|
HC ABL PERC CRYOABLATION INCL IG; LE DISTAL PN
|
Facility
|
OP
|
$6,936.00
|
|
|
Service Code
|
CPT 0441T
|
| Hospital Charge Code |
909081441
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,387.20 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,387.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,511.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,767.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,762.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,511.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,953.34
|
| Rate for Payer: Blue Shield of California Commercial |
$5,036.70
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$3,121.20
|
| Rate for Payer: Cash Price |
$3,121.20
|
| Rate for Payer: Cash Price |
$3,121.20
|
| Rate for Payer: Central Health Plan Commercial |
$5,548.80
|
| Rate for Payer: Cigna of CA HMO |
$4,439.04
|
| Rate for Payer: Cigna of CA PPO |
$5,132.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,767.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,762.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,511.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,855.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,144.02
|
| Rate for Payer: EPIC Health Plan Senior |
$2,762.68
|
| Rate for Payer: Galaxy Health WC |
$5,895.60
|
| Rate for Payer: Global Benefits Group Commercial |
$4,161.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,242.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,118.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,511.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,404.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,517.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,516.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,387.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,365.45
|
| Rate for Payer: Multiplan Commercial |
$5,202.00
|
| Rate for Payer: Multiplan WC |
$3,953.34
|
| Rate for Payer: Networks By Design Commercial |
$4,508.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,511.53
|
| Rate for Payer: Preferred Health Network WC |
$4,034.02
|
| Rate for Payer: Prime Health Services Commercial |
$5,895.60
|
| Rate for Payer: Prime Health Services Medicare |
$2,662.22
|
| Rate for Payer: Prime Health Services WC |
$3,913.00
|
| Rate for Payer: Riverside University Health System MISP |
$2,762.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,161.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,468.00
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,511.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,767.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,762.68
|
| Rate for Payer: Vantage Medical Group Senior |
$2,511.53
|
|
|
HC ABL PERC CRYOABLATION INCL IG; LE DISTAL PN
|
Facility
|
IP
|
$6,936.00
|
|
|
Service Code
|
CPT 0441T
|
| Hospital Charge Code |
909081441
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,387.20 |
| Max. Negotiated Rate |
$6,242.40 |
| Rate for Payer: Adventist Health Commercial |
$1,387.20
|
| Rate for Payer: Cash Price |
$3,121.20
|
| Rate for Payer: Central Health Plan Commercial |
$5,548.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,855.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,774.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,774.40
|
| Rate for Payer: Galaxy Health WC |
$5,895.60
|
| Rate for Payer: Global Benefits Group Commercial |
$4,161.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,242.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,404.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,092.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,387.20
|
| Rate for Payer: Multiplan Commercial |
$5,202.00
|
| Rate for Payer: Networks By Design Commercial |
$4,508.40
|
| Rate for Payer: Prime Health Services Commercial |
$5,895.60
|
|
|
HC ABLTN 1 OR MORE THYRD NDLS ADDL LOBE
|
Facility
|
IP
|
$2,588.00
|
|
|
Service Code
|
CPT 60661
|
| Hospital Charge Code |
906811873
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$517.60 |
| Max. Negotiated Rate |
$2,329.20 |
| Rate for Payer: Adventist Health Commercial |
$517.60
|
| Rate for Payer: Cash Price |
$1,164.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,070.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,811.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,035.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,035.20
|
| Rate for Payer: Galaxy Health WC |
$2,199.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,552.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,329.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,643.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,526.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$517.60
|
| Rate for Payer: Multiplan Commercial |
$1,941.00
|
| Rate for Payer: Networks By Design Commercial |
$1,682.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,199.80
|
|
|
HC ABLTN 1 OR MORE THYRD NDLS ADDL LOBE
|
Facility
|
OP
|
$2,588.00
|
|
|
Service Code
|
CPT 60661
|
| Hospital Charge Code |
906811873
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$517.60 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$517.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,199.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,423.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,941.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,253.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,505.44
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$1,164.60
|
| Rate for Payer: Cash Price |
$1,164.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,070.40
|
| Rate for Payer: Cigna of CA HMO |
$1,656.32
|
| Rate for Payer: Cigna of CA PPO |
$1,915.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,199.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,199.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,199.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,811.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,035.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,035.20
|
| Rate for Payer: Galaxy Health WC |
$2,199.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,552.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,329.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,643.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$939.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,526.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$517.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,811.60
|
| Rate for Payer: Multiplan Commercial |
$1,941.00
|
| Rate for Payer: Networks By Design Commercial |
$1,682.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,199.80
|
| Rate for Payer: Riverside University Health System MISP |
$1,035.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,552.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,294.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,294.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,294.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,294.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,199.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,199.80
|
| Rate for Payer: Vantage Medical Group Senior |
$2,199.80
|
|
|
HC ABLTN 1 OR MORE THYRD NDLS ONE LOBE
|
Facility
|
IP
|
$5,176.00
|
|
|
Service Code
|
CPT 60660
|
| Hospital Charge Code |
906811872
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,035.20 |
| Max. Negotiated Rate |
$4,658.40 |
| Rate for Payer: Adventist Health Commercial |
$1,035.20
|
| Rate for Payer: Cash Price |
$2,329.20
|
| Rate for Payer: Central Health Plan Commercial |
$4,140.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,623.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,070.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,070.40
|
| Rate for Payer: Galaxy Health WC |
$4,399.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,105.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,658.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,286.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,053.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,035.20
|
| Rate for Payer: Multiplan Commercial |
$3,882.00
|
| Rate for Payer: Networks By Design Commercial |
$3,364.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,399.60
|
|
|
HC ABLTN 1 OR MORE THYRD NDLS ONE LOBE
|
Facility
|
OP
|
$5,176.00
|
|
|
Service Code
|
CPT 60660
|
| Hospital Charge Code |
906811872
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$639.21 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,035.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,124.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,138.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,280.13
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$2,329.20
|
| Rate for Payer: Cash Price |
$2,329.20
|
| Rate for Payer: Cash Price |
$2,329.20
|
| Rate for Payer: Central Health Plan Commercial |
$4,140.80
|
| Rate for Payer: Cigna of CA HMO |
$3,312.64
|
| Rate for Payer: Cigna of CA PPO |
$3,830.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,623.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,504.98
|
| Rate for Payer: EPIC Health Plan Senior |
$2,336.65
|
| Rate for Payer: Galaxy Health WC |
$4,399.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,105.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,658.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,483.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,286.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,878.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,973.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,035.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,846.47
|
| Rate for Payer: Multiplan Commercial |
$3,882.00
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$3,364.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Preferred Health Network WC |
$3,347.07
|
| Rate for Payer: Prime Health Services Commercial |
$4,399.60
|
| Rate for Payer: Prime Health Services Medicare |
$2,251.68
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Riverside University Health System MISP |
$2,336.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,105.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,588.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,588.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,588.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,588.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,124.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
|
HC ABO BLOOD GROUP
|
Facility
|
OP
|
$253.00
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
900904523
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.42 |
| Max. Negotiated Rate |
$227.70 |
| Rate for Payer: Adventist Health Commercial |
$50.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$2.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.99
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.16
|
| Rate for Payer: Blue Shield of California Commercial |
$159.39
|
| Rate for Payer: Blue Shield of California EPN |
$100.44
|
| Rate for Payer: Cash Price |
$113.85
|
| Rate for Payer: Cash Price |
$113.85
|
| Rate for Payer: Central Health Plan Commercial |
$202.40
|
| Rate for Payer: Cigna of CA HMO |
$161.92
|
| Rate for Payer: Cigna of CA PPO |
$187.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$177.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3.29
|
| Rate for Payer: Galaxy Health WC |
$215.05
|
| Rate for Payer: Global Benefits Group Commercial |
$151.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$227.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$160.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.01
|
| Rate for Payer: Multiplan Commercial |
$189.75
|
| Rate for Payer: Networks By Design Commercial |
$164.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2.99
|
| Rate for Payer: Prime Health Services Commercial |
$215.05
|
| Rate for Payer: Prime Health Services Medicare |
$3.17
|
| Rate for Payer: Riverside University Health System MISP |
$3.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$151.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$151.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.42
|
| Rate for Payer: United Healthcare All Other HMO |
$2.42
|
| Rate for Payer: United Healthcare HMO Rider |
$2.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$2.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.29
|
| Rate for Payer: Vantage Medical Group Senior |
$2.99
|
|
|
HC ABO BLOOD GROUP
|
Facility
|
IP
|
$253.00
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
900904523
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.60 |
| Max. Negotiated Rate |
$227.70 |
| Rate for Payer: Adventist Health Commercial |
$50.60
|
| Rate for Payer: Cash Price |
$113.85
|
| Rate for Payer: Central Health Plan Commercial |
$202.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$177.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.20
|
| Rate for Payer: EPIC Health Plan Senior |
$101.20
|
| Rate for Payer: Galaxy Health WC |
$215.05
|
| Rate for Payer: Global Benefits Group Commercial |
$151.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$227.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$160.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$149.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.60
|
| Rate for Payer: Multiplan Commercial |
$189.75
|
| Rate for Payer: Networks By Design Commercial |
$164.45
|
| Rate for Payer: Prime Health Services Commercial |
$215.05
|
|
|
HC ABO UNIT CONFIRMATION
|
Facility
|
IP
|
$253.00
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
900904524
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$50.60 |
| Max. Negotiated Rate |
$227.70 |
| Rate for Payer: Adventist Health Commercial |
$50.60
|
| Rate for Payer: Cash Price |
$113.85
|
| Rate for Payer: Central Health Plan Commercial |
$202.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$177.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.20
|
| Rate for Payer: EPIC Health Plan Senior |
$101.20
|
| Rate for Payer: Galaxy Health WC |
$215.05
|
| Rate for Payer: Global Benefits Group Commercial |
$151.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$227.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$160.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$149.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.60
|
| Rate for Payer: Multiplan Commercial |
$189.75
|
| Rate for Payer: Networks By Design Commercial |
$164.45
|
| Rate for Payer: Prime Health Services Commercial |
$215.05
|
|
|
HC ABO UNIT CONFIRMATION
|
Facility
|
OP
|
$253.00
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
900904524
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Adventist Health Commercial |
$50.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$2.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.99
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$122.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.17
|
| Rate for Payer: Blue Shield of California Commercial |
$160.40
|
| Rate for Payer: Blue Shield of California EPN |
$100.95
|
| Rate for Payer: Cash Price |
$113.85
|
| Rate for Payer: Cash Price |
$113.85
|
| Rate for Payer: Cash Price |
$113.85
|
| Rate for Payer: Central Health Plan Commercial |
$202.40
|
| Rate for Payer: Cigna of CA HMO |
$161.92
|
| Rate for Payer: Cigna of CA PPO |
$187.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$177.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3.29
|
| Rate for Payer: Galaxy Health WC |
$215.05
|
| Rate for Payer: Global Benefits Group Commercial |
$151.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$227.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$160.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.01
|
| Rate for Payer: Multiplan Commercial |
$189.75
|
| Rate for Payer: Networks By Design Commercial |
$164.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2.99
|
| Rate for Payer: Prime Health Services Commercial |
$215.05
|
| Rate for Payer: Prime Health Services Medicare |
$3.17
|
| Rate for Payer: Riverside University Health System MISP |
$3.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$151.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$151.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.29
|
| Rate for Payer: Vantage Medical Group Senior |
$2.99
|
|
|
HC ABSORBNT SHEET 6X14",BAG OF 10
|
Facility
|
OP
|
$7.13
|
|
| Hospital Charge Code |
901607997
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$6.42 |
| Rate for Payer: Adventist Health Commercial |
$1.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.15
|
| Rate for Payer: Blue Shield of California Commercial |
$4.52
|
| Rate for Payer: Blue Shield of California EPN |
$2.84
|
| Rate for Payer: Cash Price |
$3.21
|
| Rate for Payer: Central Health Plan Commercial |
$5.70
|
| Rate for Payer: Cigna of CA HMO |
$4.56
|
| Rate for Payer: Cigna of CA PPO |
$5.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.85
|
| Rate for Payer: EPIC Health Plan Senior |
$2.85
|
| Rate for Payer: Galaxy Health WC |
$6.06
|
| Rate for Payer: Global Benefits Group Commercial |
$4.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.99
|
| Rate for Payer: Multiplan Commercial |
$5.35
|
| Rate for Payer: Networks By Design Commercial |
$4.63
|
| Rate for Payer: Prime Health Services Commercial |
$6.06
|
| Rate for Payer: Riverside University Health System MISP |
$2.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.56
|
| Rate for Payer: United Healthcare All Other HMO |
$3.56
|
| Rate for Payer: United Healthcare HMO Rider |
$3.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.06
|
| Rate for Payer: Vantage Medical Group Senior |
$6.06
|
|
|
HC ABSORBNT SHEET 6X14",BAG OF 10
|
Facility
|
IP
|
$7.13
|
|
| Hospital Charge Code |
901607997
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$6.42 |
| Rate for Payer: Adventist Health Commercial |
$1.43
|
| Rate for Payer: Cash Price |
$3.21
|
| Rate for Payer: Central Health Plan Commercial |
$5.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.85
|
| Rate for Payer: EPIC Health Plan Senior |
$2.85
|
| Rate for Payer: Galaxy Health WC |
$6.06
|
| Rate for Payer: Global Benefits Group Commercial |
$4.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.43
|
| Rate for Payer: Multiplan Commercial |
$5.35
|
| Rate for Payer: Networks By Design Commercial |
$4.63
|
| Rate for Payer: Prime Health Services Commercial |
$6.06
|
|
|
HC ACETAMINOPHEN (TYLENOL)
|
Facility
|
OP
|
$549.00
|
|
|
Service Code
|
CPT 80143
|
| Hospital Charge Code |
900911302
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.10 |
| Max. Negotiated Rate |
$494.10 |
| Rate for Payer: Adventist Health Commercial |
$109.80
|
| Rate for Payer: Adventist Health Commercial |
$15.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$18.64
|
| Rate for Payer: Adventist Health Medi-Cal |
$18.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$97.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$97.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$48.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$48.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.73
|
| Rate for Payer: Blue Shield of California Commercial |
$49.77
|
| Rate for Payer: Blue Shield of California Commercial |
$345.87
|
| Rate for Payer: Blue Shield of California EPN |
$31.36
|
| Rate for Payer: Blue Shield of California EPN |
$217.95
|
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: Cash Price |
$247.05
|
| Rate for Payer: Cash Price |
$247.05
|
| Rate for Payer: Central Health Plan Commercial |
$439.20
|
| Rate for Payer: Central Health Plan Commercial |
$63.20
|
| Rate for Payer: Cigna of CA HMO |
$50.56
|
| Rate for Payer: Cigna of CA HMO |
$351.36
|
| Rate for Payer: Cigna of CA PPO |
$58.46
|
| Rate for Payer: Cigna of CA PPO |
$406.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$384.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$55.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.76
|
| Rate for Payer: EPIC Health Plan Senior |
$20.50
|
| Rate for Payer: EPIC Health Plan Senior |
$20.50
|
| Rate for Payer: Galaxy Health WC |
$67.15
|
| Rate for Payer: Galaxy Health WC |
$466.65
|
| Rate for Payer: Global Benefits Group Commercial |
$47.40
|
| Rate for Payer: Global Benefits Group Commercial |
$329.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$71.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$494.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.57
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$348.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$50.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.98
|
| Rate for Payer: Multiplan Commercial |
$59.25
|
| Rate for Payer: Multiplan Commercial |
$411.75
|
| Rate for Payer: Networks By Design Commercial |
$356.85
|
| Rate for Payer: Networks By Design Commercial |
$51.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18.64
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18.64
|
| Rate for Payer: Prime Health Services Commercial |
$67.15
|
| Rate for Payer: Prime Health Services Commercial |
$466.65
|
| Rate for Payer: Prime Health Services Medicare |
$19.76
|
| Rate for Payer: Prime Health Services Medicare |
$19.76
|
| Rate for Payer: Riverside University Health System MISP |
$20.50
|
| Rate for Payer: Riverside University Health System MISP |
$20.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$329.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$47.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$47.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$329.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.10
|
| Rate for Payer: United Healthcare All Other HMO |
$15.10
|
| Rate for Payer: United Healthcare All Other HMO |
$15.10
|
| Rate for Payer: United Healthcare HMO Rider |
$15.10
|
| Rate for Payer: United Healthcare HMO Rider |
$15.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.10
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.64
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Vantage Medical Group Senior |
$18.64
|
| Rate for Payer: Vantage Medical Group Senior |
$18.64
|
|
|
HC ACETAMINOPHEN (TYLENOL)
|
Facility
|
IP
|
$549.00
|
|
|
Service Code
|
CPT 80143
|
| Hospital Charge Code |
900911302
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$109.80 |
| Max. Negotiated Rate |
$494.10 |
| Rate for Payer: Adventist Health Commercial |
$109.80
|
| Rate for Payer: Cash Price |
$247.05
|
| Rate for Payer: Central Health Plan Commercial |
$439.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$384.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$219.60
|
| Rate for Payer: EPIC Health Plan Senior |
$219.60
|
| Rate for Payer: Galaxy Health WC |
$466.65
|
| Rate for Payer: Global Benefits Group Commercial |
$329.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$494.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$348.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$323.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.80
|
| Rate for Payer: Multiplan Commercial |
$411.75
|
| Rate for Payer: Networks By Design Commercial |
$356.85
|
| Rate for Payer: Prime Health Services Commercial |
$466.65
|
|
|
HC ACETOACETATE, SEMIQUANTITATIVE
|
Facility
|
IP
|
$244.00
|
|
|
Service Code
|
CPT 82010
|
| Hospital Charge Code |
900910466
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.80 |
| Max. Negotiated Rate |
$219.60 |
| Rate for Payer: Adventist Health Commercial |
$48.80
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Central Health Plan Commercial |
$195.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$170.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.60
|
| Rate for Payer: EPIC Health Plan Senior |
$97.60
|
| Rate for Payer: Galaxy Health WC |
$207.40
|
| Rate for Payer: Global Benefits Group Commercial |
$146.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$219.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$154.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$143.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.80
|
| Rate for Payer: Multiplan Commercial |
$183.00
|
| Rate for Payer: Networks By Design Commercial |
$158.60
|
| Rate for Payer: Prime Health Services Commercial |
$207.40
|
|
|
HC ACETOACETATE, SEMIQUANTITATIVE
|
Facility
|
OP
|
$244.00
|
|
|
Service Code
|
CPT 82010
|
| Hospital Charge Code |
900910466
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.62 |
| Max. Negotiated Rate |
$219.60 |
| Rate for Payer: Adventist Health Commercial |
$48.80
|
| Rate for Payer: Adventist Health Commercial |
$8.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$8.17
|
| Rate for Payer: Adventist Health Medi-Cal |
$8.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$60.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$60.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$59.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$59.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$82.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$82.18
|
| Rate for Payer: Blue Shield of California Commercial |
$25.83
|
| Rate for Payer: Blue Shield of California Commercial |
$153.72
|
| Rate for Payer: Blue Shield of California EPN |
$16.28
|
| Rate for Payer: Blue Shield of California EPN |
$96.87
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Central Health Plan Commercial |
$195.20
|
| Rate for Payer: Central Health Plan Commercial |
$32.80
|
| Rate for Payer: Cigna of CA HMO |
$26.24
|
| Rate for Payer: Cigna of CA HMO |
$156.16
|
| Rate for Payer: Cigna of CA PPO |
$30.34
|
| Rate for Payer: Cigna of CA PPO |
$180.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$170.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.48
|
| Rate for Payer: EPIC Health Plan Senior |
$8.99
|
| Rate for Payer: EPIC Health Plan Senior |
$8.99
|
| Rate for Payer: Galaxy Health WC |
$34.85
|
| Rate for Payer: Galaxy Health WC |
$207.40
|
| Rate for Payer: Global Benefits Group Commercial |
$24.60
|
| Rate for Payer: Global Benefits Group Commercial |
$146.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$219.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$154.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.95
|
| Rate for Payer: Multiplan Commercial |
$30.75
|
| Rate for Payer: Multiplan Commercial |
$183.00
|
| Rate for Payer: Networks By Design Commercial |
$158.60
|
| Rate for Payer: Networks By Design Commercial |
$26.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$8.17
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$8.17
|
| Rate for Payer: Prime Health Services Commercial |
$34.85
|
| Rate for Payer: Prime Health Services Commercial |
$207.40
|
| Rate for Payer: Prime Health Services Medicare |
$8.66
|
| Rate for Payer: Prime Health Services Medicare |
$8.66
|
| Rate for Payer: Riverside University Health System MISP |
$8.99
|
| Rate for Payer: Riverside University Health System MISP |
$8.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$146.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$146.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.62
|
| Rate for Payer: United Healthcare All Other HMO |
$6.62
|
| Rate for Payer: United Healthcare All Other HMO |
$6.62
|
| Rate for Payer: United Healthcare HMO Rider |
$6.62
|
| Rate for Payer: United Healthcare HMO Rider |
$6.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.62
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.17
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.99
|
| Rate for Payer: Vantage Medical Group Senior |
$8.17
|
| Rate for Payer: Vantage Medical Group Senior |
$8.17
|
|
|
HC ACETYLCHOLINESTERASE STAIN
|
Facility
|
IP
|
$1,056.00
|
|
|
Service Code
|
CPT 88319
|
| Hospital Charge Code |
903800020
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$211.20 |
| Max. Negotiated Rate |
$950.40 |
| Rate for Payer: Adventist Health Commercial |
$211.20
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Central Health Plan Commercial |
$844.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$739.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$422.40
|
| Rate for Payer: EPIC Health Plan Senior |
$422.40
|
| Rate for Payer: Galaxy Health WC |
$897.60
|
| Rate for Payer: Global Benefits Group Commercial |
$633.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$950.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$670.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$623.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.20
|
| Rate for Payer: Multiplan Commercial |
$792.00
|
| Rate for Payer: Networks By Design Commercial |
$686.40
|
| Rate for Payer: Prime Health Services Commercial |
$897.60
|
|
|
HC ACETYLCHOLINESTERASE STAIN
|
Facility
|
OP
|
$1,056.00
|
|
|
Service Code
|
CPT 88319
|
| Hospital Charge Code |
903800020
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$52.16 |
| Max. Negotiated Rate |
$1,709.80 |
| Rate for Payer: Adventist Health Commercial |
$211.20
|
| Rate for Payer: Adventist Health Commercial |
$103.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,036.24
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,036.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$762.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$762.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,139.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,139.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,036.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,036.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$52.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$52.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$72.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$72.52
|
| Rate for Payer: Blue Shield of California Commercial |
$326.97
|
| Rate for Payer: Blue Shield of California Commercial |
$665.28
|
| Rate for Payer: Blue Shield of California EPN |
$206.04
|
| Rate for Payer: Blue Shield of California EPN |
$419.23
|
| Rate for Payer: Cash Price |
$233.55
|
| Rate for Payer: Cash Price |
$233.55
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Central Health Plan Commercial |
$844.80
|
| Rate for Payer: Central Health Plan Commercial |
$415.20
|
| Rate for Payer: Cigna of CA HMO |
$332.16
|
| Rate for Payer: Cigna of CA HMO |
$675.84
|
| Rate for Payer: Cigna of CA PPO |
$384.06
|
| Rate for Payer: Cigna of CA PPO |
$781.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,139.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,139.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,036.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,036.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$739.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$363.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,709.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,709.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,139.86
|
| Rate for Payer: EPIC Health Plan Senior |
$1,139.86
|
| Rate for Payer: Galaxy Health WC |
$441.15
|
| Rate for Payer: Galaxy Health WC |
$897.60
|
| Rate for Payer: Global Benefits Group Commercial |
$311.40
|
| Rate for Payer: Global Benefits Group Commercial |
$633.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$467.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$950.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,699.43
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,699.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$118.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$118.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,036.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,036.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$670.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$329.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$130.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$130.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,450.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,450.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,388.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,388.56
|
| Rate for Payer: Multiplan Commercial |
$389.25
|
| Rate for Payer: Multiplan Commercial |
$792.00
|
| Rate for Payer: Networks By Design Commercial |
$686.40
|
| Rate for Payer: Networks By Design Commercial |
$337.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,036.24
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,036.24
|
| Rate for Payer: Prime Health Services Commercial |
$441.15
|
| Rate for Payer: Prime Health Services Commercial |
$897.60
|
| Rate for Payer: Prime Health Services Medicare |
$1,098.41
|
| Rate for Payer: Prime Health Services Medicare |
$1,098.41
|
| Rate for Payer: Riverside University Health System MISP |
$1,139.86
|
| Rate for Payer: Riverside University Health System MISP |
$1,139.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$633.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$311.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$311.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$633.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$542.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$542.12
|
| Rate for Payer: United Healthcare All Other HMO |
$542.12
|
| Rate for Payer: United Healthcare All Other HMO |
$542.12
|
| Rate for Payer: United Healthcare HMO Rider |
$542.12
|
| Rate for Payer: United Healthcare HMO Rider |
$542.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.12
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,036.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,036.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,139.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,139.86
|
| Rate for Payer: Vantage Medical Group Senior |
$1,036.24
|
| Rate for Payer: Vantage Medical Group Senior |
$1,036.24
|
|
|
HC ACID FAST CONCENTRATION
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
CPT 87015
|
| Hospital Charge Code |
900911551
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.41 |
| Max. Negotiated Rate |
$125.10 |
| Rate for Payer: Adventist Health Commercial |
$27.80
|
| Rate for Payer: Adventist Health Commercial |
$5.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$6.68
|
| Rate for Payer: Adventist Health Medi-Cal |
$6.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$48.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$48.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$67.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$67.55
|
| Rate for Payer: Blue Shield of California Commercial |
$16.38
|
| Rate for Payer: Blue Shield of California Commercial |
$87.57
|
| Rate for Payer: Blue Shield of California EPN |
$10.32
|
| Rate for Payer: Blue Shield of California EPN |
$55.18
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cash Price |
$62.55
|
| Rate for Payer: Cash Price |
$62.55
|
| Rate for Payer: Central Health Plan Commercial |
$111.20
|
| Rate for Payer: Central Health Plan Commercial |
$20.80
|
| Rate for Payer: Cigna of CA HMO |
$16.64
|
| Rate for Payer: Cigna of CA HMO |
$88.96
|
| Rate for Payer: Cigna of CA PPO |
$19.24
|
| Rate for Payer: Cigna of CA PPO |
$102.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$97.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.02
|
| Rate for Payer: EPIC Health Plan Senior |
$7.35
|
| Rate for Payer: EPIC Health Plan Senior |
$7.35
|
| Rate for Payer: Galaxy Health WC |
$22.10
|
| Rate for Payer: Galaxy Health WC |
$118.15
|
| Rate for Payer: Global Benefits Group Commercial |
$15.60
|
| Rate for Payer: Global Benefits Group Commercial |
$83.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$125.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.96
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$88.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.95
|
| Rate for Payer: Multiplan Commercial |
$19.50
|
| Rate for Payer: Multiplan Commercial |
$104.25
|
| Rate for Payer: Networks By Design Commercial |
$90.35
|
| Rate for Payer: Networks By Design Commercial |
$16.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6.68
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6.68
|
| Rate for Payer: Prime Health Services Commercial |
$22.10
|
| Rate for Payer: Prime Health Services Commercial |
$118.15
|
| Rate for Payer: Prime Health Services Medicare |
$7.08
|
| Rate for Payer: Prime Health Services Medicare |
$7.08
|
| Rate for Payer: Riverside University Health System MISP |
$7.35
|
| Rate for Payer: Riverside University Health System MISP |
$7.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$83.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$83.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.41
|
| Rate for Payer: United Healthcare All Other HMO |
$5.41
|
| Rate for Payer: United Healthcare All Other HMO |
$5.41
|
| Rate for Payer: United Healthcare HMO Rider |
$5.41
|
| Rate for Payer: United Healthcare HMO Rider |
$5.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.41
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.68
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.35
|
| Rate for Payer: Vantage Medical Group Senior |
$6.68
|
| Rate for Payer: Vantage Medical Group Senior |
$6.68
|
|
|
HC ACID FAST CONCENTRATION
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
CPT 87015
|
| Hospital Charge Code |
900911551
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$27.80 |
| Max. Negotiated Rate |
$125.10 |
| Rate for Payer: Adventist Health Commercial |
$27.80
|
| Rate for Payer: Cash Price |
$62.55
|
| Rate for Payer: Central Health Plan Commercial |
$111.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$97.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.60
|
| Rate for Payer: EPIC Health Plan Senior |
$55.60
|
| Rate for Payer: Galaxy Health WC |
$118.15
|
| Rate for Payer: Global Benefits Group Commercial |
$83.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$125.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$88.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$82.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.80
|
| Rate for Payer: Multiplan Commercial |
$104.25
|
| Rate for Payer: Networks By Design Commercial |
$90.35
|
| Rate for Payer: Prime Health Services Commercial |
$118.15
|
|
|
HC ACID HEMOGLOBIN CONFIRMATION
|
Facility
|
OP
|
$59.00
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
900913569
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.42 |
| Max. Negotiated Rate |
$110.58 |
| Rate for Payer: Adventist Health Commercial |
$11.80
|
| Rate for Payer: Adventist Health Commercial |
$15.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.87
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$79.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$79.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.58
|
| Rate for Payer: Blue Shield of California Commercial |
$47.25
|
| Rate for Payer: Blue Shield of California Commercial |
$37.17
|
| Rate for Payer: Blue Shield of California EPN |
$29.77
|
| Rate for Payer: Blue Shield of California EPN |
$23.42
|
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: Cash Price |
$33.75
|
| 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: Central Health Plan Commercial |
$60.00
|
| Rate for Payer: Cigna of CA HMO |
$48.00
|
| Rate for Payer: Cigna of CA HMO |
$37.76
|
| Rate for Payer: Cigna of CA PPO |
$55.50
|
| Rate for Payer: Cigna of CA PPO |
$43.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$41.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$52.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.24
|
| Rate for Payer: EPIC Health Plan Senior |
$14.16
|
| Rate for Payer: EPIC Health Plan Senior |
$14.16
|
| Rate for Payer: Galaxy Health WC |
$63.75
|
| Rate for Payer: Galaxy Health WC |
$50.15
|
| Rate for Payer: Global Benefits Group Commercial |
$45.00
|
| Rate for Payer: Global Benefits Group Commercial |
$35.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$67.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.11
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$37.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$47.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.25
|
| Rate for Payer: Multiplan Commercial |
$56.25
|
| Rate for Payer: Multiplan Commercial |
$44.25
|
| Rate for Payer: Networks By Design Commercial |
$38.35
|
| Rate for Payer: Networks By Design Commercial |
$48.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.87
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.87
|
| Rate for Payer: Prime Health Services Commercial |
$63.75
|
| Rate for Payer: Prime Health Services Commercial |
$50.15
|
| Rate for Payer: Prime Health Services Medicare |
$13.64
|
| Rate for Payer: Prime Health Services Medicare |
$13.64
|
| Rate for Payer: Riverside University Health System MISP |
$14.16
|
| Rate for Payer: Riverside University Health System MISP |
$14.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.42
|
| Rate for Payer: United Healthcare All Other HMO |
$10.42
|
| Rate for Payer: United Healthcare All Other HMO |
$10.42
|
| Rate for Payer: United Healthcare HMO Rider |
$10.42
|
| Rate for Payer: United Healthcare HMO Rider |
$10.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.87
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Vantage Medical Group Senior |
$12.87
|
| Rate for Payer: Vantage Medical Group Senior |
$12.87
|
|
|
HC ACID HEMOGLOBIN CONFIRMATION
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
900913569
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Adventist Health Commercial |
$15.00
|
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: Central Health Plan Commercial |
$60.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$52.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.00
|
| Rate for Payer: EPIC Health Plan Senior |
$30.00
|
| Rate for Payer: Galaxy Health WC |
$63.75
|
| Rate for Payer: Global Benefits Group Commercial |
$45.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$67.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$47.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$44.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.00
|
| Rate for Payer: Multiplan Commercial |
$56.25
|
| Rate for Payer: Networks By Design Commercial |
$48.75
|
| Rate for Payer: Prime Health Services Commercial |
$63.75
|
|
|
HC A.C. JOINTS
|
Facility
|
OP
|
$1,264.00
|
|
|
Service Code
|
CPT 73050
|
| Hospital Charge Code |
909001501
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$44.55 |
| Max. Negotiated Rate |
$1,137.60 |
| Rate for Payer: Adventist Health Commercial |
$252.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$174.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$139.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$193.92
|
| Rate for Payer: Blue Shield of California Commercial |
$796.32
|
| Rate for Payer: Blue Shield of California EPN |
$501.81
|
| Rate for Payer: Cash Price |
$568.80
|
| Rate for Payer: Cash Price |
$568.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,011.20
|
| Rate for Payer: Cigna of CA HMO |
$808.96
|
| Rate for Payer: Cigna of CA PPO |
$935.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$884.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| Rate for Payer: Galaxy Health WC |
$1,074.40
|
| Rate for Payer: Global Benefits Group Commercial |
$758.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,137.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$44.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$802.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$49.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$948.00
|
| Rate for Payer: Networks By Design Commercial |
$821.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.93
|
| Rate for Payer: Prime Health Services Commercial |
$1,074.40
|
| Rate for Payer: Prime Health Services Medicare |
$118.65
|
| Rate for Payer: Riverside University Health System MISP |
$123.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$758.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$758.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
HC A.C. JOINTS
|
Facility
|
IP
|
$1,264.00
|
|
|
Service Code
|
CPT 73050
|
| Hospital Charge Code |
909001501
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$252.80 |
| Max. Negotiated Rate |
$1,137.60 |
| Rate for Payer: Adventist Health Commercial |
$252.80
|
| Rate for Payer: Cash Price |
$568.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,011.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$884.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$505.60
|
| Rate for Payer: EPIC Health Plan Senior |
$505.60
|
| Rate for Payer: Galaxy Health WC |
$1,074.40
|
| Rate for Payer: Global Benefits Group Commercial |
$758.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,137.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$802.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$745.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.80
|
| Rate for Payer: Multiplan Commercial |
$948.00
|
| Rate for Payer: Networks By Design Commercial |
$821.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,074.40
|
|
|
HC ACQ-CADAVERIC-HEART
|
Facility
|
IP
|
$137,547.00
|
|
| Hospital Charge Code |
902200101
|
|
Hospital Revenue Code
|
812
|
| Min. Negotiated Rate |
$27,509.40 |
| Max. Negotiated Rate |
$123,792.30 |
| Rate for Payer: Adventist Health Commercial |
$27,509.40
|
| Rate for Payer: Cash Price |
$61,896.15
|
| Rate for Payer: Cash Price |
$61,896.15
|
| Rate for Payer: Central Health Plan Commercial |
$110,037.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$96,282.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$55,018.80
|
| Rate for Payer: EPIC Health Plan Senior |
$55,018.80
|
| Rate for Payer: Galaxy Health WC |
$116,914.95
|
| Rate for Payer: Global Benefits Group Commercial |
$82,528.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$123,792.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$87,342.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$81,152.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27,509.40
|
| Rate for Payer: Multiplan Commercial |
$103,160.25
|
| Rate for Payer: Networks By Design Commercial |
$89,405.55
|
| Rate for Payer: Prime Health Services Commercial |
$116,914.95
|
|
