|
|
|
HC VANCOMYCIN PEAK
|
Facility
OP
|
$50.00
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
900912232
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$120.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$13.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$99.40
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.89
|
| Rate for Payer: AlphaCare 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 HMO/PPO |
$120.20
|
| Rate for Payer: BCBS Transplant Transplant |
$30.00
|
| Rate for Payer: Blue Shield of California Commercial |
$30.90
|
| Rate for Payer: Blue Shield of California EPN |
$24.30
|
| Rate for Payer: Caremore Medicare Advantage |
$13.54
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: Cigna of CA HMO |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.54
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$37.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.21
|
| Rate for Payer: IEHP medi-cal |
$22.34
|
| Rate for Payer: IEHP Medicare Advantage |
$13.54
|
| Rate for Payer: Innovage PACE Commercial |
$20.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.14
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Prime Health Services Medicare |
$14.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: Riverside University Health MISP |
$14.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| 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 HMO Rider |
$10.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.97
|
| 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 Senior |
$13.54
|
|
|
HC VANCOMYCIN PEAK
|
Facility
IP
|
$250.00
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
900912232
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Central Health Plan Commercial |
$200.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.00
|
| Rate for Payer: Galaxy Health WC |
$212.50
|
| Rate for Payer: Global Benefits Group Commercial |
$150.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$225.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.00
|
| Rate for Payer: Multiplan Commercial |
$187.50
|
| Rate for Payer: Networks By Design Commercial |
$162.50
|
| Rate for Payer: Prime Health Services Commercial |
$212.50
|
|
|
HC VANILLYLMANDELIC ACID URINE 24 HOURS
|
Facility
IP
|
$204.00
|
|
|
Service Code
|
CPT 84585
|
| Hospital Charge Code |
900912225
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$183.60 |
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Central Health Plan Commercial |
$163.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.60
|
| Rate for Payer: Galaxy Health WC |
$173.40
|
| Rate for Payer: Global Benefits Group Commercial |
$122.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$183.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$136.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.80
|
| Rate for Payer: Multiplan Commercial |
$153.00
|
| Rate for Payer: Networks By Design Commercial |
$132.60
|
| Rate for Payer: Prime Health Services Commercial |
$173.40
|
|
|
HC VANILLYLMANDELIC ACID URINE 24 HOURS
|
Facility
OP
|
$59.00
|
|
|
Service Code
|
CPT 84585
|
| Hospital Charge Code |
900912225
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.80 |
| Max. Negotiated Rate |
$137.58 |
| Rate for Payer: Adventist Health Medi-Cal |
$15.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$113.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$23.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$17.05
|
| Rate for Payer: AlphaCare 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 HMO/PPO |
$137.58
|
| Rate for Payer: BCBS Transplant Transplant |
$35.40
|
| Rate for Payer: Blue Shield of California Commercial |
$36.46
|
| Rate for Payer: Blue Shield of California EPN |
$28.67
|
| Rate for Payer: Caremore Medicare Advantage |
$15.50
|
| Rate for Payer: Cash Price |
$26.55
|
| Rate for Payer: Cash Price |
$26.55
|
| Rate for Payer: Central Health Plan Commercial |
$47.20
|
| Rate for Payer: Cigna of CA HMO |
$37.76
|
| Rate for Payer: Cigna of CA PPO |
$43.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.92
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$15.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.50
|
| Rate for Payer: Galaxy Health WC |
$50.15
|
| Rate for Payer: Global Benefits Group Commercial |
$35.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$44.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$25.42
|
| Rate for Payer: IEHP medi-cal |
$25.58
|
| Rate for Payer: IEHP Medicare Advantage |
$15.50
|
| Rate for Payer: Innovage PACE Commercial |
$23.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.77
|
| Rate for Payer: Multiplan Commercial |
$44.25
|
| Rate for Payer: Networks By Design Commercial |
$38.35
|
| Rate for Payer: Prime Health Services Commercial |
$50.15
|
| Rate for Payer: Prime Health Services Medicare |
$16.43
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$35.40
|
| Rate for Payer: Riverside University Health MISP |
$17.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.56
|
| Rate for Payer: United Healthcare All Other HMO |
$12.56
|
| Rate for Payer: United Healthcare HMO Rider |
$12.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.56
|
| 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 Senior |
$15.50
|
|
|
HC VANILLYLMANDELIC ACID URINE RANDOM
|
Facility
OP
|
$59.00
|
|
|
Service Code
|
CPT 84585
|
| Hospital Charge Code |
900912224
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.80 |
| Max. Negotiated Rate |
$137.58 |
| Rate for Payer: Adventist Health Medi-Cal |
$15.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$113.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$23.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$17.05
|
| Rate for Payer: AlphaCare 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 HMO/PPO |
$137.58
|
| Rate for Payer: BCBS Transplant Transplant |
$35.40
|
| Rate for Payer: Blue Shield of California Commercial |
$36.46
|
| Rate for Payer: Blue Shield of California EPN |
$28.67
|
| Rate for Payer: Caremore Medicare Advantage |
$15.50
|
| Rate for Payer: Cash Price |
$26.55
|
| Rate for Payer: Cash Price |
$26.55
|
| Rate for Payer: Central Health Plan Commercial |
$47.20
|
| Rate for Payer: Cigna of CA HMO |
$37.76
|
| Rate for Payer: Cigna of CA PPO |
$43.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.92
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$15.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.50
|
| Rate for Payer: Galaxy Health WC |
$50.15
|
| Rate for Payer: Global Benefits Group Commercial |
$35.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$44.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$25.42
|
| Rate for Payer: IEHP medi-cal |
$25.58
|
| Rate for Payer: IEHP Medicare Advantage |
$15.50
|
| Rate for Payer: Innovage PACE Commercial |
$23.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.77
|
| Rate for Payer: Multiplan Commercial |
$44.25
|
| Rate for Payer: Networks By Design Commercial |
$38.35
|
| Rate for Payer: Prime Health Services Commercial |
$50.15
|
| Rate for Payer: Prime Health Services Medicare |
$16.43
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$35.40
|
| Rate for Payer: Riverside University Health MISP |
$17.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.56
|
| Rate for Payer: United Healthcare All Other HMO |
$12.56
|
| Rate for Payer: United Healthcare HMO Rider |
$12.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.56
|
| 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 Senior |
$15.50
|
|
|
HC VANILLYLMANDELIC ACID URINE RANDOM
|
Facility
IP
|
$204.00
|
|
|
Service Code
|
CPT 84585
|
| Hospital Charge Code |
900912224
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$183.60 |
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Central Health Plan Commercial |
$163.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.60
|
| Rate for Payer: Galaxy Health WC |
$173.40
|
| Rate for Payer: Global Benefits Group Commercial |
$122.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$183.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$136.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.80
|
| Rate for Payer: Multiplan Commercial |
$153.00
|
| Rate for Payer: Networks By Design Commercial |
$132.60
|
| Rate for Payer: Prime Health Services Commercial |
$173.40
|
|
|
HC VANILMANDELIC ACID
|
Facility
IP
|
$204.00
|
|
|
Service Code
|
CPT 84585
|
| Hospital Charge Code |
900910531
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$183.60 |
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Central Health Plan Commercial |
$163.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.60
|
| Rate for Payer: Galaxy Health WC |
$173.40
|
| Rate for Payer: Global Benefits Group Commercial |
$122.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$183.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$136.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.80
|
| Rate for Payer: Multiplan Commercial |
$153.00
|
| Rate for Payer: Networks By Design Commercial |
$132.60
|
| Rate for Payer: Prime Health Services Commercial |
$173.40
|
|
|
HC VANILMANDELIC ACID
|
Facility
OP
|
$59.00
|
|
|
Service Code
|
CPT 84585
|
| Hospital Charge Code |
900910531
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.80 |
| Max. Negotiated Rate |
$137.58 |
| Rate for Payer: Adventist Health Medi-Cal |
$15.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$113.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$23.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$17.05
|
| Rate for Payer: AlphaCare 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 HMO/PPO |
$137.58
|
| Rate for Payer: BCBS Transplant Transplant |
$35.40
|
| Rate for Payer: Blue Shield of California Commercial |
$36.46
|
| Rate for Payer: Blue Shield of California EPN |
$28.67
|
| Rate for Payer: Caremore Medicare Advantage |
$15.50
|
| Rate for Payer: Cash Price |
$26.55
|
| Rate for Payer: Cash Price |
$26.55
|
| Rate for Payer: Central Health Plan Commercial |
$47.20
|
| Rate for Payer: Cigna of CA HMO |
$37.76
|
| Rate for Payer: Cigna of CA PPO |
$43.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.92
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$15.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.50
|
| Rate for Payer: Galaxy Health WC |
$50.15
|
| Rate for Payer: Global Benefits Group Commercial |
$35.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$44.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$25.42
|
| Rate for Payer: IEHP medi-cal |
$25.58
|
| Rate for Payer: IEHP Medicare Advantage |
$15.50
|
| Rate for Payer: Innovage PACE Commercial |
$23.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.77
|
| Rate for Payer: Multiplan Commercial |
$44.25
|
| Rate for Payer: Networks By Design Commercial |
$38.35
|
| Rate for Payer: Prime Health Services Commercial |
$50.15
|
| Rate for Payer: Prime Health Services Medicare |
$16.43
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$35.40
|
| Rate for Payer: Riverside University Health MISP |
$17.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.56
|
| Rate for Payer: United Healthcare All Other HMO |
$12.56
|
| Rate for Payer: United Healthcare HMO Rider |
$12.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.56
|
| 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 Senior |
$15.50
|
|
|
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: Aetna of CA HMO/PPO |
$312.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$385.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$249.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$249.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$207.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$252.88
|
| Rate for Payer: BCBS Transplant Transplant |
$272.40
|
| Rate for Payer: Blue Shield of California Commercial |
$340.50
|
| Rate for Payer: Blue Shield of California EPN |
$246.98
|
| Rate for Payer: Cash Price |
$204.30
|
| 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: EPIC Health Plan Commercial |
$181.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$340.50
|
| Rate for Payer: IEHP medi-cal |
$158.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$302.82
|
| 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: Riverside University Health 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 |
$227.00
|
| Rate for Payer: United Healthcare All Other HMO |
$227.00
|
| Rate for Payer: United Healthcare HMO Rider |
$227.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$227.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$385.90
|
| Rate for Payer: Vantage Medical Group Senior |
$385.90
|
|
|
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: Blue Shield of California EPN |
$242.44
|
| 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: EPIC Health Plan Commercial |
$181.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$302.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.80
|
| Rate for Payer: Multiplan Commercial |
$340.50
|
| Rate for Payer: Prime Health Services Commercial |
$385.90
|
|
|
HC VARICELLA ADMINISTRATION
|
Facility
OP
|
$30.00
|
|
|
Service Code
|
CPT 90716
|
| Hospital Charge Code |
902890228
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$2,356.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,090.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$25.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$16.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$16.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: BCBS Transplant Transplant |
$18.00
|
| Rate for Payer: Blue Shield of California Commercial |
$18.87
|
| Rate for Payer: Blue Shield of California EPN |
$14.67
|
| 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: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$22.50
|
| Rate for Payer: IEHP medi-cal |
$10.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$18.00
|
| Rate for Payer: Riverside University Health 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 |
$15.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15.00
|
| Rate for Payer: United Healthcare HMO Rider |
$15.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.50
|
| Rate for Payer: Vantage Medical Group Senior |
$25.50
|
|
|
HC VARICELLA ADMINISTRATION
|
Facility
IP
|
$30.00
|
|
|
Service Code
|
CPT 90716
|
| Hospital Charge Code |
902890228
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Central Health Plan Commercial |
$24.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$20.01
|
| 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 ZOSTER ANTIBODY
|
Facility
IP
|
$58.00
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
900913671
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.60 |
| Max. Negotiated Rate |
$52.20 |
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Central Health Plan Commercial |
$46.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.20
|
| Rate for Payer: Galaxy Health WC |
$49.30
|
| Rate for Payer: Global Benefits Group Commercial |
$34.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$52.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.60
|
| Rate for Payer: Multiplan Commercial |
$43.50
|
| Rate for Payer: Networks By Design Commercial |
$37.70
|
| Rate for Payer: Prime Health Services Commercial |
$49.30
|
|
|
HC VARICELLA ZOSTER ANTIBODY
|
Facility
OP
|
$39.00
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
900913671
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$114.34 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.55
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: AlphaCare 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 HMO/PPO |
$114.34
|
| Rate for Payer: BCBS Transplant Transplant |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$24.10
|
| Rate for Payer: Blue Shield of California EPN |
$18.95
|
| Rate for Payer: Caremore Medicare Advantage |
$12.88
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Central Health Plan Commercial |
$31.20
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.39
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.88
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$29.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.12
|
| Rate for Payer: IEHP medi-cal |
$21.25
|
| Rate for Payer: IEHP Medicare Advantage |
$12.88
|
| Rate for Payer: Innovage PACE Commercial |
$19.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.26
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Prime Health Services Medicare |
$13.65
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: Riverside University Health MISP |
$14.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| 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 HMO Rider |
$10.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.43
|
| 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 Senior |
$12.88
|
|
|
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 |
$82.25 |
| Max. Negotiated Rate |
$520.68 |
| Rate for Payer: Aetna of CA HMO/PPO |
$520.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$199.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$129.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$129.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$113.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$138.84
|
| Rate for Payer: BCBS Transplant Transplant |
$141.00
|
| Rate for Payer: Blue Shield of California Commercial |
$176.25
|
| Rate for Payer: Blue Shield of California EPN |
$127.84
|
| 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: EPIC Health Plan Commercial |
$94.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$176.25
|
| Rate for Payer: IEHP medi-cal |
$82.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$156.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.35
|
| 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 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 |
$117.50
|
| Rate for Payer: United Healthcare All Other HMO |
$117.50
|
| Rate for Payer: United Healthcare HMO Rider |
$117.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$117.50
|
| 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: Blue Shield of California EPN |
$125.49
|
| 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: EPIC Health Plan Commercial |
$94.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$156.74
|
| 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 |
$117.50
|
| Rate for Payer: Prime Health Services Commercial |
$199.75
|
|
|
HC VASC EMBOLIZATION, VENOUS, TUMORS, ORG ISCHEM, INFARC
|
Facility
IP
|
$33,516.00
|
|
|
Service Code
|
CPT 37243
|
| Hospital Charge Code |
900100013
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,703.20 |
| Max. Negotiated Rate |
$30,164.40 |
| Rate for Payer: Cash Price |
$15,082.20
|
| Rate for Payer: Central Health Plan Commercial |
$26,812.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,406.40
|
| Rate for Payer: Galaxy Health WC |
$28,488.60
|
| Rate for Payer: Global Benefits Group Commercial |
$20,109.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$30,164.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22,355.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,703.20
|
| Rate for Payer: Multiplan Commercial |
$25,137.00
|
| Rate for Payer: Networks By Design Commercial |
$21,785.40
|
| Rate for Payer: Prime Health Services Commercial |
$28,488.60
|
|
