|
HAND AND WRIST PROCEDURES
|
Facility
|
IP
|
$18,230.44
|
|
|
Service Code
|
APR-DRG 3162
|
| Min. Negotiated Rate |
$11,513.96 |
| Max. Negotiated Rate |
$18,230.44 |
| Rate for Payer: Adventist Health Medi-Cal |
$11,513.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13,720.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18,230.44
|
|
|
HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$41,434.00
|
|
|
Service Code
|
MSDRG 513
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$41,434.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$41,434.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$26,764.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37,471.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$37,313.78
|
| Rate for Payer: EPIC Health Plan Senior |
$24,875.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,614.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31,660.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$30,303.31
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$22,614.41
|
| Rate for Payer: Prime Health Services Medicare |
$23,971.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$26,905.91
|
|
|
Service Code
|
MSDRG 514
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$26,905.91 |
| Rate for Payer: Aetna of CA HMO/PPO |
$26,905.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17,380.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24,332.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$24,751.98
|
| Rate for Payer: EPIC Health Plan Senior |
$16,501.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15,001.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21,001.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20,101.61
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$15,001.20
|
| Rate for Payer: Prime Health Services Medicare |
$15,901.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
HAND PROCEDURES FOR INJURIES
|
Facility
|
IP
|
$46,384.61
|
|
|
Service Code
|
MSDRG 906
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$46,384.61 |
| Rate for Payer: Aetna of CA HMO/PPO |
$46,384.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$29,962.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41,948.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$46,188.99
|
| Rate for Payer: EPIC Health Plan Senior |
$30,792.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27,993.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$39,190.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$37,511.06
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$27,993.33
|
| Rate for Payer: Prime Health Services Medicare |
$29,672.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
HB COVID-19 RNA
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
900913685
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$30.40 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Central Health Plan Commercial |
$121.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$106.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.80
|
| Rate for Payer: EPIC Health Plan Senior |
$60.80
|
| Rate for Payer: Galaxy Health WC |
$129.20
|
| Rate for Payer: Global Benefits Group Commercial |
$91.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$136.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$96.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$89.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.40
|
| Rate for Payer: Multiplan Commercial |
$114.00
|
| Rate for Payer: Networks By Design Commercial |
$98.80
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
|
|
HB COVID-19 RNA
|
Facility
|
OP
|
$134.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
900913685
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$26.80 |
| Max. Negotiated Rate |
$364.89 |
| Rate for Payer: Adventist Health Commercial |
$26.80
|
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$51.31
|
| Rate for Payer: Adventist Health Medi-Cal |
$51.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$55.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$55.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.31
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$262.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$262.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$364.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$364.89
|
| Rate for Payer: Blue Shield of California Commercial |
$95.76
|
| Rate for Payer: Blue Shield of California Commercial |
$84.42
|
| Rate for Payer: Blue Shield of California EPN |
$60.34
|
| Rate for Payer: Blue Shield of California EPN |
$53.20
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Central Health Plan Commercial |
$107.20
|
| Rate for Payer: Central Health Plan Commercial |
$121.60
|
| Rate for Payer: Cigna of CA HMO |
$97.28
|
| Rate for Payer: Cigna of CA HMO |
$85.76
|
| Rate for Payer: Cigna of CA PPO |
$112.48
|
| Rate for Payer: Cigna of CA PPO |
$99.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$93.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$106.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.66
|
| Rate for Payer: EPIC Health Plan Senior |
$56.44
|
| Rate for Payer: EPIC Health Plan Senior |
$56.44
|
| Rate for Payer: Galaxy Health WC |
$129.20
|
| Rate for Payer: Galaxy Health WC |
$113.90
|
| Rate for Payer: Global Benefits Group Commercial |
$91.20
|
| Rate for Payer: Global Benefits Group Commercial |
$80.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$136.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$120.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$84.15
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$84.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$88.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$88.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$85.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$96.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$97.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$97.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$68.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$68.76
|
| Rate for Payer: Multiplan Commercial |
$114.00
|
| Rate for Payer: Multiplan Commercial |
$100.50
|
| Rate for Payer: Networks By Design Commercial |
$87.10
|
| Rate for Payer: Networks By Design Commercial |
$98.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$51.31
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$51.31
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
| Rate for Payer: Prime Health Services Commercial |
$113.90
|
| Rate for Payer: Prime Health Services Medicare |
$54.39
|
| Rate for Payer: Prime Health Services Medicare |
$54.39
|
| Rate for Payer: Riverside University Health System MISP |
$56.44
|
| Rate for Payer: Riverside University Health System MISP |
$56.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$80.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$91.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$91.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$80.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.56
|
| Rate for Payer: United Healthcare All Other HMO |
$41.56
|
| Rate for Payer: United Healthcare All Other HMO |
$41.56
|
| Rate for Payer: United Healthcare HMO Rider |
$41.56
|
| Rate for Payer: United Healthcare HMO Rider |
$41.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$51.31
|
| Rate for Payer: Upland Medical Group Pediatric |
$51.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.44
|
| Rate for Payer: Vantage Medical Group Senior |
$51.31
|
| Rate for Payer: Vantage Medical Group Senior |
$51.31
|
|
|
HC 25 CH VITAMIN D2 D3
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 82306
|
| Hospital Charge Code |
900912226
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.98 |
| Max. Negotiated Rate |
$299.39 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Adventist Health Commercial |
$31.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$29.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$29.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$217.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$217.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$44.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$44.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$215.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$215.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$299.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$299.39
|
| Rate for Payer: Blue Shield of California Commercial |
$99.54
|
| Rate for Payer: Blue Shield of California Commercial |
$75.60
|
| Rate for Payer: Blue Shield of California EPN |
$62.73
|
| Rate for Payer: Blue Shield of California EPN |
$47.64
|
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Central Health Plan Commercial |
$96.00
|
| Rate for Payer: Central Health Plan Commercial |
$126.40
|
| Rate for Payer: Cigna of CA HMO |
$101.12
|
| Rate for Payer: Cigna of CA HMO |
$76.80
|
| Rate for Payer: Cigna of CA PPO |
$116.92
|
| Rate for Payer: Cigna of CA PPO |
$88.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$84.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$110.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.84
|
| Rate for Payer: EPIC Health Plan Senior |
$32.56
|
| Rate for Payer: EPIC Health Plan Senior |
$32.56
|
| Rate for Payer: Galaxy Health WC |
$134.30
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$94.80
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$142.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$48.54
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$48.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$35.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$35.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$29.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$29.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$76.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$100.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$39.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$39.66
|
| Rate for Payer: Multiplan Commercial |
$118.50
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Networks By Design Commercial |
$78.00
|
| Rate for Payer: Networks By Design Commercial |
$102.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$29.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$29.60
|
| Rate for Payer: Prime Health Services Commercial |
$134.30
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: Prime Health Services Medicare |
$31.38
|
| Rate for Payer: Prime Health Services Medicare |
$31.38
|
| Rate for Payer: Riverside University Health System MISP |
$32.56
|
| Rate for Payer: Riverside University Health System MISP |
$32.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$94.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$94.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.98
|
| Rate for Payer: United Healthcare All Other HMO |
$23.98
|
| Rate for Payer: United Healthcare All Other HMO |
$23.98
|
| Rate for Payer: United Healthcare HMO Rider |
$23.98
|
| Rate for Payer: United Healthcare HMO Rider |
$23.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.98
|
| Rate for Payer: Upland Medical Group Pediatric |
$29.60
|
| Rate for Payer: Upland Medical Group Pediatric |
$29.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$44.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$44.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.56
|
| Rate for Payer: Vantage Medical Group Senior |
$29.60
|
| Rate for Payer: Vantage Medical Group Senior |
$29.60
|
|
|
HC 25 CH VITAMIN D2 D3
|
Facility
|
IP
|
$158.00
|
|
|
Service Code
|
CPT 82306
|
| Hospital Charge Code |
900912226
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.60 |
| Max. Negotiated Rate |
$142.20 |
| Rate for Payer: Adventist Health Commercial |
$31.60
|
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Central Health Plan Commercial |
$126.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$110.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.20
|
| Rate for Payer: EPIC Health Plan Senior |
$63.20
|
| Rate for Payer: Galaxy Health WC |
$134.30
|
| Rate for Payer: Global Benefits Group Commercial |
$94.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$142.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$100.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$93.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.60
|
| Rate for Payer: Multiplan Commercial |
$118.50
|
| Rate for Payer: Networks By Design Commercial |
$102.70
|
| Rate for Payer: Prime Health Services Commercial |
$134.30
|
|
|
HC 2-PIECE WITH THORACIC EXT.
|
Facility
|
OP
|
$551.00
|
|
|
Service Code
|
CPT L0174
|
| Hospital Charge Code |
905350174
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$180.45 |
| Max. Negotiated Rate |
$495.90 |
| Rate for Payer: Adventist Health Commercial |
$225.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$468.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$303.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$413.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$320.52
|
| Rate for Payer: Blue Shield of California Commercial |
$441.90
|
| Rate for Payer: Blue Shield of California EPN |
$277.70
|
| Rate for Payer: Cash Price |
$247.95
|
| Rate for Payer: Cash Price |
$247.95
|
| Rate for Payer: Central Health Plan Commercial |
$440.80
|
| Rate for Payer: Cigna of CA HMO |
$385.70
|
| Rate for Payer: Cigna of CA PPO |
$385.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$468.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$468.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$468.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$385.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$220.40
|
| Rate for Payer: EPIC Health Plan Senior |
$220.40
|
| Rate for Payer: Galaxy Health WC |
$468.35
|
| Rate for Payer: Global Benefits Group Commercial |
$330.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$495.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$314.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$349.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$347.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$325.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$225.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$385.70
|
| Rate for Payer: Multiplan Commercial |
$413.25
|
| Rate for Payer: Networks By Design Commercial |
$275.50
|
| Rate for Payer: Prime Health Services Commercial |
$468.35
|
| Rate for Payer: Riverside University Health System MISP |
$220.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$330.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$330.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$206.79
|
| Rate for Payer: United Healthcare All Other HMO |
$201.28
|
| Rate for Payer: United Healthcare HMO Rider |
$196.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$180.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$468.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$468.35
|
| Rate for Payer: Vantage Medical Group Senior |
$468.35
|
|
|
HC 2-PIECE WITH THORACIC EXT.
|
Facility
|
IP
|
$551.00
|
|
|
Service Code
|
CPT L0174
|
| Hospital Charge Code |
905350174
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$110.20 |
| Max. Negotiated Rate |
$495.90 |
| Rate for Payer: Adventist Health Commercial |
$110.20
|
| Rate for Payer: Blue Shield of California Commercial |
$441.90
|
| Rate for Payer: Blue Shield of California EPN |
$277.70
|
| Rate for Payer: Cash Price |
$247.95
|
| Rate for Payer: Central Health Plan Commercial |
$440.80
|
| Rate for Payer: Cigna of CA HMO |
$385.70
|
| Rate for Payer: Cigna of CA PPO |
$385.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$385.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$220.40
|
| Rate for Payer: EPIC Health Plan Senior |
$220.40
|
| Rate for Payer: Galaxy Health WC |
$468.35
|
| Rate for Payer: Global Benefits Group Commercial |
$330.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$495.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$349.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$325.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.20
|
| Rate for Payer: Multiplan Commercial |
$413.25
|
| Rate for Payer: Networks By Design Commercial |
$358.15
|
| Rate for Payer: Prime Health Services Commercial |
$468.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$206.79
|
| Rate for Payer: United Healthcare All Other HMO |
$201.28
|
| Rate for Payer: United Healthcare HMO Rider |
$196.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$180.45
|
|
|
HC 2-PIECE WITH THORACIC EXT.
|
Facility
|
OP
|
$551.00
|
|
|
Service Code
|
CPT L0174
|
| Hospital Charge Code |
915350174
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$180.45 |
| Max. Negotiated Rate |
$495.90 |
| Rate for Payer: Adventist Health Commercial |
$225.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$468.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$303.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$413.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$320.52
|
| Rate for Payer: Blue Shield of California Commercial |
$441.90
|
| Rate for Payer: Blue Shield of California EPN |
$277.70
|
| Rate for Payer: Cash Price |
$247.95
|
| Rate for Payer: Cash Price |
$247.95
|
| Rate for Payer: Central Health Plan Commercial |
$440.80
|
| Rate for Payer: Cigna of CA HMO |
$385.70
|
| Rate for Payer: Cigna of CA PPO |
$385.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$468.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$468.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$468.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$385.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$220.40
|
| Rate for Payer: EPIC Health Plan Senior |
$220.40
|
| Rate for Payer: Galaxy Health WC |
$468.35
|
| Rate for Payer: Global Benefits Group Commercial |
$330.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$495.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$314.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$349.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$347.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$325.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$225.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$385.70
|
| Rate for Payer: Multiplan Commercial |
$413.25
|
| Rate for Payer: Networks By Design Commercial |
$275.50
|
| Rate for Payer: Prime Health Services Commercial |
$468.35
|
| Rate for Payer: Riverside University Health System MISP |
$220.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$330.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$330.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$206.79
|
| Rate for Payer: United Healthcare All Other HMO |
$201.28
|
| Rate for Payer: United Healthcare HMO Rider |
$196.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$180.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$468.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$468.35
|
| Rate for Payer: Vantage Medical Group Senior |
$468.35
|
|
|
HC 2-PIECE WITH THORACIC EXT.
|
Facility
|
IP
|
$551.00
|
|
|
Service Code
|
CPT L0174
|
| Hospital Charge Code |
915350174
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$110.20 |
| Max. Negotiated Rate |
$495.90 |
| Rate for Payer: Adventist Health Commercial |
$110.20
|
| Rate for Payer: Blue Shield of California Commercial |
$441.90
|
| Rate for Payer: Blue Shield of California EPN |
$277.70
|
| Rate for Payer: Cash Price |
$247.95
|
| Rate for Payer: Central Health Plan Commercial |
$440.80
|
| Rate for Payer: Cigna of CA HMO |
$385.70
|
| Rate for Payer: Cigna of CA PPO |
$385.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$385.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$220.40
|
| Rate for Payer: EPIC Health Plan Senior |
$220.40
|
| Rate for Payer: Galaxy Health WC |
$468.35
|
| Rate for Payer: Global Benefits Group Commercial |
$330.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$495.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$349.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$325.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.20
|
| Rate for Payer: Multiplan Commercial |
$413.25
|
| Rate for Payer: Networks By Design Commercial |
$358.15
|
| Rate for Payer: Prime Health Services Commercial |
$468.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$206.79
|
| Rate for Payer: United Healthcare All Other HMO |
$201.28
|
| Rate for Payer: United Healthcare HMO Rider |
$196.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$180.45
|
|
|
HC 3D ECHO IMG CGEN CAR ANOMAL
|
Facility
|
OP
|
$1,621.00
|
|
|
Service Code
|
CPT 93319
|
| Hospital Charge Code |
900200319
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$94.69 |
| Max. Negotiated Rate |
$1,458.90 |
| Rate for Payer: Adventist Health Commercial |
$324.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$142.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,377.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$891.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,215.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$420.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$942.94
|
| Rate for Payer: Blue Shield of California Commercial |
$1,021.23
|
| Rate for Payer: Blue Shield of California EPN |
$643.54
|
| Rate for Payer: Cash Price |
$729.45
|
| Rate for Payer: Cash Price |
$729.45
|
| Rate for Payer: Cash Price |
$729.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,296.80
|
| Rate for Payer: Cigna of CA HMO |
$1,037.44
|
| Rate for Payer: Cigna of CA PPO |
$1,199.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,377.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,377.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,377.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,134.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.40
|
| Rate for Payer: EPIC Health Plan Senior |
$648.40
|
| Rate for Payer: Galaxy Health WC |
$1,377.85
|
| Rate for Payer: Global Benefits Group Commercial |
$972.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,458.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$94.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,029.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$104.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$956.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$324.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,134.70
|
| Rate for Payer: Multiplan Commercial |
$1,215.75
|
| Rate for Payer: Networks By Design Commercial |
$1,053.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,377.85
|
| Rate for Payer: Riverside University Health System MISP |
$648.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$972.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$972.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$968.00
|
| Rate for Payer: United Healthcare All Other HMO |
$982.00
|
| Rate for Payer: United Healthcare HMO Rider |
$832.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$762.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,377.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,377.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,377.85
|
|
|
HC 3D ECHO IMG CGEN CAR ANOMAL
|
Facility
|
IP
|
$1,621.00
|
|
|
Service Code
|
CPT 93319
|
| Hospital Charge Code |
900200319
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$324.20 |
| Max. Negotiated Rate |
$1,458.90 |
| Rate for Payer: Adventist Health Commercial |
$324.20
|
| Rate for Payer: Cash Price |
$729.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,296.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,134.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.40
|
| Rate for Payer: EPIC Health Plan Senior |
$648.40
|
| Rate for Payer: Galaxy Health WC |
$1,377.85
|
| Rate for Payer: Global Benefits Group Commercial |
$972.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,458.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,029.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$956.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$324.20
|
| Rate for Payer: Multiplan Commercial |
$1,215.75
|
| Rate for Payer: Networks By Design Commercial |
$1,053.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,377.85
|
|
|
HC 3D RENDERING W/POSTPROCESSING
|
Facility
|
IP
|
$2,658.00
|
|
|
Service Code
|
CPT 76377
|
| Hospital Charge Code |
909201370
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$531.60 |
| Max. Negotiated Rate |
$2,392.20 |
| Rate for Payer: Adventist Health Commercial |
$531.60
|
| Rate for Payer: Cash Price |
$1,196.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,126.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,860.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,063.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,063.20
|
| Rate for Payer: Galaxy Health WC |
$2,259.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,594.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,392.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,687.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,568.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$531.60
|
| Rate for Payer: Multiplan Commercial |
$1,993.50
|
| Rate for Payer: Networks By Design Commercial |
$1,727.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,259.30
|
|
|
HC 3D RENDERING W/POSTPROCESSING
|
Facility
|
OP
|
$2,658.00
|
|
|
Service Code
|
CPT 76377
|
| Hospital Charge Code |
909201370
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$531.60 |
| Max. Negotiated Rate |
$2,392.20 |
| Rate for Payer: Adventist Health Commercial |
$531.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,259.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,461.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,993.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$739.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,546.16
|
| Rate for Payer: Blue Shield of California Commercial |
$1,674.54
|
| Rate for Payer: Blue Shield of California EPN |
$1,055.23
|
| Rate for Payer: Cash Price |
$1,196.10
|
| Rate for Payer: Cash Price |
$1,196.10
|
| Rate for Payer: Cash Price |
$1,196.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,126.40
|
| Rate for Payer: Cigna of CA HMO |
$1,701.12
|
| Rate for Payer: Cigna of CA PPO |
$1,966.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,259.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,259.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,259.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,860.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,063.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,063.20
|
| Rate for Payer: Galaxy Health WC |
$2,259.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,594.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,392.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,687.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$964.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,568.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$531.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,860.60
|
| Rate for Payer: Multiplan Commercial |
$1,993.50
|
| Rate for Payer: Networks By Design Commercial |
$1,727.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,259.30
|
| Rate for Payer: Riverside University Health System MISP |
$1,063.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,594.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,594.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,329.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,329.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,329.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,329.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,259.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,259.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2,259.30
|
|
|
HC 3-PHASE BONE SCAN
|
Facility
|
IP
|
$2,846.00
|
|
|
Service Code
|
CPT 78315
|
| Hospital Charge Code |
909301372
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$569.20 |
| Max. Negotiated Rate |
$2,561.40 |
| Rate for Payer: Adventist Health Commercial |
$569.20
|
| Rate for Payer: Cash Price |
$1,280.70
|
| Rate for Payer: Central Health Plan Commercial |
$2,276.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,992.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,138.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,138.40
|
| Rate for Payer: Galaxy Health WC |
$2,419.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,707.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,561.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,807.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,679.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$569.20
|
| Rate for Payer: Multiplan Commercial |
$2,134.50
|
| Rate for Payer: Networks By Design Commercial |
$1,849.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,419.10
|
|
|
HC 3-PHASE BONE SCAN
|
Facility
|
OP
|
$2,846.00
|
|
|
Service Code
|
CPT 78315
|
| Hospital Charge Code |
909301372
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$225.49 |
| Max. Negotiated Rate |
$2,561.40 |
| Rate for Payer: Adventist Health Commercial |
$569.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$514.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,554.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$514.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$917.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,655.52
|
| Rate for Payer: Blue Shield of California Commercial |
$1,792.98
|
| Rate for Payer: Blue Shield of California EPN |
$1,129.86
|
| Rate for Payer: Cash Price |
$1,280.70
|
| Rate for Payer: Cash Price |
$1,280.70
|
| Rate for Payer: Central Health Plan Commercial |
$2,276.80
|
| Rate for Payer: Cigna of CA HMO |
$1,821.44
|
| Rate for Payer: Cigna of CA PPO |
$2,106.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$771.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$565.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$514.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,992.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$848.38
|
| Rate for Payer: EPIC Health Plan Senior |
$565.59
|
| Rate for Payer: Galaxy Health WC |
$2,419.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,707.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,561.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$843.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$225.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$514.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,807.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$249.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$719.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$569.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$688.99
|
| Rate for Payer: Multiplan Commercial |
$2,134.50
|
| Rate for Payer: Networks By Design Commercial |
$1,849.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$514.17
|
| Rate for Payer: Prime Health Services Commercial |
$2,419.10
|
| Rate for Payer: Prime Health Services Medicare |
$545.02
|
| Rate for Payer: Riverside University Health System MISP |
$565.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,707.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,707.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$632.16
|
| Rate for Payer: United Healthcare All Other HMO |
$632.16
|
| Rate for Payer: United Healthcare HMO Rider |
$632.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$632.16
|
| Rate for Payer: Upland Medical Group Pediatric |
$514.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Vantage Medical Group Senior |
$514.17
|
|
|
HC 59 FE CHLORIDE
|
Facility
|
IP
|
$1,217.00
|
|
|
Service Code
|
CPT A4641
|
| Hospital Charge Code |
909301497
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$243.40 |
| Max. Negotiated Rate |
$1,095.30 |
| Rate for Payer: Adventist Health Commercial |
$243.40
|
| Rate for Payer: Blue Shield of California Commercial |
$976.03
|
| Rate for Payer: Blue Shield of California EPN |
$613.37
|
| Rate for Payer: Cash Price |
$547.65
|
| Rate for Payer: Central Health Plan Commercial |
$973.60
|
| Rate for Payer: Cigna of CA HMO |
$851.90
|
| Rate for Payer: Cigna of CA PPO |
$851.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$851.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$486.80
|
| Rate for Payer: EPIC Health Plan Senior |
$486.80
|
| Rate for Payer: Galaxy Health WC |
$1,034.45
|
| Rate for Payer: Global Benefits Group Commercial |
$730.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,095.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$772.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$718.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$243.40
|
| Rate for Payer: Multiplan Commercial |
$912.75
|
| Rate for Payer: Networks By Design Commercial |
$608.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,034.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$456.74
|
| Rate for Payer: United Healthcare All Other HMO |
$444.57
|
| Rate for Payer: United Healthcare HMO Rider |
$434.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$398.57
|
|
|
HC 59 FE CHLORIDE
|
Facility
|
OP
|
$1,217.00
|
|
|
Service Code
|
CPT A4641
|
| Hospital Charge Code |
909301497
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$243.40 |
| Max. Negotiated Rate |
$1,095.30 |
| Rate for Payer: Adventist Health Commercial |
$243.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,034.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$669.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$912.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$589.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$707.93
|
| Rate for Payer: Blue Shield of California Commercial |
$771.58
|
| Rate for Payer: Blue Shield of California EPN |
$485.58
|
| Rate for Payer: Cash Price |
$547.65
|
| Rate for Payer: Central Health Plan Commercial |
$973.60
|
| Rate for Payer: Cigna of CA HMO |
$851.90
|
| Rate for Payer: Cigna of CA PPO |
$851.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,034.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,034.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,034.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$851.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$486.80
|
| Rate for Payer: EPIC Health Plan Senior |
$486.80
|
| Rate for Payer: Galaxy Health WC |
$1,034.45
|
| Rate for Payer: Global Benefits Group Commercial |
$730.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,095.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$772.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$718.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$243.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$851.90
|
| Rate for Payer: Multiplan Commercial |
$912.75
|
| Rate for Payer: Networks By Design Commercial |
$608.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,034.45
|
| Rate for Payer: Riverside University Health System MISP |
$486.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$730.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$730.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$456.74
|
| Rate for Payer: United Healthcare All Other HMO |
$444.57
|
| Rate for Payer: United Healthcare HMO Rider |
$434.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$398.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,034.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,034.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1,034.45
|
|
|
HC 5-HIAA BY HPLC
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
CPT 83497
|
| Hospital Charge Code |
900910535
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$37.80 |
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Central Health Plan Commercial |
$33.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.80
|
| Rate for Payer: EPIC Health Plan Senior |
$16.80
|
| Rate for Payer: Galaxy Health WC |
$35.70
|
| Rate for Payer: Global Benefits Group Commercial |
$25.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$37.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.40
|
| Rate for Payer: Multiplan Commercial |
$31.50
|
| Rate for Payer: Networks By Design Commercial |
$27.30
|
| Rate for Payer: Prime Health Services Commercial |
$35.70
|
|
|
HC 5-HIAA BY HPLC
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
CPT 83497
|
| Hospital Charge Code |
900910535
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$130.46 |
| Rate for Payer: Adventist Health Commercial |
$7.60
|
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.90
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$93.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$93.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.46
|
| Rate for Payer: Blue Shield of California Commercial |
$26.46
|
| Rate for Payer: Blue Shield of California Commercial |
$23.94
|
| Rate for Payer: Blue Shield of California EPN |
$16.67
|
| Rate for Payer: Blue Shield of California EPN |
$15.09
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Central Health Plan Commercial |
$30.40
|
| Rate for Payer: Central Health Plan Commercial |
$33.60
|
| Rate for Payer: Cigna of CA HMO |
$26.88
|
| Rate for Payer: Cigna of CA HMO |
$24.32
|
| Rate for Payer: Cigna of CA PPO |
$31.08
|
| Rate for Payer: Cigna of CA PPO |
$28.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.29
|
| Rate for Payer: EPIC Health Plan Senior |
$14.19
|
| Rate for Payer: EPIC Health Plan Senior |
$14.19
|
| Rate for Payer: Galaxy Health WC |
$35.70
|
| Rate for Payer: Galaxy Health WC |
$32.30
|
| Rate for Payer: Global Benefits Group Commercial |
$25.20
|
| Rate for Payer: Global Benefits Group Commercial |
$22.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$37.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.16
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.29
|
| Rate for Payer: Multiplan Commercial |
$31.50
|
| Rate for Payer: Multiplan Commercial |
$28.50
|
| Rate for Payer: Networks By Design Commercial |
$24.70
|
| Rate for Payer: Networks By Design Commercial |
$27.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.90
|
| Rate for Payer: Prime Health Services Commercial |
$35.70
|
| Rate for Payer: Prime Health Services Commercial |
$32.30
|
| Rate for Payer: Prime Health Services Medicare |
$13.67
|
| Rate for Payer: Prime Health Services Medicare |
$13.67
|
| Rate for Payer: Riverside University Health System MISP |
$14.19
|
| Rate for Payer: Riverside University Health System MISP |
$14.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.45
|
| Rate for Payer: United Healthcare All Other HMO |
$10.45
|
| Rate for Payer: United Healthcare All Other HMO |
$10.45
|
| Rate for Payer: United Healthcare HMO Rider |
$10.45
|
| Rate for Payer: United Healthcare HMO Rider |
$10.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.45
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.90
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.19
|
| Rate for Payer: Vantage Medical Group Senior |
$12.90
|
| Rate for Payer: Vantage Medical Group Senior |
$12.90
|
|
|
HC 5-HYDROXYINDOLACETIC ACID URINE 24 HOURS
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
CPT 83497
|
| Hospital Charge Code |
900912191
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$130.46 |
| Rate for Payer: Adventist Health Commercial |
$7.60
|
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.90
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$93.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$93.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.46
|
| Rate for Payer: Blue Shield of California Commercial |
$26.46
|
| Rate for Payer: Blue Shield of California Commercial |
$23.94
|
| Rate for Payer: Blue Shield of California EPN |
$16.67
|
| Rate for Payer: Blue Shield of California EPN |
$15.09
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Central Health Plan Commercial |
$30.40
|
| Rate for Payer: Central Health Plan Commercial |
$33.60
|
| Rate for Payer: Cigna of CA HMO |
$26.88
|
| Rate for Payer: Cigna of CA HMO |
$24.32
|
| Rate for Payer: Cigna of CA PPO |
$31.08
|
| Rate for Payer: Cigna of CA PPO |
$28.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.29
|
| Rate for Payer: EPIC Health Plan Senior |
$14.19
|
| Rate for Payer: EPIC Health Plan Senior |
$14.19
|
| Rate for Payer: Galaxy Health WC |
$35.70
|
| Rate for Payer: Galaxy Health WC |
$32.30
|
| Rate for Payer: Global Benefits Group Commercial |
$25.20
|
| Rate for Payer: Global Benefits Group Commercial |
$22.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$37.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.16
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.29
|
| Rate for Payer: Multiplan Commercial |
$31.50
|
| Rate for Payer: Multiplan Commercial |
$28.50
|
| Rate for Payer: Networks By Design Commercial |
$24.70
|
| Rate for Payer: Networks By Design Commercial |
$27.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.90
|
| Rate for Payer: Prime Health Services Commercial |
$35.70
|
| Rate for Payer: Prime Health Services Commercial |
$32.30
|
| Rate for Payer: Prime Health Services Medicare |
$13.67
|
| Rate for Payer: Prime Health Services Medicare |
$13.67
|
| Rate for Payer: Riverside University Health System MISP |
$14.19
|
| Rate for Payer: Riverside University Health System MISP |
$14.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.45
|
| Rate for Payer: United Healthcare All Other HMO |
$10.45
|
| Rate for Payer: United Healthcare All Other HMO |
$10.45
|
| Rate for Payer: United Healthcare HMO Rider |
$10.45
|
| Rate for Payer: United Healthcare HMO Rider |
$10.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.45
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.90
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.19
|
| Rate for Payer: Vantage Medical Group Senior |
$12.90
|
| Rate for Payer: Vantage Medical Group Senior |
$12.90
|
|
|
HC 5-HYDROXYINDOLACETIC ACID URINE 24 HOURS
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
CPT 83497
|
| Hospital Charge Code |
900912191
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$37.80 |
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Central Health Plan Commercial |
$33.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.80
|
| Rate for Payer: EPIC Health Plan Senior |
$16.80
|
| Rate for Payer: Galaxy Health WC |
$35.70
|
| Rate for Payer: Global Benefits Group Commercial |
$25.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$37.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.40
|
| Rate for Payer: Multiplan Commercial |
$31.50
|
| Rate for Payer: Networks By Design Commercial |
$27.30
|
| Rate for Payer: Prime Health Services Commercial |
$35.70
|
|
|
HC 5-HYDROXYINDOLACETIC ACID URINE RANDOM
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
CPT 83497
|
| Hospital Charge Code |
900912190
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$130.46 |
| Rate for Payer: Adventist Health Commercial |
$7.60
|
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.90
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$93.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$93.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.46
|
| Rate for Payer: Blue Shield of California Commercial |
$26.46
|
| Rate for Payer: Blue Shield of California Commercial |
$23.94
|
| Rate for Payer: Blue Shield of California EPN |
$16.67
|
| Rate for Payer: Blue Shield of California EPN |
$15.09
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Central Health Plan Commercial |
$30.40
|
| Rate for Payer: Central Health Plan Commercial |
$33.60
|
| Rate for Payer: Cigna of CA HMO |
$26.88
|
| Rate for Payer: Cigna of CA HMO |
$24.32
|
| Rate for Payer: Cigna of CA PPO |
$31.08
|
| Rate for Payer: Cigna of CA PPO |
$28.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.29
|
| Rate for Payer: EPIC Health Plan Senior |
$14.19
|
| Rate for Payer: EPIC Health Plan Senior |
$14.19
|
| Rate for Payer: Galaxy Health WC |
$35.70
|
| Rate for Payer: Galaxy Health WC |
$32.30
|
| Rate for Payer: Global Benefits Group Commercial |
$25.20
|
| Rate for Payer: Global Benefits Group Commercial |
$22.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$37.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.16
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.29
|
| Rate for Payer: Multiplan Commercial |
$31.50
|
| Rate for Payer: Multiplan Commercial |
$28.50
|
| Rate for Payer: Networks By Design Commercial |
$24.70
|
| Rate for Payer: Networks By Design Commercial |
$27.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.90
|
| Rate for Payer: Prime Health Services Commercial |
$35.70
|
| Rate for Payer: Prime Health Services Commercial |
$32.30
|
| Rate for Payer: Prime Health Services Medicare |
$13.67
|
| Rate for Payer: Prime Health Services Medicare |
$13.67
|
| Rate for Payer: Riverside University Health System MISP |
$14.19
|
| Rate for Payer: Riverside University Health System MISP |
$14.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.45
|
| Rate for Payer: United Healthcare All Other HMO |
$10.45
|
| Rate for Payer: United Healthcare All Other HMO |
$10.45
|
| Rate for Payer: United Healthcare HMO Rider |
$10.45
|
| Rate for Payer: United Healthcare HMO Rider |
$10.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.45
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.90
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.19
|
| Rate for Payer: Vantage Medical Group Senior |
$12.90
|
| Rate for Payer: Vantage Medical Group Senior |
$12.90
|
|
