|
HC AMPLATZ RENAL DILATOR SET
|
Facility
|
OP
|
$630.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
909081443
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$126.00 |
| Max. Negotiated Rate |
$567.00 |
| Rate for Payer: Adventist Health Commercial |
$126.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$535.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$346.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$472.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$287.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$345.49
|
| Rate for Payer: Blue Shield of California Commercial |
$505.26
|
| Rate for Payer: Blue Shield of California EPN |
$317.52
|
| Rate for Payer: Cash Price |
$283.50
|
| Rate for Payer: Central Health Plan Commercial |
$504.00
|
| Rate for Payer: Cigna of CA HMO |
$441.00
|
| Rate for Payer: Cigna of CA PPO |
$441.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$535.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$535.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$535.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$441.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$252.00
|
| Rate for Payer: EPIC Health Plan Senior |
$252.00
|
| Rate for Payer: Galaxy Health WC |
$535.50
|
| Rate for Payer: Global Benefits Group Commercial |
$378.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$567.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$400.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$228.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$371.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$441.00
|
| Rate for Payer: Multiplan Commercial |
$472.50
|
| Rate for Payer: Networks By Design Commercial |
$315.00
|
| Rate for Payer: Prime Health Services Commercial |
$535.50
|
| Rate for Payer: Riverside University Health System MISP |
$252.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$378.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$378.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$236.44
|
| Rate for Payer: United Healthcare All Other HMO |
$230.14
|
| Rate for Payer: United Healthcare HMO Rider |
$225.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$535.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$535.50
|
| Rate for Payer: Vantage Medical Group Senior |
$535.50
|
|
|
HC AMPLATZ SNARE
|
Facility
|
OP
|
$810.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
909081269
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$162.00 |
| Max. Negotiated Rate |
$2,522.20 |
| Rate for Payer: Adventist Health Commercial |
$162.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,522.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$688.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$445.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$607.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$392.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$471.18
|
| Rate for Payer: Blue Shield of California Commercial |
$513.54
|
| Rate for Payer: Blue Shield of California EPN |
$323.19
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Central Health Plan Commercial |
$648.00
|
| Rate for Payer: Cigna of CA HMO |
$518.40
|
| Rate for Payer: Cigna of CA PPO |
$599.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$688.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$688.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$688.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$567.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$324.00
|
| Rate for Payer: EPIC Health Plan Senior |
$324.00
|
| Rate for Payer: Galaxy Health WC |
$688.50
|
| Rate for Payer: Global Benefits Group Commercial |
$486.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$729.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$514.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$294.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$477.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$567.00
|
| Rate for Payer: Multiplan Commercial |
$607.50
|
| Rate for Payer: Networks By Design Commercial |
$526.50
|
| Rate for Payer: Prime Health Services Commercial |
$688.50
|
| Rate for Payer: Riverside University Health System MISP |
$324.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$486.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$486.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$405.00
|
| Rate for Payer: United Healthcare All Other HMO |
$405.00
|
| Rate for Payer: United Healthcare HMO Rider |
$405.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$405.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$688.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$688.50
|
| Rate for Payer: Vantage Medical Group Senior |
$688.50
|
|
|
HC AMPLATZ SNARE
|
Facility
|
IP
|
$810.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
909081269
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$162.00 |
| Max. Negotiated Rate |
$729.00 |
| Rate for Payer: Adventist Health Commercial |
$162.00
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Central Health Plan Commercial |
$648.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$567.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$324.00
|
| Rate for Payer: EPIC Health Plan Senior |
$324.00
|
| Rate for Payer: Galaxy Health WC |
$688.50
|
| Rate for Payer: Global Benefits Group Commercial |
$486.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$729.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$514.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$477.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.00
|
| Rate for Payer: Multiplan Commercial |
$607.50
|
| Rate for Payer: Networks By Design Commercial |
$526.50
|
| Rate for Payer: Prime Health Services Commercial |
$688.50
|
|
|
HC AMPLATZ THROMBECTOMY 120 CM
|
Facility
|
OP
|
$2,160.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081295
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$432.00 |
| Max. Negotiated Rate |
$1,944.00 |
| Rate for Payer: Adventist Health Commercial |
$432.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,836.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,188.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,620.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$986.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,184.54
|
| Rate for Payer: Blue Shield of California Commercial |
$1,732.32
|
| Rate for Payer: Blue Shield of California EPN |
$1,088.64
|
| Rate for Payer: Cash Price |
$972.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,728.00
|
| Rate for Payer: Cigna of CA HMO |
$1,512.00
|
| Rate for Payer: Cigna of CA PPO |
$1,512.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,836.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,836.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,836.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,512.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$864.00
|
| Rate for Payer: EPIC Health Plan Senior |
$864.00
|
| Rate for Payer: Galaxy Health WC |
$1,836.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,296.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,944.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,371.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$784.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,274.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$432.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,512.00
|
| Rate for Payer: Multiplan Commercial |
$1,620.00
|
| Rate for Payer: Networks By Design Commercial |
$1,080.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,836.00
|
| Rate for Payer: Riverside University Health System MISP |
$864.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,296.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,296.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$810.65
|
| Rate for Payer: United Healthcare All Other HMO |
$789.05
|
| Rate for Payer: United Healthcare HMO Rider |
$771.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$707.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,836.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,836.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,836.00
|
|
|
HC AMPLATZ THROMBECTOMY 120 CM
|
Facility
|
IP
|
$2,160.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081295
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$432.00 |
| Max. Negotiated Rate |
$1,944.00 |
| Rate for Payer: Adventist Health Commercial |
$432.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,732.32
|
| Rate for Payer: Blue Shield of California EPN |
$1,088.64
|
| Rate for Payer: Cash Price |
$972.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,728.00
|
| Rate for Payer: Cigna of CA HMO |
$1,512.00
|
| Rate for Payer: Cigna of CA PPO |
$1,512.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,512.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$864.00
|
| Rate for Payer: EPIC Health Plan Senior |
$864.00
|
| Rate for Payer: Galaxy Health WC |
$1,836.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,296.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,944.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,371.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,274.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$432.00
|
| Rate for Payer: Multiplan Commercial |
$1,620.00
|
| Rate for Payer: Networks By Design Commercial |
$1,080.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,836.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$810.65
|
| Rate for Payer: United Healthcare All Other HMO |
$789.05
|
| Rate for Payer: United Healthcare HMO Rider |
$771.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$707.40
|
|
|
HC AMPLATZ THROMBECTOMY 50 CM
|
Facility
|
IP
|
$1,320.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081294
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$264.00 |
| Max. Negotiated Rate |
$1,188.00 |
| Rate for Payer: Adventist Health Commercial |
$264.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,058.64
|
| Rate for Payer: Blue Shield of California EPN |
$665.28
|
| Rate for Payer: Cash Price |
$594.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,056.00
|
| Rate for Payer: Cigna of CA HMO |
$924.00
|
| Rate for Payer: Cigna of CA PPO |
$924.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$924.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$528.00
|
| Rate for Payer: EPIC Health Plan Senior |
$528.00
|
| Rate for Payer: Galaxy Health WC |
$1,122.00
|
| Rate for Payer: Global Benefits Group Commercial |
$792.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,188.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$838.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$778.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.00
|
| Rate for Payer: Multiplan Commercial |
$990.00
|
| Rate for Payer: Networks By Design Commercial |
$660.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,122.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$495.40
|
| Rate for Payer: United Healthcare All Other HMO |
$482.20
|
| Rate for Payer: United Healthcare HMO Rider |
$471.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$432.30
|
|
|
HC AMPLATZ THROMBECTOMY 50 CM
|
Facility
|
OP
|
$1,320.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081294
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$264.00 |
| Max. Negotiated Rate |
$1,188.00 |
| Rate for Payer: Adventist Health Commercial |
$264.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,122.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$726.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$990.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$602.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$723.89
|
| Rate for Payer: Blue Shield of California Commercial |
$1,058.64
|
| Rate for Payer: Blue Shield of California EPN |
$665.28
|
| Rate for Payer: Cash Price |
$594.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,056.00
|
| Rate for Payer: Cigna of CA HMO |
$924.00
|
| Rate for Payer: Cigna of CA PPO |
$924.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,122.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,122.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,122.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$924.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$528.00
|
| Rate for Payer: EPIC Health Plan Senior |
$528.00
|
| Rate for Payer: Galaxy Health WC |
$1,122.00
|
| Rate for Payer: Global Benefits Group Commercial |
$792.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,188.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$838.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$479.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$778.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$924.00
|
| Rate for Payer: Multiplan Commercial |
$990.00
|
| Rate for Payer: Networks By Design Commercial |
$660.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,122.00
|
| Rate for Payer: Riverside University Health System MISP |
$528.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$792.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$792.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$495.40
|
| Rate for Payer: United Healthcare All Other HMO |
$482.20
|
| Rate for Payer: United Healthcare HMO Rider |
$471.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$432.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,122.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,122.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,122.00
|
|
|
HC AMPLATZ TORQUEWIRE
|
Facility
|
IP
|
$292.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081231
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.40 |
| Max. Negotiated Rate |
$262.80 |
| Rate for Payer: Adventist Health Commercial |
$58.40
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Central Health Plan Commercial |
$233.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$204.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.80
|
| Rate for Payer: EPIC Health Plan Senior |
$116.80
|
| Rate for Payer: Galaxy Health WC |
$248.20
|
| Rate for Payer: Global Benefits Group Commercial |
$175.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$262.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$185.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$172.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.40
|
| Rate for Payer: Multiplan Commercial |
$219.00
|
| Rate for Payer: Networks By Design Commercial |
$189.80
|
| Rate for Payer: Prime Health Services Commercial |
$248.20
|
|
|
HC AMPLATZ TORQUEWIRE
|
Facility
|
OP
|
$292.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081231
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.40 |
| Max. Negotiated Rate |
$396.30 |
| Rate for Payer: Adventist Health Commercial |
$58.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$396.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$248.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$160.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$219.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$141.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$169.86
|
| Rate for Payer: Blue Shield of California Commercial |
$185.13
|
| Rate for Payer: Blue Shield of California EPN |
$116.51
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Central Health Plan Commercial |
$233.60
|
| Rate for Payer: Cigna of CA HMO |
$186.88
|
| Rate for Payer: Cigna of CA PPO |
$216.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$248.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$248.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$204.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.80
|
| Rate for Payer: EPIC Health Plan Senior |
$116.80
|
| Rate for Payer: Galaxy Health WC |
$248.20
|
| Rate for Payer: Global Benefits Group Commercial |
$175.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$262.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$185.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$106.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$172.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$204.40
|
| Rate for Payer: Multiplan Commercial |
$219.00
|
| Rate for Payer: Networks By Design Commercial |
$189.80
|
| Rate for Payer: Prime Health Services Commercial |
$248.20
|
| Rate for Payer: Riverside University Health System MISP |
$116.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$175.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$175.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$146.00
|
| Rate for Payer: United Healthcare All Other HMO |
$146.00
|
| Rate for Payer: United Healthcare HMO Rider |
$146.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$146.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$248.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.20
|
| Rate for Payer: Vantage Medical Group Senior |
$248.20
|
|
|
HC AMPLATZ TRACT MASTER
|
Facility
|
OP
|
$792.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
909001099
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$158.40 |
| Max. Negotiated Rate |
$712.80 |
| Rate for Payer: Adventist Health Commercial |
$158.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$435.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$594.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$361.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$434.33
|
| Rate for Payer: Blue Shield of California Commercial |
$635.18
|
| Rate for Payer: Blue Shield of California EPN |
$399.17
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Central Health Plan Commercial |
$633.60
|
| Rate for Payer: Cigna of CA HMO |
$554.40
|
| Rate for Payer: Cigna of CA PPO |
$554.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$673.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$673.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$554.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$316.80
|
| Rate for Payer: EPIC Health Plan Senior |
$316.80
|
| Rate for Payer: Galaxy Health WC |
$673.20
|
| Rate for Payer: Global Benefits Group Commercial |
$475.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$712.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$502.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$287.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$467.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$554.40
|
| Rate for Payer: Multiplan Commercial |
$594.00
|
| Rate for Payer: Networks By Design Commercial |
$396.00
|
| Rate for Payer: Prime Health Services Commercial |
$673.20
|
| Rate for Payer: Riverside University Health System MISP |
$316.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$475.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$475.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$297.24
|
| Rate for Payer: United Healthcare All Other HMO |
$289.32
|
| Rate for Payer: United Healthcare HMO Rider |
$283.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$259.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$673.20
|
| Rate for Payer: Vantage Medical Group Senior |
$673.20
|
|
|
HC AMPLATZ TRACT MASTER
|
Facility
|
IP
|
$792.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
909001099
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$158.40 |
| Max. Negotiated Rate |
$712.80 |
| Rate for Payer: Adventist Health Commercial |
$158.40
|
| Rate for Payer: Blue Shield of California Commercial |
$635.18
|
| Rate for Payer: Blue Shield of California EPN |
$399.17
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Central Health Plan Commercial |
$633.60
|
| Rate for Payer: Cigna of CA HMO |
$554.40
|
| Rate for Payer: Cigna of CA PPO |
$554.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$554.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$316.80
|
| Rate for Payer: EPIC Health Plan Senior |
$316.80
|
| Rate for Payer: Galaxy Health WC |
$673.20
|
| Rate for Payer: Global Benefits Group Commercial |
$475.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$712.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$502.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$467.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.40
|
| Rate for Payer: Multiplan Commercial |
$594.00
|
| Rate for Payer: Networks By Design Commercial |
$396.00
|
| Rate for Payer: Prime Health Services Commercial |
$673.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$297.24
|
| Rate for Payer: United Healthcare All Other HMO |
$289.32
|
| Rate for Payer: United Healthcare HMO Rider |
$283.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$259.38
|
|
|
HC AMPUTATION FINGER/THUMB SNGL
|
Facility
|
IP
|
$12,062.00
|
|
|
Service Code
|
CPT 26910
|
| Hospital Charge Code |
900501259
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,412.40 |
| Max. Negotiated Rate |
$10,855.80 |
| Rate for Payer: Adventist Health Commercial |
$2,412.40
|
| Rate for Payer: Cash Price |
$5,427.90
|
| Rate for Payer: Central Health Plan Commercial |
$9,649.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,443.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,824.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,824.80
|
| Rate for Payer: Galaxy Health WC |
$10,252.70
|
| Rate for Payer: Global Benefits Group Commercial |
$7,237.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,855.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,659.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,116.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,412.40
|
| Rate for Payer: Multiplan Commercial |
$9,046.50
|
| Rate for Payer: Networks By Design Commercial |
$7,840.30
|
| Rate for Payer: Prime Health Services Commercial |
$10,252.70
|
|
|
HC AMPUTATION FINGER/THUMB SNGL
|
Facility
|
OP
|
$12,062.00
|
|
|
Service Code
|
CPT 26910
|
| Hospital Charge Code |
900501259
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$10,855.80 |
| Rate for Payer: Adventist Health Commercial |
$2,412.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,568.63
|
| Rate for Payer: Cash Price |
$5,427.90
|
| Rate for Payer: Cash Price |
$5,427.90
|
| Rate for Payer: Cash Price |
$5,427.90
|
| Rate for Payer: Cash Price |
$5,427.90
|
| Rate for Payer: Central Health Plan Commercial |
$9,649.60
|
| Rate for Payer: Cigna of CA HMO |
$7,719.68
|
| Rate for Payer: Cigna of CA PPO |
$8,925.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,443.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,943.76
|
| Rate for Payer: EPIC Health Plan Senior |
$4,629.17
|
| Rate for Payer: Galaxy Health WC |
$10,252.70
|
| Rate for Payer: Global Benefits Group Commercial |
$7,237.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,855.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,901.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,659.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$645.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,523.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,412.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,639.18
|
| Rate for Payer: Multiplan Commercial |
$9,046.50
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$7,840.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Preferred Health Network WC |
$6,702.68
|
| Rate for Payer: Prime Health Services Commercial |
$10,252.70
|
| Rate for Payer: Prime Health Services Medicare |
$4,460.84
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Riverside University Health System MISP |
$4,629.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,237.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,031.00
|
| Rate for Payer: United Healthcare All Other HMO |
$6,031.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,031.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,031.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,208.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
HC AMPUTATION FINGER/THUMB W/V-Y
|
Facility
|
IP
|
$16,572.00
|
|
|
Service Code
|
CPT 26952
|
| Hospital Charge Code |
900501462
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,314.40 |
| Max. Negotiated Rate |
$14,914.80 |
| Rate for Payer: Adventist Health Commercial |
$3,314.40
|
| Rate for Payer: Cash Price |
$7,457.40
|
| Rate for Payer: Central Health Plan Commercial |
$13,257.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11,600.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,628.80
|
| Rate for Payer: EPIC Health Plan Senior |
$6,628.80
|
| Rate for Payer: Galaxy Health WC |
$14,086.20
|
| Rate for Payer: Global Benefits Group Commercial |
$9,943.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,914.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,523.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,777.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,314.40
|
| Rate for Payer: Multiplan Commercial |
$12,429.00
|
| Rate for Payer: Networks By Design Commercial |
$10,771.80
|
| Rate for Payer: Prime Health Services Commercial |
$14,086.20
|
|
|
HC AMPUTATION FINGER/THUMB W/V-Y
|
Facility
|
OP
|
$16,572.00
|
|
|
Service Code
|
CPT 26952
|
| Hospital Charge Code |
900501462
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$14,914.80 |
| Rate for Payer: Adventist Health Commercial |
$3,314.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,924.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,568.63
|
| Rate for Payer: Cash Price |
$7,457.40
|
| Rate for Payer: Cash Price |
$7,457.40
|
| Rate for Payer: Cash Price |
$7,457.40
|
| Rate for Payer: Cash Price |
$7,457.40
|
| Rate for Payer: Central Health Plan Commercial |
$13,257.60
|
| Rate for Payer: Cigna of CA HMO |
$10,606.08
|
| Rate for Payer: Cigna of CA PPO |
$12,263.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11,600.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,943.76
|
| Rate for Payer: EPIC Health Plan Senior |
$4,629.17
|
| Rate for Payer: Galaxy Health WC |
$14,086.20
|
| Rate for Payer: Global Benefits Group Commercial |
$9,943.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,914.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,901.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,523.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$590.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,523.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,314.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,639.18
|
| Rate for Payer: Multiplan Commercial |
$12,429.00
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$10,771.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Preferred Health Network WC |
$6,702.68
|
| Rate for Payer: Prime Health Services Commercial |
$14,086.20
|
| Rate for Payer: Prime Health Services Medicare |
$4,460.84
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Riverside University Health System MISP |
$4,629.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,943.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,286.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,286.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,286.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,286.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,208.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
HC AMPUTATION OF TOE
|
Facility
|
IP
|
$13,234.00
|
|
|
Service Code
|
CPT 28820
|
| Hospital Charge Code |
900501402
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,646.80 |
| Max. Negotiated Rate |
$11,910.60 |
| Rate for Payer: Adventist Health Commercial |
$2,646.80
|
| Rate for Payer: Cash Price |
$5,955.30
|
| Rate for Payer: Central Health Plan Commercial |
$10,587.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,263.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,293.60
|
| Rate for Payer: EPIC Health Plan Senior |
$5,293.60
|
| Rate for Payer: Galaxy Health WC |
$11,248.90
|
| Rate for Payer: Global Benefits Group Commercial |
$7,940.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,910.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,403.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,808.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,646.80
|
| Rate for Payer: Multiplan Commercial |
$9,925.50
|
| Rate for Payer: Networks By Design Commercial |
$8,602.10
|
| Rate for Payer: Prime Health Services Commercial |
$11,248.90
|
|
|
HC AMPUTATION OF TOE
|
Facility
|
OP
|
$13,234.00
|
|
|
Service Code
|
CPT 28820
|
| Hospital Charge Code |
900501402
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$11,910.60 |
| Rate for Payer: Adventist Health Commercial |
$2,646.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,568.63
|
| Rate for Payer: Cash Price |
$5,955.30
|
| Rate for Payer: Cash Price |
$5,955.30
|
| Rate for Payer: Cash Price |
$5,955.30
|
| Rate for Payer: Cash Price |
$5,955.30
|
| Rate for Payer: Central Health Plan Commercial |
$10,587.20
|
| Rate for Payer: Cigna of CA HMO |
$8,469.76
|
| Rate for Payer: Cigna of CA PPO |
$9,793.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,263.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,943.76
|
| Rate for Payer: EPIC Health Plan Senior |
$4,629.17
|
| Rate for Payer: Galaxy Health WC |
$11,248.90
|
| Rate for Payer: Global Benefits Group Commercial |
$7,940.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,910.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,901.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,403.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$433.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,523.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,646.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,639.18
|
| Rate for Payer: Multiplan Commercial |
$9,925.50
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$8,602.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Preferred Health Network WC |
$6,702.68
|
| Rate for Payer: Prime Health Services Commercial |
$11,248.90
|
| Rate for Payer: Prime Health Services Medicare |
$4,460.84
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Riverside University Health System MISP |
$4,629.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,940.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,617.00
|
| Rate for Payer: United Healthcare All Other HMO |
$6,617.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,617.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,617.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,208.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
HC AMYLASE
|
Facility
|
IP
|
$258.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
900910236
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$51.60 |
| Max. Negotiated Rate |
$232.20 |
| Rate for Payer: Adventist Health Commercial |
$51.60
|
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: Central Health Plan Commercial |
$206.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$180.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.20
|
| Rate for Payer: EPIC Health Plan Senior |
$103.20
|
| Rate for Payer: Galaxy Health WC |
$219.30
|
| Rate for Payer: Global Benefits Group Commercial |
$154.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$232.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$163.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$152.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.60
|
| Rate for Payer: Multiplan Commercial |
$193.50
|
| Rate for Payer: Networks By Design Commercial |
$167.70
|
| Rate for Payer: Prime Health Services Commercial |
$219.30
|
|
|
HC AMYLASE
|
Facility
|
OP
|
$258.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
900910236
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$232.20 |
| Rate for Payer: Adventist Health Commercial |
$51.60
|
| Rate for Payer: Adventist Health Commercial |
$7.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$6.48
|
| Rate for Payer: Adventist Health Medi-Cal |
$6.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$47.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$47.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$47.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$47.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.64
|
| Rate for Payer: Blue Shield of California Commercial |
$23.94
|
| Rate for Payer: Blue Shield of California Commercial |
$162.54
|
| Rate for Payer: Blue Shield of California EPN |
$15.09
|
| Rate for Payer: Blue Shield of California EPN |
$102.43
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: Central Health Plan Commercial |
$206.40
|
| Rate for Payer: Central Health Plan Commercial |
$30.40
|
| Rate for Payer: Cigna of CA HMO |
$24.32
|
| Rate for Payer: Cigna of CA HMO |
$165.12
|
| Rate for Payer: Cigna of CA PPO |
$28.12
|
| Rate for Payer: Cigna of CA PPO |
$190.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$180.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.69
|
| Rate for Payer: EPIC Health Plan Senior |
$7.13
|
| Rate for Payer: EPIC Health Plan Senior |
$7.13
|
| Rate for Payer: Galaxy Health WC |
$32.30
|
| Rate for Payer: Galaxy Health WC |
$219.30
|
| Rate for Payer: Global Benefits Group Commercial |
$22.80
|
| Rate for Payer: Global Benefits Group Commercial |
$154.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$232.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.63
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$163.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.68
|
| Rate for Payer: Multiplan Commercial |
$28.50
|
| Rate for Payer: Multiplan Commercial |
$193.50
|
| Rate for Payer: Networks By Design Commercial |
$167.70
|
| Rate for Payer: Networks By Design Commercial |
$24.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6.48
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6.48
|
| Rate for Payer: Prime Health Services Commercial |
$32.30
|
| Rate for Payer: Prime Health Services Commercial |
$219.30
|
| Rate for Payer: Prime Health Services Medicare |
$6.87
|
| Rate for Payer: Prime Health Services Medicare |
$6.87
|
| Rate for Payer: Riverside University Health System MISP |
$7.13
|
| Rate for Payer: Riverside University Health System MISP |
$7.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$154.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$154.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.25
|
| Rate for Payer: United Healthcare All Other HMO |
$5.25
|
| Rate for Payer: United Healthcare All Other HMO |
$5.25
|
| Rate for Payer: United Healthcare HMO Rider |
$5.25
|
| Rate for Payer: United Healthcare HMO Rider |
$5.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.25
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.48
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: Vantage Medical Group Senior |
$6.48
|
| Rate for Payer: Vantage Medical Group Senior |
$6.48
|
|
|
HC AMYLASE BODY FLUID
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
900910242
|
|
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 |
$25.20
|
| Rate for Payer: Central Health Plan Commercial |
$44.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$39.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$35.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.04
|
| 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 AMYLASE BODY FLUID
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
900910242
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$65.64 |
| Rate for Payer: Adventist Health Commercial |
$7.60
|
| Rate for Payer: Adventist Health Commercial |
$11.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$6.48
|
| Rate for Payer: Adventist Health Medi-Cal |
$6.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$47.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$47.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$47.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$47.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.64
|
| Rate for Payer: Blue Shield of California Commercial |
$35.28
|
| Rate for Payer: Blue Shield of California Commercial |
$23.94
|
| Rate for Payer: Blue Shield of California EPN |
$22.23
|
| Rate for Payer: Blue Shield of California EPN |
$15.09
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Central Health Plan Commercial |
$30.40
|
| Rate for Payer: Central Health Plan Commercial |
$44.80
|
| Rate for Payer: Cigna of CA HMO |
$35.84
|
| Rate for Payer: Cigna of CA HMO |
$24.32
|
| Rate for Payer: Cigna of CA PPO |
$41.44
|
| Rate for Payer: Cigna of CA PPO |
$28.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$39.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.69
|
| Rate for Payer: EPIC Health Plan Senior |
$7.13
|
| Rate for Payer: EPIC Health Plan Senior |
$7.13
|
| Rate for Payer: Galaxy Health WC |
$47.60
|
| Rate for Payer: Galaxy Health WC |
$32.30
|
| Rate for Payer: Global Benefits Group Commercial |
$33.60
|
| Rate for Payer: Global Benefits Group Commercial |
$22.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$50.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.63
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$35.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.68
|
| Rate for Payer: Multiplan Commercial |
$42.00
|
| Rate for Payer: Multiplan Commercial |
$28.50
|
| Rate for Payer: Networks By Design Commercial |
$24.70
|
| Rate for Payer: Networks By Design Commercial |
$36.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6.48
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6.48
|
| Rate for Payer: Prime Health Services Commercial |
$47.60
|
| Rate for Payer: Prime Health Services Commercial |
$32.30
|
| Rate for Payer: Prime Health Services Medicare |
$6.87
|
| Rate for Payer: Prime Health Services Medicare |
$6.87
|
| Rate for Payer: Riverside University Health System MISP |
$7.13
|
| Rate for Payer: Riverside University Health System MISP |
$7.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.25
|
| Rate for Payer: United Healthcare All Other HMO |
$5.25
|
| Rate for Payer: United Healthcare All Other HMO |
$5.25
|
| Rate for Payer: United Healthcare HMO Rider |
$5.25
|
| Rate for Payer: United Healthcare HMO Rider |
$5.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.25
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.48
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: Vantage Medical Group Senior |
$6.48
|
| Rate for Payer: Vantage Medical Group Senior |
$6.48
|
|
|
HC AMYLASE URINE
|
Facility
|
IP
|
$258.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
900910237
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$51.60 |
| Max. Negotiated Rate |
$232.20 |
| Rate for Payer: Adventist Health Commercial |
$51.60
|
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: Central Health Plan Commercial |
$206.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$180.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.20
|
| Rate for Payer: EPIC Health Plan Senior |
$103.20
|
| Rate for Payer: Galaxy Health WC |
$219.30
|
| Rate for Payer: Global Benefits Group Commercial |
$154.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$232.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$163.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$152.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.60
|
| Rate for Payer: Multiplan Commercial |
$193.50
|
| Rate for Payer: Networks By Design Commercial |
$167.70
|
| Rate for Payer: Prime Health Services Commercial |
$219.30
|
|
|
HC AMYLASE URINE
|
Facility
|
OP
|
$258.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
900910237
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$232.20 |
| Rate for Payer: Adventist Health Commercial |
$51.60
|
| Rate for Payer: Adventist Health Commercial |
$11.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$6.48
|
| Rate for Payer: Adventist Health Medi-Cal |
$6.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$47.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$47.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$47.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$47.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.64
|
| Rate for Payer: Blue Shield of California Commercial |
$35.28
|
| Rate for Payer: Blue Shield of California Commercial |
$162.54
|
| Rate for Payer: Blue Shield of California EPN |
$22.23
|
| Rate for Payer: Blue Shield of California EPN |
$102.43
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: Central Health Plan Commercial |
$206.40
|
| Rate for Payer: Central Health Plan Commercial |
$44.80
|
| Rate for Payer: Cigna of CA HMO |
$35.84
|
| Rate for Payer: Cigna of CA HMO |
$165.12
|
| Rate for Payer: Cigna of CA PPO |
$41.44
|
| Rate for Payer: Cigna of CA PPO |
$190.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$180.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$39.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.69
|
| Rate for Payer: EPIC Health Plan Senior |
$7.13
|
| Rate for Payer: EPIC Health Plan Senior |
$7.13
|
| Rate for Payer: Galaxy Health WC |
$47.60
|
| Rate for Payer: Galaxy Health WC |
$219.30
|
| Rate for Payer: Global Benefits Group Commercial |
$33.60
|
| Rate for Payer: Global Benefits Group Commercial |
$154.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$50.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$232.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.63
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$163.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$35.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.68
|
| Rate for Payer: Multiplan Commercial |
$42.00
|
| Rate for Payer: Multiplan Commercial |
$193.50
|
| Rate for Payer: Networks By Design Commercial |
$167.70
|
| Rate for Payer: Networks By Design Commercial |
$36.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6.48
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6.48
|
| Rate for Payer: Prime Health Services Commercial |
$47.60
|
| Rate for Payer: Prime Health Services Commercial |
$219.30
|
| Rate for Payer: Prime Health Services Medicare |
$6.87
|
| Rate for Payer: Prime Health Services Medicare |
$6.87
|
| Rate for Payer: Riverside University Health System MISP |
$7.13
|
| Rate for Payer: Riverside University Health System MISP |
$7.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$154.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$154.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.25
|
| Rate for Payer: United Healthcare All Other HMO |
$5.25
|
| Rate for Payer: United Healthcare All Other HMO |
$5.25
|
| Rate for Payer: United Healthcare HMO Rider |
$5.25
|
| Rate for Payer: United Healthcare HMO Rider |
$5.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.25
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.48
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: Vantage Medical Group Senior |
$6.48
|
| Rate for Payer: Vantage Medical Group Senior |
$6.48
|
|
|
HC AMYLASE URINE 24 HOURS
|
Facility
|
OP
|
$258.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
900912194
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$232.20 |
| Rate for Payer: Adventist Health Commercial |
$51.60
|
| Rate for Payer: Adventist Health Commercial |
$11.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$6.48
|
| Rate for Payer: Adventist Health Medi-Cal |
$6.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$47.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$47.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$47.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$47.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.64
|
| Rate for Payer: Blue Shield of California Commercial |
$35.28
|
| Rate for Payer: Blue Shield of California Commercial |
$162.54
|
| Rate for Payer: Blue Shield of California EPN |
$22.23
|
| Rate for Payer: Blue Shield of California EPN |
$102.43
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: Central Health Plan Commercial |
$206.40
|
| Rate for Payer: Central Health Plan Commercial |
$44.80
|
| Rate for Payer: Cigna of CA HMO |
$35.84
|
| Rate for Payer: Cigna of CA HMO |
$165.12
|
| Rate for Payer: Cigna of CA PPO |
$41.44
|
| Rate for Payer: Cigna of CA PPO |
$190.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$180.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$39.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.69
|
| Rate for Payer: EPIC Health Plan Senior |
$7.13
|
| Rate for Payer: EPIC Health Plan Senior |
$7.13
|
| Rate for Payer: Galaxy Health WC |
$47.60
|
| Rate for Payer: Galaxy Health WC |
$219.30
|
| Rate for Payer: Global Benefits Group Commercial |
$33.60
|
| Rate for Payer: Global Benefits Group Commercial |
$154.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$50.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$232.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.63
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$163.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$35.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.68
|
| Rate for Payer: Multiplan Commercial |
$42.00
|
| Rate for Payer: Multiplan Commercial |
$193.50
|
| Rate for Payer: Networks By Design Commercial |
$167.70
|
| Rate for Payer: Networks By Design Commercial |
$36.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6.48
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6.48
|
| Rate for Payer: Prime Health Services Commercial |
$47.60
|
| Rate for Payer: Prime Health Services Commercial |
$219.30
|
| Rate for Payer: Prime Health Services Medicare |
$6.87
|
| Rate for Payer: Prime Health Services Medicare |
$6.87
|
| Rate for Payer: Riverside University Health System MISP |
$7.13
|
| Rate for Payer: Riverside University Health System MISP |
$7.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$154.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$154.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.25
|
| Rate for Payer: United Healthcare All Other HMO |
$5.25
|
| Rate for Payer: United Healthcare All Other HMO |
$5.25
|
| Rate for Payer: United Healthcare HMO Rider |
$5.25
|
| Rate for Payer: United Healthcare HMO Rider |
$5.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.25
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.48
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: Vantage Medical Group Senior |
$6.48
|
| Rate for Payer: Vantage Medical Group Senior |
$6.48
|
|
|
HC AMYLASE URINE 24 HOURS
|
Facility
|
IP
|
$258.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
900912194
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$51.60 |
| Max. Negotiated Rate |
$232.20 |
| Rate for Payer: Adventist Health Commercial |
$51.60
|
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: Central Health Plan Commercial |
$206.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$180.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.20
|
| Rate for Payer: EPIC Health Plan Senior |
$103.20
|
| Rate for Payer: Galaxy Health WC |
$219.30
|
| Rate for Payer: Global Benefits Group Commercial |
$154.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$232.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$163.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$152.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.60
|
| Rate for Payer: Multiplan Commercial |
$193.50
|
| Rate for Payer: Networks By Design Commercial |
$167.70
|
| Rate for Payer: Prime Health Services Commercial |
$219.30
|
|
