|
HC AK STUBBIES W/ ARTICULTD ANKLE
|
Facility
|
IP
|
$8,217.00
|
|
|
Service Code
|
CPT L5220
|
| Hospital Charge Code |
905355220
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,643.40 |
| Max. Negotiated Rate |
$7,395.30 |
| Rate for Payer: Adventist Health Commercial |
$1,643.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6,351.74
|
| Rate for Payer: Blue Shield of California EPN |
$4,141.37
|
| Rate for Payer: Cash Price |
$4,519.35
|
| Rate for Payer: Central Health Plan Commercial |
$6,573.60
|
| Rate for Payer: Cigna of CA HMO |
$5,751.90
|
| Rate for Payer: Cigna of CA PPO |
$5,751.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,286.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,286.80
|
| Rate for Payer: Galaxy Health WC |
$6,984.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,930.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,395.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,480.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,130.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,086.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,643.40
|
| Rate for Payer: Multiplan Commercial |
$6,162.75
|
| Rate for Payer: Networks By Design Commercial |
$5,341.05
|
| Rate for Payer: Prime Health Services Commercial |
$6,984.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,083.84
|
| Rate for Payer: United Healthcare All Other HMO |
$3,001.67
|
| Rate for Payer: United Healthcare HMO Rider |
$2,936.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,691.07
|
|
|
HC AK STUBBIES W/ ARTICULTD ANKLE
|
Facility
|
OP
|
$8,217.00
|
|
|
Service Code
|
CPT L5220
|
| Hospital Charge Code |
915355220
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,691.07 |
| Max. Negotiated Rate |
$7,395.30 |
| Rate for Payer: Adventist Health Commercial |
$3,368.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,984.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,519.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,162.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,825.84
|
| Rate for Payer: Blue Shield of California Commercial |
$6,351.74
|
| Rate for Payer: Blue Shield of California EPN |
$4,141.37
|
| Rate for Payer: Cash Price |
$4,519.35
|
| Rate for Payer: Cash Price |
$4,519.35
|
| Rate for Payer: Central Health Plan Commercial |
$6,573.60
|
| Rate for Payer: Cigna of CA HMO |
$5,751.90
|
| Rate for Payer: Cigna of CA PPO |
$5,751.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,984.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,984.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,984.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,286.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,286.80
|
| Rate for Payer: Galaxy Health WC |
$6,984.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,930.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,395.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,276.07
|
| Rate for Payer: InnovAge PACE Commercial |
$4,108.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,480.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,618.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,086.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,368.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,751.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,751.90
|
| Rate for Payer: Multiplan Commercial |
$6,162.75
|
| Rate for Payer: Networks By Design Commercial |
$4,108.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,984.45
|
| Rate for Payer: Riverside University Health System MISP |
$3,286.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,930.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,930.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,083.84
|
| Rate for Payer: United Healthcare All Other HMO |
$3,001.67
|
| Rate for Payer: United Healthcare HMO Rider |
$2,936.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,691.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,984.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,984.45
|
| Rate for Payer: Vantage Medical Group Senior |
$6,984.45
|
|
|
HC AK STUBBIES W/ ARTICULTD ANKLE
|
Facility
|
IP
|
$8,217.00
|
|
|
Service Code
|
CPT L5220
|
| Hospital Charge Code |
915355220
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,643.40 |
| Max. Negotiated Rate |
$7,395.30 |
| Rate for Payer: Adventist Health Commercial |
$1,643.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6,351.74
|
| Rate for Payer: Blue Shield of California EPN |
$4,141.37
|
| Rate for Payer: Cash Price |
$4,519.35
|
| Rate for Payer: Central Health Plan Commercial |
$6,573.60
|
| Rate for Payer: Cigna of CA HMO |
$5,751.90
|
| Rate for Payer: Cigna of CA PPO |
$5,751.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,286.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,286.80
|
| Rate for Payer: Galaxy Health WC |
$6,984.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,930.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,395.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,480.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,130.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,086.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,643.40
|
| Rate for Payer: Multiplan Commercial |
$6,162.75
|
| Rate for Payer: Networks By Design Commercial |
$5,341.05
|
| Rate for Payer: Prime Health Services Commercial |
$6,984.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,083.84
|
| Rate for Payer: United Healthcare All Other HMO |
$3,001.67
|
| Rate for Payer: United Healthcare HMO Rider |
$2,936.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,691.07
|
|
|
HC AK STUBBIES W/ ARTICULTD ANKLE
|
Facility
|
OP
|
$8,217.00
|
|
|
Service Code
|
CPT L5220
|
| Hospital Charge Code |
905355220
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,691.07 |
| Max. Negotiated Rate |
$7,395.30 |
| Rate for Payer: Adventist Health Commercial |
$3,368.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,984.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,519.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,162.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,825.84
|
| Rate for Payer: Blue Shield of California Commercial |
$6,351.74
|
| Rate for Payer: Blue Shield of California EPN |
$4,141.37
|
| Rate for Payer: Cash Price |
$4,519.35
|
| Rate for Payer: Cash Price |
$4,519.35
|
| Rate for Payer: Central Health Plan Commercial |
$6,573.60
|
| Rate for Payer: Cigna of CA HMO |
$5,751.90
|
| Rate for Payer: Cigna of CA PPO |
$5,751.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,984.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,984.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,984.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,286.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,286.80
|
| Rate for Payer: Galaxy Health WC |
$6,984.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,930.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,395.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,276.07
|
| Rate for Payer: InnovAge PACE Commercial |
$4,108.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,480.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,618.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,086.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,368.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,751.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,751.90
|
| Rate for Payer: Multiplan Commercial |
$6,162.75
|
| Rate for Payer: Networks By Design Commercial |
$4,108.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,984.45
|
| Rate for Payer: Riverside University Health System MISP |
$3,286.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,930.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,930.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,083.84
|
| Rate for Payer: United Healthcare All Other HMO |
$3,001.67
|
| Rate for Payer: United Healthcare HMO Rider |
$2,936.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,691.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,984.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,984.45
|
| Rate for Payer: Vantage Medical Group Senior |
$6,984.45
|
|
|
HC ALAIR BRONCH THERMOPLASTY CATH
|
Facility
|
OP
|
$7,813.00
|
|
|
Service Code
|
CPT C1886
|
| Hospital Charge Code |
900801886
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,562.60 |
| Max. Negotiated Rate |
$7,031.70 |
| Rate for Payer: Adventist Health Commercial |
$1,562.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,641.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,297.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,859.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,567.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,326.06
|
| Rate for Payer: Blue Shield of California Commercial |
$6,039.45
|
| Rate for Payer: Blue Shield of California EPN |
$3,937.75
|
| Rate for Payer: Cash Price |
$4,297.15
|
| Rate for Payer: Central Health Plan Commercial |
$6,250.40
|
| Rate for Payer: Cigna of CA HMO |
$5,469.10
|
| Rate for Payer: Cigna of CA PPO |
$5,469.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,641.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,641.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,641.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,125.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,125.20
|
| Rate for Payer: Galaxy Health WC |
$6,641.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,687.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,031.70
|
| Rate for Payer: InnovAge PACE Commercial |
$3,906.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,211.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,836.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,562.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,469.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,469.10
|
| Rate for Payer: Multiplan Commercial |
$5,859.75
|
| Rate for Payer: Networks By Design Commercial |
$3,906.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,641.05
|
| Rate for Payer: Riverside University Health System MISP |
$3,125.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,687.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,687.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,932.22
|
| Rate for Payer: United Healthcare All Other HMO |
$2,854.09
|
| Rate for Payer: United Healthcare HMO Rider |
$2,792.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,558.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,641.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,641.05
|
| Rate for Payer: Vantage Medical Group Senior |
$6,641.05
|
|
|
HC ALAIR BRONCH THERMOPLASTY CATH
|
Facility
|
IP
|
$7,813.00
|
|
|
Service Code
|
CPT C1886
|
| Hospital Charge Code |
900801886
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,562.60 |
| Max. Negotiated Rate |
$7,031.70 |
| Rate for Payer: Adventist Health Commercial |
$1,562.60
|
| Rate for Payer: Blue Shield of California Commercial |
$6,039.45
|
| Rate for Payer: Blue Shield of California EPN |
$3,937.75
|
| Rate for Payer: Cash Price |
$4,297.15
|
| Rate for Payer: Central Health Plan Commercial |
$6,250.40
|
| Rate for Payer: Cigna of CA HMO |
$5,469.10
|
| Rate for Payer: Cigna of CA PPO |
$5,469.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,125.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,125.20
|
| Rate for Payer: Galaxy Health WC |
$6,641.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,687.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,031.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,211.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,976.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,836.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,562.60
|
| Rate for Payer: Multiplan Commercial |
$5,859.75
|
| Rate for Payer: Networks By Design Commercial |
$3,906.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,641.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,932.22
|
| Rate for Payer: United Healthcare All Other HMO |
$2,854.09
|
| Rate for Payer: United Healthcare HMO Rider |
$2,792.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,558.76
|
|
|
HC ALBUMIN
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
900910220
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Adventist Health Commercial |
$6.80
|
| Rate for Payer: Cash Price |
$18.70
|
| Rate for Payer: Central Health Plan Commercial |
$27.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.60
|
| Rate for Payer: EPIC Health Plan Senior |
$13.60
|
| Rate for Payer: Galaxy Health WC |
$28.90
|
| Rate for Payer: Global Benefits Group Commercial |
$20.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.80
|
| Rate for Payer: Multiplan Commercial |
$25.50
|
| Rate for Payer: Networks By Design Commercial |
$22.10
|
| Rate for Payer: Prime Health Services Commercial |
$28.90
|
|
|
HC ALBUMIN
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
900910220
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$36.05 |
| Rate for Payer: Adventist Health Commercial |
$6.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$20.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$36.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.32
|
| Rate for Payer: Blue Shield of California Commercial |
$20.64
|
| Rate for Payer: Blue Shield of California EPN |
$13.50
|
| Rate for Payer: Cash Price |
$18.70
|
| Rate for Payer: Cash Price |
$18.70
|
| Rate for Payer: Central Health Plan Commercial |
$27.20
|
| Rate for Payer: Cigna of CA HMO |
$21.76
|
| Rate for Payer: Cigna of CA PPO |
$25.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.68
|
| Rate for Payer: EPIC Health Plan Senior |
$4.95
|
| Rate for Payer: Galaxy Health WC |
$28.90
|
| Rate for Payer: Global Benefits Group Commercial |
$20.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.95
|
| Rate for Payer: InnovAge PACE Commercial |
$7.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.63
|
| Rate for Payer: Multiplan Commercial |
$25.50
|
| Rate for Payer: Networks By Design Commercial |
$22.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.95
|
| Rate for Payer: Prime Health Services Commercial |
$28.90
|
| Rate for Payer: Prime Health Services Medicare |
$5.25
|
| Rate for Payer: Riverside University Health System MISP |
$5.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.01
|
| Rate for Payer: United Healthcare All Other HMO |
$4.01
|
| Rate for Payer: United Healthcare HMO Rider |
$4.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.01
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.45
|
| Rate for Payer: Vantage Medical Group Senior |
$4.95
|
|
|
HC ALBUMIN BODY FLUID
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
900910715
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.87 |
| Max. Negotiated Rate |
$37.61 |
| Rate for Payer: Adventist Health Commercial |
$5.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$7.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$37.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.63
|
| Rate for Payer: Blue Shield of California Commercial |
$16.39
|
| Rate for Payer: Blue Shield of California EPN |
$10.72
|
| Rate for Payer: Cash Price |
$14.85
|
| Rate for Payer: Cash Price |
$14.85
|
| Rate for Payer: Central Health Plan Commercial |
$21.60
|
| Rate for Payer: Cigna of CA HMO |
$17.28
|
| Rate for Payer: Cigna of CA PPO |
$19.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.50
|
| Rate for Payer: EPIC Health Plan Senior |
$7.78
|
| Rate for Payer: Galaxy Health WC |
$22.95
|
| Rate for Payer: Global Benefits Group Commercial |
$16.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$24.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.78
|
| Rate for Payer: InnovAge PACE Commercial |
$11.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.43
|
| Rate for Payer: Multiplan Commercial |
$20.25
|
| Rate for Payer: Networks By Design Commercial |
$17.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7.78
|
| Rate for Payer: Prime Health Services Commercial |
$22.95
|
| Rate for Payer: Prime Health Services Medicare |
$8.25
|
| Rate for Payer: Riverside University Health System MISP |
$8.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.30
|
| Rate for Payer: United Healthcare All Other HMO |
$6.30
|
| Rate for Payer: United Healthcare HMO Rider |
$6.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.30
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.56
|
| Rate for Payer: Vantage Medical Group Senior |
$7.78
|
|
|
HC ALBUMIN BODY FLUID
|
Facility
|
IP
|
$27.00
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
900910715
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.40 |
| Max. Negotiated Rate |
$24.30 |
| Rate for Payer: Adventist Health Commercial |
$5.40
|
| Rate for Payer: Cash Price |
$14.85
|
| Rate for Payer: Central Health Plan Commercial |
$21.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.80
|
| Rate for Payer: EPIC Health Plan Senior |
$10.80
|
| Rate for Payer: Galaxy Health WC |
$22.95
|
| Rate for Payer: Global Benefits Group Commercial |
$16.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$24.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.40
|
| Rate for Payer: Multiplan Commercial |
$20.25
|
| Rate for Payer: Networks By Design Commercial |
$17.55
|
| Rate for Payer: Prime Health Services Commercial |
$22.95
|
|
|
HC ALCOHOL ETHANOL (SERUM/URINE)
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
900910322
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$50.40 |
| Rate for Payer: Adventist Health Commercial |
$11.20
|
| Rate for Payer: Cash Price |
$30.80
|
| Rate for Payer: Central Health Plan Commercial |
$44.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.40
|
| Rate for Payer: EPIC Health Plan Senior |
$22.40
|
| Rate for Payer: Galaxy Health WC |
$47.60
|
| Rate for Payer: Global Benefits Group Commercial |
$33.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$50.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$37.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.20
|
| Rate for Payer: Multiplan Commercial |
$42.00
|
| Rate for Payer: Networks By Design Commercial |
$36.40
|
| Rate for Payer: Prime Health Services Commercial |
$47.60
|
|
|
HC ALCOHOL ETHANOL (SERUM/URINE)
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
900910322
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$75.42 |
| Rate for Payer: Adventist Health Commercial |
$11.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$34.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$47.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$30.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$75.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.31
|
| Rate for Payer: Blue Shield of California Commercial |
$33.99
|
| Rate for Payer: Blue Shield of California EPN |
$22.23
|
| Rate for Payer: Cash Price |
$30.80
|
| Rate for Payer: Cash Price |
$30.80
|
| Rate for Payer: Central Health Plan Commercial |
$44.80
|
| Rate for Payer: Cigna of CA HMO |
$35.84
|
| Rate for Payer: Cigna of CA PPO |
$41.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$47.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$47.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.40
|
| Rate for Payer: EPIC Health Plan Senior |
$22.40
|
| Rate for Payer: Galaxy Health WC |
$47.60
|
| Rate for Payer: Global Benefits Group Commercial |
$33.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$50.40
|
| Rate for Payer: InnovAge PACE Commercial |
$28.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$37.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$39.20
|
| Rate for Payer: Multiplan Commercial |
$42.00
|
| Rate for Payer: Networks By Design Commercial |
$36.40
|
| Rate for Payer: Prime Health Services Commercial |
$47.60
|
| Rate for Payer: Riverside University Health System MISP |
$22.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28.00
|
| Rate for Payer: United Healthcare HMO Rider |
$28.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$47.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.60
|
| Rate for Payer: Vantage Medical Group Senior |
$47.60
|
|
|
HC ALCOHOL INJECTION INTO ORBIT
|
Facility
|
OP
|
$1,513.00
|
|
|
Service Code
|
CPT 67505
|
| Hospital Charge Code |
900567505
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$229.20 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$620.33
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$569.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$417.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$379.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$888.58
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$605.18
|
| Rate for Payer: Cash Price |
$832.15
|
| Rate for Payer: Cash Price |
$832.15
|
| Rate for Payer: Cash Price |
$832.15
|
| Rate for Payer: Cash Price |
$832.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,210.40
|
| Rate for Payer: Cigna of CA HMO |
$968.32
|
| Rate for Payer: Cigna of CA PPO |
$1,119.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$569.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$417.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$379.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$512.76
|
| Rate for Payer: EPIC Health Plan Senior |
$379.82
|
| Rate for Payer: Galaxy Health WC |
$1,286.05
|
| Rate for Payer: Global Benefits Group Commercial |
$907.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,361.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$622.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$379.82
|
| Rate for Payer: InnovAge PACE Commercial |
$569.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,009.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$229.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$379.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$302.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$508.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$508.96
|
| Rate for Payer: Multiplan Commercial |
$1,134.75
|
| Rate for Payer: Multiplan WC |
$605.18
|
| Rate for Payer: Networks By Design Commercial |
$983.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$379.82
|
| Rate for Payer: Preferred Health Network WC |
$617.53
|
| Rate for Payer: Prime Health Services Commercial |
$1,286.05
|
| Rate for Payer: Prime Health Services Medicare |
$402.61
|
| Rate for Payer: Prime Health Services WC |
$599.00
|
| Rate for Payer: Riverside University Health System MISP |
$417.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$907.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$907.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$379.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$569.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$417.80
|
| Rate for Payer: Vantage Medical Group Senior |
$379.82
|
|
|
HC ALCOHOL INJECTION INTO ORBIT
|
Facility
|
IP
|
$1,513.00
|
|
|
Service Code
|
CPT 67505
|
| Hospital Charge Code |
900567505
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$302.60 |
| Max. Negotiated Rate |
$1,361.70 |
| Rate for Payer: Adventist Health Commercial |
$302.60
|
| Rate for Payer: Cash Price |
$832.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,210.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$605.20
|
| Rate for Payer: EPIC Health Plan Senior |
$605.20
|
| Rate for Payer: Galaxy Health WC |
$1,286.05
|
| Rate for Payer: Global Benefits Group Commercial |
$907.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,361.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,009.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$576.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$936.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$302.60
|
| Rate for Payer: Multiplan Commercial |
$1,134.75
|
| Rate for Payer: Networks By Design Commercial |
$983.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,286.05
|
|
|
HC ALCOHOL INJECTION INTO ORBIT
|
Facility
|
OP
|
$1,513.00
|
|
|
Service Code
|
CPT 67505
|
| Hospital Charge Code |
900567505
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$229.20 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$302.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$569.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$417.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$379.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$605.18
|
| Rate for Payer: Cash Price |
$832.15
|
| Rate for Payer: Cash Price |
$832.15
|
| Rate for Payer: Cash Price |
$832.15
|
| Rate for Payer: Cash Price |
$832.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,210.40
|
| Rate for Payer: Cigna of CA HMO |
$968.32
|
| Rate for Payer: Cigna of CA PPO |
$1,119.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$569.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$417.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$379.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$512.76
|
| Rate for Payer: EPIC Health Plan Senior |
$379.82
|
| Rate for Payer: Galaxy Health WC |
$1,286.05
|
| Rate for Payer: Global Benefits Group Commercial |
$907.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,361.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$622.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$379.82
|
| Rate for Payer: InnovAge PACE Commercial |
$569.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,009.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$229.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$379.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$302.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$508.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$508.96
|
| Rate for Payer: Multiplan Commercial |
$1,134.75
|
| Rate for Payer: Multiplan WC |
$605.18
|
| Rate for Payer: Networks By Design Commercial |
$983.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$379.82
|
| Rate for Payer: Preferred Health Network WC |
$617.53
|
| Rate for Payer: Prime Health Services Commercial |
$1,286.05
|
| Rate for Payer: Prime Health Services Medicare |
$402.61
|
| Rate for Payer: Prime Health Services WC |
$599.00
|
| Rate for Payer: Riverside University Health System MISP |
$417.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$907.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$756.50
|
| Rate for Payer: United Healthcare All Other HMO |
$756.50
|
| Rate for Payer: United Healthcare HMO Rider |
$756.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$756.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$379.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$569.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$417.80
|
| Rate for Payer: Vantage Medical Group Senior |
$379.82
|
|
|
HC ALCOHOL INJECTION INTO ORBIT
|
Facility
|
OP
|
$1,513.00
|
|
|
Service Code
|
CPT 67505
|
| Hospital Charge Code |
900567505
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$207.48 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$302.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$379.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$569.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$417.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$379.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$732.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$888.58
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$605.18
|
| Rate for Payer: Blue Shield of California Commercial |
$979.68
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$832.15
|
| Rate for Payer: Cash Price |
$832.15
|
| Rate for Payer: Cash Price |
$832.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,210.40
|
| Rate for Payer: Cigna of CA HMO |
$968.32
|
| Rate for Payer: Cigna of CA PPO |
$1,119.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$569.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$417.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$379.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$512.76
|
| Rate for Payer: EPIC Health Plan Senior |
$379.82
|
| Rate for Payer: Galaxy Health WC |
$1,286.05
|
| Rate for Payer: Global Benefits Group Commercial |
$907.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,361.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$622.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$207.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$379.82
|
| Rate for Payer: InnovAge PACE Commercial |
$569.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,009.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$229.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$379.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$302.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$508.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$508.96
|
| Rate for Payer: Multiplan Commercial |
$1,134.75
|
| Rate for Payer: Multiplan WC |
$605.18
|
| Rate for Payer: Networks By Design Commercial |
$983.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$379.82
|
| Rate for Payer: Preferred Health Network WC |
$617.53
|
| Rate for Payer: Prime Health Services Commercial |
$1,286.05
|
| Rate for Payer: Prime Health Services Medicare |
$402.61
|
| Rate for Payer: Prime Health Services WC |
$599.00
|
| Rate for Payer: Riverside University Health System MISP |
$417.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$907.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$379.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$569.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$417.80
|
| Rate for Payer: Vantage Medical Group Senior |
$379.82
|
|
|
HC ALCOHOL INJECTION INTO ORBIT
|
Facility
|
IP
|
$1,513.00
|
|
|
Service Code
|
CPT 67505
|
| Hospital Charge Code |
900567505
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$302.60 |
| Max. Negotiated Rate |
$1,361.70 |
| Rate for Payer: Adventist Health Commercial |
$302.60
|
| Rate for Payer: Cash Price |
$832.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,210.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$605.20
|
| Rate for Payer: EPIC Health Plan Senior |
$605.20
|
| Rate for Payer: Galaxy Health WC |
$1,286.05
|
| Rate for Payer: Global Benefits Group Commercial |
$907.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,361.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,009.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$576.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$936.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$302.60
|
| Rate for Payer: Multiplan Commercial |
$1,134.75
|
| Rate for Payer: Networks By Design Commercial |
$983.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,286.05
|
|
|
HC ALCOHOL INJECTION INTO ORBIT
|
Facility
|
IP
|
$1,513.00
|
|
|
Service Code
|
CPT 67505
|
| Hospital Charge Code |
900567505
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$302.60 |
| Max. Negotiated Rate |
$1,361.70 |
| Rate for Payer: Adventist Health Commercial |
$302.60
|
| Rate for Payer: Cash Price |
$832.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,210.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$605.20
|
| Rate for Payer: EPIC Health Plan Senior |
$605.20
|
| Rate for Payer: Galaxy Health WC |
$1,286.05
|
| Rate for Payer: Global Benefits Group Commercial |
$907.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,361.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,009.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$576.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$936.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$302.60
|
| Rate for Payer: Multiplan Commercial |
$1,134.75
|
| Rate for Payer: Networks By Design Commercial |
$983.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,286.05
|
|
|
HC ALCOHOL URINE
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
900912192
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$75.42 |
| Rate for Payer: Adventist Health Commercial |
$10.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$43.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$38.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$75.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.31
|
| Rate for Payer: Blue Shield of California Commercial |
$30.96
|
| Rate for Payer: Blue Shield of California EPN |
$20.25
|
| Rate for Payer: Cash Price |
$28.05
|
| Rate for Payer: Cash Price |
$28.05
|
| Rate for Payer: Central Health Plan Commercial |
$40.80
|
| Rate for Payer: Cigna of CA HMO |
$32.64
|
| Rate for Payer: Cigna of CA PPO |
$37.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$43.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$43.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$43.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.40
|
| Rate for Payer: EPIC Health Plan Senior |
$20.40
|
| Rate for Payer: Galaxy Health WC |
$43.35
|
| Rate for Payer: Global Benefits Group Commercial |
$30.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.90
|
| Rate for Payer: InnovAge PACE Commercial |
$25.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35.70
|
| Rate for Payer: Multiplan Commercial |
$38.25
|
| Rate for Payer: Networks By Design Commercial |
$33.15
|
| Rate for Payer: Prime Health Services Commercial |
$43.35
|
| Rate for Payer: Riverside University Health System MISP |
$20.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.50
|
| Rate for Payer: United Healthcare All Other HMO |
$25.50
|
| Rate for Payer: United Healthcare HMO Rider |
$25.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$43.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$43.35
|
| Rate for Payer: Vantage Medical Group Senior |
$43.35
|
|
|
HC ALCOHOL URINE
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
900912192
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Adventist Health Commercial |
$10.20
|
| Rate for Payer: Cash Price |
$28.05
|
| Rate for Payer: Central Health Plan Commercial |
$40.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.40
|
| Rate for Payer: EPIC Health Plan Senior |
$20.40
|
| Rate for Payer: Galaxy Health WC |
$43.35
|
| Rate for Payer: Global Benefits Group Commercial |
$30.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.20
|
| Rate for Payer: Multiplan Commercial |
$38.25
|
| Rate for Payer: Networks By Design Commercial |
$33.15
|
| Rate for Payer: Prime Health Services Commercial |
$43.35
|
|
|
HC ALELRGEN CUCUMBER IGE
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913581
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$115.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.34
|
| Rate for Payer: Blue Shield of California Commercial |
$30.35
|
| Rate for Payer: Blue Shield of California EPN |
$19.85
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: Cigna of CA HMO |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.05
|
| Rate for Payer: EPIC Health Plan Senior |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.22
|
| Rate for Payer: InnovAge PACE Commercial |
$7.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.99
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.22
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Prime Health Services Medicare |
$5.53
|
| Rate for Payer: Riverside University Health System MISP |
$5.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Other HMO |
$4.23
|
| Rate for Payer: United Healthcare HMO Rider |
$4.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
|
HC ALELRGEN CUCUMBER IGE
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913581
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
|
|
HC ALELRGEN GRAPEFRUIT IGE
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913587
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
|
|
HC ALELRGEN GRAPEFRUIT IGE
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913587
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$115.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.34
|
| Rate for Payer: Blue Shield of California Commercial |
$30.35
|
| Rate for Payer: Blue Shield of California EPN |
$19.85
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: Cigna of CA HMO |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.05
|
| Rate for Payer: EPIC Health Plan Senior |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.22
|
| Rate for Payer: InnovAge PACE Commercial |
$7.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.99
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.22
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Prime Health Services Medicare |
$5.53
|
| Rate for Payer: Riverside University Health System MISP |
$5.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Other HMO |
$4.23
|
| Rate for Payer: United Healthcare HMO Rider |
$4.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
|
HC ALKALINE PHOSPHATASE
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
CPT 84075
|
| Hospital Charge Code |
900910219
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.19 |
| Max. Negotiated Rate |
$37.61 |
| Rate for Payer: Adventist Health Commercial |
$6.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$20.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$37.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.63
|
| Rate for Payer: Blue Shield of California Commercial |
$20.64
|
| Rate for Payer: Blue Shield of California EPN |
$13.50
|
| Rate for Payer: Cash Price |
$18.70
|
| Rate for Payer: Cash Price |
$18.70
|
| Rate for Payer: Central Health Plan Commercial |
$27.20
|
| Rate for Payer: Cigna of CA HMO |
$21.76
|
| Rate for Payer: Cigna of CA PPO |
$25.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.99
|
| Rate for Payer: EPIC Health Plan Senior |
$5.18
|
| Rate for Payer: Galaxy Health WC |
$28.90
|
| Rate for Payer: Global Benefits Group Commercial |
$20.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: InnovAge PACE Commercial |
$7.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.94
|
| Rate for Payer: Multiplan Commercial |
$25.50
|
| Rate for Payer: Networks By Design Commercial |
$22.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.18
|
| Rate for Payer: Prime Health Services Commercial |
$28.90
|
| Rate for Payer: Prime Health Services Medicare |
$5.49
|
| Rate for Payer: Riverside University Health System MISP |
$5.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.19
|
| Rate for Payer: United Healthcare All Other HMO |
$4.19
|
| Rate for Payer: United Healthcare HMO Rider |
$4.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.19
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
|
