|
HC ANTIGEN TYPING PATIENT
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
CPT 86905
|
| Hospital Charge Code |
900904701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$66.20 |
| Max. Negotiated Rate |
$297.90 |
| Rate for Payer: Adventist Health Commercial |
$66.20
|
| Rate for Payer: Cash Price |
$148.95
|
| Rate for Payer: Central Health Plan Commercial |
$264.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$231.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$132.40
|
| Rate for Payer: EPIC Health Plan Senior |
$132.40
|
| Rate for Payer: Galaxy Health WC |
$281.35
|
| Rate for Payer: Global Benefits Group Commercial |
$198.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$297.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$210.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$195.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.20
|
| Rate for Payer: Multiplan Commercial |
$248.25
|
| Rate for Payer: Networks By Design Commercial |
$215.15
|
| Rate for Payer: Prime Health Services Commercial |
$281.35
|
|
|
HC ANTIGEN TYPING UNIT
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
CPT 86902
|
| Hospital Charge Code |
900904410
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.15 |
| Max. Negotiated Rate |
$297.90 |
| Rate for Payer: Adventist Health Commercial |
$66.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$6.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$22.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.64
|
| Rate for Payer: Blue Shield of California Commercial |
$208.53
|
| Rate for Payer: Blue Shield of California EPN |
$131.41
|
| Rate for Payer: Cash Price |
$148.95
|
| Rate for Payer: Cash Price |
$148.95
|
| Rate for Payer: Central Health Plan Commercial |
$264.80
|
| Rate for Payer: Cigna of CA HMO |
$211.84
|
| Rate for Payer: Cigna of CA PPO |
$244.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$231.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.48
|
| Rate for Payer: EPIC Health Plan Senior |
$6.99
|
| Rate for Payer: Galaxy Health WC |
$281.35
|
| Rate for Payer: Global Benefits Group Commercial |
$198.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$297.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$210.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.51
|
| Rate for Payer: Multiplan Commercial |
$248.25
|
| Rate for Payer: Networks By Design Commercial |
$215.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6.35
|
| Rate for Payer: Prime Health Services Commercial |
$281.35
|
| Rate for Payer: Prime Health Services Medicare |
$6.73
|
| Rate for Payer: Riverside University Health System MISP |
$6.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$198.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$198.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.15
|
| Rate for Payer: United Healthcare All Other HMO |
$5.15
|
| Rate for Payer: United Healthcare HMO Rider |
$5.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.15
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.99
|
| Rate for Payer: Vantage Medical Group Senior |
$6.35
|
|
|
HC ANTIGEN TYPING UNIT
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
CPT 86902
|
| Hospital Charge Code |
900904410
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$66.20 |
| Max. Negotiated Rate |
$297.90 |
| Rate for Payer: Adventist Health Commercial |
$66.20
|
| Rate for Payer: Cash Price |
$148.95
|
| Rate for Payer: Central Health Plan Commercial |
$264.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$231.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$132.40
|
| Rate for Payer: EPIC Health Plan Senior |
$132.40
|
| Rate for Payer: Galaxy Health WC |
$281.35
|
| Rate for Payer: Global Benefits Group Commercial |
$198.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$297.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$210.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$195.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.20
|
| Rate for Payer: Multiplan Commercial |
$248.25
|
| Rate for Payer: Networks By Design Commercial |
$215.15
|
| Rate for Payer: Prime Health Services Commercial |
$281.35
|
|
|
HC ANTIMICROB SUSCEPTIBILITY TEST
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
900911660
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Central Health Plan Commercial |
$168.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$147.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Senior |
$84.00
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$189.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$133.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$123.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: Networks By Design Commercial |
$136.50
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
|
|
HC ANTIMICROB SUSCEPTIBILITY TEST
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
900911660
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$22.81 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.75
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$16.41
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$16.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.81
|
| Rate for Payer: Blue Shield of California Commercial |
$132.30
|
| Rate for Payer: Blue Shield of California Commercial |
$11.34
|
| Rate for Payer: Blue Shield of California EPN |
$83.37
|
| Rate for Payer: Blue Shield of California EPN |
$7.15
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Central Health Plan Commercial |
$14.40
|
| Rate for Payer: Central Health Plan Commercial |
$168.00
|
| Rate for Payer: Cigna of CA HMO |
$134.40
|
| Rate for Payer: Cigna of CA HMO |
$11.52
|
| Rate for Payer: Cigna of CA PPO |
$155.40
|
| Rate for Payer: Cigna of CA PPO |
$13.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$147.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.84
|
| Rate for Payer: EPIC Health Plan Senior |
$5.22
|
| Rate for Payer: EPIC Health Plan Senior |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$189.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.79
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$133.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.37
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
| Rate for Payer: Networks By Design Commercial |
$11.70
|
| Rate for Payer: Networks By Design Commercial |
$136.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.75
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: Prime Health Services Medicare |
$5.04
|
| Rate for Payer: Prime Health Services Medicare |
$5.04
|
| Rate for Payer: Riverside University Health System MISP |
$5.22
|
| Rate for Payer: Riverside University Health System MISP |
$5.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$126.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$126.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.85
|
| Rate for Payer: United Healthcare All Other HMO |
$3.85
|
| Rate for Payer: United Healthcare All Other HMO |
$3.85
|
| Rate for Payer: United Healthcare HMO Rider |
$3.85
|
| Rate for Payer: United Healthcare HMO Rider |
$3.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.85
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.75
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Vantage Medical Group Senior |
$4.75
|
| Rate for Payer: Vantage Medical Group Senior |
$4.75
|
|
|
HC ANTINUCLEAR ANTIBODIES (ANA)
|
Facility
|
OP
|
$223.00
|
|
|
Service Code
|
CPT 86038
|
| Hospital Charge Code |
900910969
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.79 |
| Max. Negotiated Rate |
$200.70 |
| Rate for Payer: Adventist Health Commercial |
$44.60
|
| Rate for Payer: Adventist Health Commercial |
$10.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.09
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$88.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$88.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$87.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$87.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.22
|
| Rate for Payer: Blue Shield of California Commercial |
$33.39
|
| Rate for Payer: Blue Shield of California Commercial |
$140.49
|
| Rate for Payer: Blue Shield of California EPN |
$21.04
|
| Rate for Payer: Blue Shield of California EPN |
$88.53
|
| Rate for Payer: Cash Price |
$23.85
|
| Rate for Payer: Cash Price |
$23.85
|
| Rate for Payer: Cash Price |
$100.35
|
| Rate for Payer: Cash Price |
$100.35
|
| Rate for Payer: Central Health Plan Commercial |
$178.40
|
| Rate for Payer: Central Health Plan Commercial |
$42.40
|
| Rate for Payer: Cigna of CA HMO |
$33.92
|
| Rate for Payer: Cigna of CA HMO |
$142.72
|
| Rate for Payer: Cigna of CA PPO |
$39.22
|
| Rate for Payer: Cigna of CA PPO |
$165.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$156.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.95
|
| Rate for Payer: EPIC Health Plan Senior |
$13.30
|
| Rate for Payer: EPIC Health Plan Senior |
$13.30
|
| Rate for Payer: Galaxy Health WC |
$45.05
|
| Rate for Payer: Galaxy Health WC |
$189.55
|
| Rate for Payer: Global Benefits Group Commercial |
$31.80
|
| Rate for Payer: Global Benefits Group Commercial |
$133.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$47.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$200.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.83
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$141.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$33.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.20
|
| Rate for Payer: Multiplan Commercial |
$39.75
|
| Rate for Payer: Multiplan Commercial |
$167.25
|
| Rate for Payer: Networks By Design Commercial |
$144.95
|
| Rate for Payer: Networks By Design Commercial |
$34.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.09
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.09
|
| Rate for Payer: Prime Health Services Commercial |
$45.05
|
| Rate for Payer: Prime Health Services Commercial |
$189.55
|
| Rate for Payer: Prime Health Services Medicare |
$12.82
|
| Rate for Payer: Prime Health Services Medicare |
$12.82
|
| Rate for Payer: Riverside University Health System MISP |
$13.30
|
| Rate for Payer: Riverside University Health System MISP |
$13.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$133.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$133.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.79
|
| Rate for Payer: United Healthcare All Other HMO |
$9.79
|
| Rate for Payer: United Healthcare All Other HMO |
$9.79
|
| Rate for Payer: United Healthcare HMO Rider |
$9.79
|
| Rate for Payer: United Healthcare HMO Rider |
$9.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.79
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.09
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.30
|
| Rate for Payer: Vantage Medical Group Senior |
$12.09
|
| Rate for Payer: Vantage Medical Group Senior |
$12.09
|
|
|
HC ANTINUCLEAR ANTIBODIES (ANA)
|
Facility
|
IP
|
$223.00
|
|
|
Service Code
|
CPT 86038
|
| Hospital Charge Code |
900910969
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$44.60 |
| Max. Negotiated Rate |
$200.70 |
| Rate for Payer: Adventist Health Commercial |
$44.60
|
| Rate for Payer: Cash Price |
$100.35
|
| Rate for Payer: Central Health Plan Commercial |
$178.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$156.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.20
|
| Rate for Payer: EPIC Health Plan Senior |
$89.20
|
| Rate for Payer: Galaxy Health WC |
$189.55
|
| Rate for Payer: Global Benefits Group Commercial |
$133.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$200.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$141.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$131.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.60
|
| Rate for Payer: Multiplan Commercial |
$167.25
|
| Rate for Payer: Networks By Design Commercial |
$144.95
|
| Rate for Payer: Prime Health Services Commercial |
$189.55
|
|
|
HC ANTI-REFLUX FILTER W/NG TUBES
|
Facility
|
OP
|
$45.67
|
|
| Hospital Charge Code |
901698758
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.13 |
| Max. Negotiated Rate |
$41.10 |
| Rate for Payer: Adventist Health Commercial |
$9.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$34.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$22.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.57
|
| Rate for Payer: Blue Shield of California Commercial |
$28.95
|
| Rate for Payer: Blue Shield of California EPN |
$18.22
|
| Rate for Payer: Cash Price |
$20.55
|
| Rate for Payer: Central Health Plan Commercial |
$36.54
|
| Rate for Payer: Cigna of CA HMO |
$29.23
|
| Rate for Payer: Cigna of CA PPO |
$33.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$38.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$31.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.27
|
| Rate for Payer: EPIC Health Plan Senior |
$18.27
|
| Rate for Payer: Galaxy Health WC |
$38.82
|
| Rate for Payer: Global Benefits Group Commercial |
$27.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$41.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$29.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$31.97
|
| Rate for Payer: Multiplan Commercial |
$34.25
|
| Rate for Payer: Networks By Design Commercial |
$29.69
|
| Rate for Payer: Prime Health Services Commercial |
$38.82
|
| Rate for Payer: Riverside University Health System MISP |
$18.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.84
|
| Rate for Payer: United Healthcare All Other HMO |
$22.84
|
| Rate for Payer: United Healthcare HMO Rider |
$22.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.82
|
| Rate for Payer: Vantage Medical Group Senior |
$38.82
|
|
|
HC ANTI-REFLUX FILTER W/NG TUBES
|
Facility
|
IP
|
$45.67
|
|
| Hospital Charge Code |
901698758
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.13 |
| Max. Negotiated Rate |
$41.10 |
| Rate for Payer: Adventist Health Commercial |
$9.13
|
| Rate for Payer: Cash Price |
$20.55
|
| Rate for Payer: Central Health Plan Commercial |
$36.54
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$31.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.27
|
| Rate for Payer: EPIC Health Plan Senior |
$18.27
|
| Rate for Payer: Galaxy Health WC |
$38.82
|
| Rate for Payer: Global Benefits Group Commercial |
$27.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$41.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$29.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.13
|
| Rate for Payer: Multiplan Commercial |
$34.25
|
| Rate for Payer: Networks By Design Commercial |
$29.69
|
| Rate for Payer: Prime Health Services Commercial |
$38.82
|
|
|
HC ANTI REFLUX VALVE SALEM SUMP
|
Facility
|
IP
|
$12.22
|
|
| Hospital Charge Code |
901698823
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.44 |
| Max. Negotiated Rate |
$11.00 |
| Rate for Payer: Adventist Health Commercial |
$2.44
|
| Rate for Payer: Cash Price |
$5.50
|
| Rate for Payer: Central Health Plan Commercial |
$9.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.89
|
| Rate for Payer: EPIC Health Plan Senior |
$4.89
|
| Rate for Payer: Galaxy Health WC |
$10.39
|
| Rate for Payer: Global Benefits Group Commercial |
$7.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.44
|
| Rate for Payer: Multiplan Commercial |
$9.16
|
| Rate for Payer: Networks By Design Commercial |
$7.94
|
| Rate for Payer: Prime Health Services Commercial |
$10.39
|
|
|
HC ANTI REFLUX VALVE SALEM SUMP
|
Facility
|
OP
|
$12.22
|
|
| Hospital Charge Code |
901698823
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.44 |
| Max. Negotiated Rate |
$11.00 |
| Rate for Payer: Adventist Health Commercial |
$2.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.11
|
| Rate for Payer: Blue Shield of California Commercial |
$7.75
|
| Rate for Payer: Blue Shield of California EPN |
$4.88
|
| Rate for Payer: Cash Price |
$5.50
|
| Rate for Payer: Central Health Plan Commercial |
$9.78
|
| Rate for Payer: Cigna of CA HMO |
$7.82
|
| Rate for Payer: Cigna of CA PPO |
$9.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.89
|
| Rate for Payer: EPIC Health Plan Senior |
$4.89
|
| Rate for Payer: Galaxy Health WC |
$10.39
|
| Rate for Payer: Global Benefits Group Commercial |
$7.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.55
|
| Rate for Payer: Multiplan Commercial |
$9.16
|
| Rate for Payer: Networks By Design Commercial |
$7.94
|
| Rate for Payer: Prime Health Services Commercial |
$10.39
|
| Rate for Payer: Riverside University Health System MISP |
$4.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.11
|
| Rate for Payer: United Healthcare All Other HMO |
$6.11
|
| Rate for Payer: United Healthcare HMO Rider |
$6.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.39
|
| Rate for Payer: Vantage Medical Group Senior |
$10.39
|
|
|
HC ANTISTREPTOLYSIN O
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
900910881
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$167.40 |
| Rate for Payer: Adventist Health Commercial |
$37.20
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Central Health Plan Commercial |
$148.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$130.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.40
|
| Rate for Payer: EPIC Health Plan Senior |
$74.40
|
| Rate for Payer: Galaxy Health WC |
$158.10
|
| Rate for Payer: Global Benefits Group Commercial |
$111.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$167.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$118.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$109.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.20
|
| Rate for Payer: Multiplan Commercial |
$139.50
|
| Rate for Payer: Networks By Design Commercial |
$120.90
|
| Rate for Payer: Prime Health Services Commercial |
$158.10
|
|
|
HC ANTISTREPTOLYSIN O
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
900910881
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.02 |
| Max. Negotiated Rate |
$167.40 |
| Rate for Payer: Adventist Health Commercial |
$37.20
|
| Rate for Payer: Adventist Health Commercial |
$15.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$99.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$99.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$99.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$99.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$137.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$137.68
|
| Rate for Payer: Blue Shield of California Commercial |
$47.25
|
| Rate for Payer: Blue Shield of California Commercial |
$117.18
|
| Rate for Payer: Blue Shield of California EPN |
$29.77
|
| Rate for Payer: Blue Shield of California EPN |
$73.84
|
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Central Health Plan Commercial |
$148.80
|
| Rate for Payer: Central Health Plan Commercial |
$60.00
|
| Rate for Payer: Cigna of CA HMO |
$48.00
|
| Rate for Payer: Cigna of CA HMO |
$119.04
|
| Rate for Payer: Cigna of CA PPO |
$55.50
|
| Rate for Payer: Cigna of CA PPO |
$137.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$130.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$52.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.44
|
| Rate for Payer: EPIC Health Plan Senior |
$14.96
|
| Rate for Payer: EPIC Health Plan Senior |
$14.96
|
| Rate for Payer: Galaxy Health WC |
$63.75
|
| Rate for Payer: Galaxy Health WC |
$158.10
|
| Rate for Payer: Global Benefits Group Commercial |
$45.00
|
| Rate for Payer: Global Benefits Group Commercial |
$111.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$67.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$167.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$118.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$47.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.22
|
| Rate for Payer: Multiplan Commercial |
$56.25
|
| Rate for Payer: Multiplan Commercial |
$139.50
|
| Rate for Payer: Networks By Design Commercial |
$120.90
|
| Rate for Payer: Networks By Design Commercial |
$48.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.60
|
| Rate for Payer: Prime Health Services Commercial |
$63.75
|
| Rate for Payer: Prime Health Services Commercial |
$158.10
|
| Rate for Payer: Prime Health Services Medicare |
$14.42
|
| Rate for Payer: Prime Health Services Medicare |
$14.42
|
| Rate for Payer: Riverside University Health System MISP |
$14.96
|
| Rate for Payer: Riverside University Health System MISP |
$14.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$111.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$111.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.02
|
| Rate for Payer: United Healthcare All Other HMO |
$11.02
|
| Rate for Payer: United Healthcare All Other HMO |
$11.02
|
| Rate for Payer: United Healthcare HMO Rider |
$11.02
|
| Rate for Payer: United Healthcare HMO Rider |
$11.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.02
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.60
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.96
|
| Rate for Payer: Vantage Medical Group Senior |
$13.60
|
| Rate for Payer: Vantage Medical Group Senior |
$13.60
|
|
|
HC ANTITHROMBIN III ACTIVITY
|
Facility
|
IP
|
$242.00
|
|
|
Service Code
|
CPT 85300
|
| Hospital Charge Code |
900912010
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$48.40 |
| Max. Negotiated Rate |
$217.80 |
| Rate for Payer: Adventist Health Commercial |
$48.40
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Central Health Plan Commercial |
$193.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$169.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.80
|
| Rate for Payer: EPIC Health Plan Senior |
$96.80
|
| Rate for Payer: Galaxy Health WC |
$205.70
|
| Rate for Payer: Global Benefits Group Commercial |
$145.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$217.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$153.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$142.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.40
|
| Rate for Payer: Multiplan Commercial |
$181.50
|
| Rate for Payer: Networks By Design Commercial |
$157.30
|
| Rate for Payer: Prime Health Services Commercial |
$205.70
|
|
|
HC ANTITHROMBIN III ACTIVITY
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT 85300
|
| Hospital Charge Code |
900912010
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$119.84 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Adventist Health Commercial |
$48.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$11.85
|
| Rate for Payer: Adventist Health Medi-Cal |
$11.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$87.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$87.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$86.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$86.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$119.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$119.84
|
| Rate for Payer: Blue Shield of California Commercial |
$152.46
|
| Rate for Payer: Blue Shield of California Commercial |
$69.30
|
| Rate for Payer: Blue Shield of California EPN |
$96.07
|
| Rate for Payer: Blue Shield of California EPN |
$43.67
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Central Health Plan Commercial |
$88.00
|
| Rate for Payer: Central Health Plan Commercial |
$193.60
|
| Rate for Payer: Cigna of CA HMO |
$154.88
|
| Rate for Payer: Cigna of CA HMO |
$70.40
|
| Rate for Payer: Cigna of CA PPO |
$179.08
|
| Rate for Payer: Cigna of CA PPO |
$81.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$77.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$169.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.55
|
| Rate for Payer: EPIC Health Plan Senior |
$13.04
|
| Rate for Payer: EPIC Health Plan Senior |
$13.04
|
| Rate for Payer: Galaxy Health WC |
$205.70
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$145.20
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$217.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.43
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$69.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$153.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.88
|
| Rate for Payer: Multiplan Commercial |
$181.50
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
| Rate for Payer: Networks By Design Commercial |
$71.50
|
| Rate for Payer: Networks By Design Commercial |
$157.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11.85
|
| Rate for Payer: Prime Health Services Commercial |
$205.70
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
| Rate for Payer: Prime Health Services Medicare |
$12.56
|
| Rate for Payer: Prime Health Services Medicare |
$12.56
|
| Rate for Payer: Riverside University Health System MISP |
$13.04
|
| Rate for Payer: Riverside University Health System MISP |
$13.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$66.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$145.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$145.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.60
|
| Rate for Payer: United Healthcare All Other HMO |
$9.60
|
| Rate for Payer: United Healthcare All Other HMO |
$9.60
|
| Rate for Payer: United Healthcare HMO Rider |
$9.60
|
| Rate for Payer: United Healthcare HMO Rider |
$9.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.60
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.85
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.04
|
| Rate for Payer: Vantage Medical Group Senior |
$11.85
|
| Rate for Payer: Vantage Medical Group Senior |
$11.85
|
|
|
HC ANTITHROMBIN III ANTIGEN
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
CPT 85301
|
| Hospital Charge Code |
900912011
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.76 |
| Max. Negotiated Rate |
$109.35 |
| Rate for Payer: Adventist Health Commercial |
$20.40
|
| Rate for Payer: Adventist Health Commercial |
$32.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$10.81
|
| Rate for Payer: Adventist Health Medi-Cal |
$10.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$79.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$79.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$78.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$78.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$109.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$109.35
|
| Rate for Payer: Blue Shield of California Commercial |
$102.69
|
| Rate for Payer: Blue Shield of California Commercial |
$64.26
|
| Rate for Payer: Blue Shield of California EPN |
$64.71
|
| Rate for Payer: Blue Shield of California EPN |
$40.49
|
| Rate for Payer: Cash Price |
$73.35
|
| Rate for Payer: Cash Price |
$73.35
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Central Health Plan Commercial |
$81.60
|
| Rate for Payer: Central Health Plan Commercial |
$130.40
|
| Rate for Payer: Cigna of CA HMO |
$104.32
|
| Rate for Payer: Cigna of CA HMO |
$65.28
|
| Rate for Payer: Cigna of CA PPO |
$120.62
|
| Rate for Payer: Cigna of CA PPO |
$75.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$71.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$114.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.84
|
| Rate for Payer: EPIC Health Plan Senior |
$11.89
|
| Rate for Payer: EPIC Health Plan Senior |
$11.89
|
| Rate for Payer: Galaxy Health WC |
$138.55
|
| Rate for Payer: Galaxy Health WC |
$86.70
|
| Rate for Payer: Global Benefits Group Commercial |
$97.80
|
| Rate for Payer: Global Benefits Group Commercial |
$61.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$146.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$91.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$17.73
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$17.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$16.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$16.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$64.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$103.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14.49
|
| Rate for Payer: Multiplan Commercial |
$122.25
|
| Rate for Payer: Multiplan Commercial |
$76.50
|
| Rate for Payer: Networks By Design Commercial |
$66.30
|
| Rate for Payer: Networks By Design Commercial |
$105.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$10.81
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$10.81
|
| Rate for Payer: Prime Health Services Commercial |
$138.55
|
| Rate for Payer: Prime Health Services Commercial |
$86.70
|
| Rate for Payer: Prime Health Services Medicare |
$11.46
|
| Rate for Payer: Prime Health Services Medicare |
$11.46
|
| Rate for Payer: Riverside University Health System MISP |
$11.89
|
| Rate for Payer: Riverside University Health System MISP |
$11.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$61.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$97.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$97.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$61.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.76
|
| Rate for Payer: United Healthcare All Other HMO |
$8.76
|
| Rate for Payer: United Healthcare All Other HMO |
$8.76
|
| Rate for Payer: United Healthcare HMO Rider |
$8.76
|
| Rate for Payer: United Healthcare HMO Rider |
$8.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.76
|
| Rate for Payer: Upland Medical Group Pediatric |
$10.81
|
| Rate for Payer: Upland Medical Group Pediatric |
$10.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.89
|
| Rate for Payer: Vantage Medical Group Senior |
$10.81
|
| Rate for Payer: Vantage Medical Group Senior |
$10.81
|
|
|
HC ANTITHROMBIN III ANTIGEN
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
CPT 85301
|
| Hospital Charge Code |
900912011
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$32.60 |
| Max. Negotiated Rate |
$146.70 |
| Rate for Payer: Adventist Health Commercial |
$32.60
|
| Rate for Payer: Cash Price |
$73.35
|
| Rate for Payer: Central Health Plan Commercial |
$130.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$114.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.20
|
| Rate for Payer: EPIC Health Plan Senior |
$65.20
|
| Rate for Payer: Galaxy Health WC |
$138.55
|
| Rate for Payer: Global Benefits Group Commercial |
$97.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$146.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$103.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$96.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.60
|
| Rate for Payer: Multiplan Commercial |
$122.25
|
| Rate for Payer: Networks By Design Commercial |
$105.95
|
| Rate for Payer: Prime Health Services Commercial |
$138.55
|
|
|
HC ANTI-XA APIXABAN
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
CPT 85520
|
| Hospital Charge Code |
900912042
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Adventist Health Commercial |
$12.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Central Health Plan Commercial |
$51.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$44.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.60
|
| Rate for Payer: EPIC Health Plan Senior |
$25.60
|
| Rate for Payer: Galaxy Health WC |
$54.40
|
| Rate for Payer: Global Benefits Group Commercial |
$38.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$57.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$40.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$37.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.80
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: Networks By Design Commercial |
$41.60
|
| Rate for Payer: Prime Health Services Commercial |
$54.40
|
|
|
HC ANTI-XA APIXABAN
|
Facility
|
OP
|
$58.00
|
|
|
Service Code
|
CPT 85520
|
| Hospital Charge Code |
900912042
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.60 |
| Max. Negotiated Rate |
$112.48 |
| Rate for Payer: Adventist Health Commercial |
$11.60
|
| Rate for Payer: Adventist Health Commercial |
$12.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.09
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$96.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$96.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$80.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$80.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$112.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$112.48
|
| Rate for Payer: Blue Shield of California Commercial |
$40.32
|
| Rate for Payer: Blue Shield of California Commercial |
$36.54
|
| Rate for Payer: Blue Shield of California EPN |
$25.41
|
| Rate for Payer: Blue Shield of California EPN |
$23.03
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Central Health Plan Commercial |
$46.40
|
| Rate for Payer: Central Health Plan Commercial |
$51.20
|
| Rate for Payer: Cigna of CA HMO |
$40.96
|
| Rate for Payer: Cigna of CA HMO |
$37.12
|
| Rate for Payer: Cigna of CA PPO |
$47.36
|
| Rate for Payer: Cigna of CA PPO |
$42.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$40.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$44.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14.40
|
| Rate for Payer: EPIC Health Plan Senior |
$14.40
|
| Rate for Payer: Galaxy Health WC |
$54.40
|
| Rate for Payer: Galaxy Health WC |
$49.30
|
| Rate for Payer: Global Benefits Group Commercial |
$38.40
|
| Rate for Payer: Global Benefits Group Commercial |
$34.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$57.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$52.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.47
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$36.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$40.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.54
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: Multiplan Commercial |
$43.50
|
| Rate for Payer: Networks By Design Commercial |
$37.70
|
| Rate for Payer: Networks By Design Commercial |
$41.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.09
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.09
|
| Rate for Payer: Prime Health Services Commercial |
$54.40
|
| Rate for Payer: Prime Health Services Commercial |
$49.30
|
| Rate for Payer: Prime Health Services Medicare |
$13.88
|
| Rate for Payer: Prime Health Services Medicare |
$13.88
|
| Rate for Payer: Riverside University Health System MISP |
$14.40
|
| Rate for Payer: Riverside University Health System MISP |
$14.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$38.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$38.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$34.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.60
|
| Rate for Payer: United Healthcare All Other HMO |
$10.60
|
| Rate for Payer: United Healthcare All Other HMO |
$10.60
|
| Rate for Payer: United Healthcare HMO Rider |
$10.60
|
| Rate for Payer: United Healthcare HMO Rider |
$10.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.60
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.09
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.40
|
| Rate for Payer: Vantage Medical Group Senior |
$13.09
|
| Rate for Payer: Vantage Medical Group Senior |
$13.09
|
|
|
HC ANTI-XA UNFRACTIONATED HEPARIN
|
Facility
|
IP
|
$123.00
|
|
|
Service Code
|
CPT 85520
|
| Hospital Charge Code |
900912030
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$24.60 |
| Max. Negotiated Rate |
$110.70 |
| Rate for Payer: Adventist Health Commercial |
$24.60
|
| Rate for Payer: Cash Price |
$55.35
|
| Rate for Payer: Central Health Plan Commercial |
$98.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$86.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.20
|
| Rate for Payer: EPIC Health Plan Senior |
$49.20
|
| Rate for Payer: Galaxy Health WC |
$104.55
|
| Rate for Payer: Global Benefits Group Commercial |
$73.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$110.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$78.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$72.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.60
|
| Rate for Payer: Multiplan Commercial |
$92.25
|
| Rate for Payer: Networks By Design Commercial |
$79.95
|
| Rate for Payer: Prime Health Services Commercial |
$104.55
|
|
|
HC ANTI-XA UNFRACTIONATED HEPARIN
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
CPT 85520
|
| Hospital Charge Code |
900912030
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.60 |
| Max. Negotiated Rate |
$112.48 |
| Rate for Payer: Adventist Health Commercial |
$23.80
|
| Rate for Payer: Adventist Health Commercial |
$24.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.09
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$96.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$96.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$80.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$80.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$112.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$112.48
|
| Rate for Payer: Blue Shield of California Commercial |
$77.49
|
| Rate for Payer: Blue Shield of California Commercial |
$74.97
|
| Rate for Payer: Blue Shield of California EPN |
$48.83
|
| Rate for Payer: Blue Shield of California EPN |
$47.24
|
| Rate for Payer: Cash Price |
$55.35
|
| Rate for Payer: Cash Price |
$55.35
|
| Rate for Payer: Cash Price |
$53.55
|
| Rate for Payer: Cash Price |
$53.55
|
| Rate for Payer: Central Health Plan Commercial |
$95.20
|
| Rate for Payer: Central Health Plan Commercial |
$98.40
|
| Rate for Payer: Cigna of CA HMO |
$78.72
|
| Rate for Payer: Cigna of CA HMO |
$76.16
|
| Rate for Payer: Cigna of CA PPO |
$91.02
|
| Rate for Payer: Cigna of CA PPO |
$88.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$83.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$86.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14.40
|
| Rate for Payer: EPIC Health Plan Senior |
$14.40
|
| Rate for Payer: Galaxy Health WC |
$104.55
|
| Rate for Payer: Galaxy Health WC |
$101.15
|
| Rate for Payer: Global Benefits Group Commercial |
$73.80
|
| Rate for Payer: Global Benefits Group Commercial |
$71.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$110.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$107.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.47
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$75.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$78.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.54
|
| Rate for Payer: Multiplan Commercial |
$92.25
|
| Rate for Payer: Multiplan Commercial |
$89.25
|
| Rate for Payer: Networks By Design Commercial |
$77.35
|
| Rate for Payer: Networks By Design Commercial |
$79.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.09
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.09
|
| Rate for Payer: Prime Health Services Commercial |
$104.55
|
| Rate for Payer: Prime Health Services Commercial |
$101.15
|
| Rate for Payer: Prime Health Services Medicare |
$13.88
|
| Rate for Payer: Prime Health Services Medicare |
$13.88
|
| Rate for Payer: Riverside University Health System MISP |
$14.40
|
| Rate for Payer: Riverside University Health System MISP |
$14.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$71.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$73.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$73.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$71.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.60
|
| Rate for Payer: United Healthcare All Other HMO |
$10.60
|
| Rate for Payer: United Healthcare All Other HMO |
$10.60
|
| Rate for Payer: United Healthcare HMO Rider |
$10.60
|
| Rate for Payer: United Healthcare HMO Rider |
$10.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.60
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.09
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.40
|
| Rate for Payer: Vantage Medical Group Senior |
$13.09
|
| Rate for Payer: Vantage Medical Group Senior |
$13.09
|
|
|
HC AORTA CATHETER (FEMORAL/AX
|
Facility
|
OP
|
$1,384.00
|
|
|
Service Code
|
CPT 36200
|
| Hospital Charge Code |
909081318
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$256.14 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$276.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,176.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$761.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,038.00
|
| 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: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,107.20
|
| Rate for Payer: Cigna of CA HMO |
$885.76
|
| Rate for Payer: Cigna of CA PPO |
$1,024.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,176.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,176.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,176.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$968.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$553.60
|
| Rate for Payer: EPIC Health Plan Senior |
$553.60
|
| Rate for Payer: Galaxy Health WC |
$1,176.40
|
| Rate for Payer: Global Benefits Group Commercial |
$830.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,245.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$256.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$878.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$282.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$816.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$276.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$968.80
|
| Rate for Payer: Multiplan Commercial |
$1,038.00
|
| Rate for Payer: Networks By Design Commercial |
$899.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,176.40
|
| Rate for Payer: Riverside University Health System MISP |
$553.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$830.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$692.00
|
| 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: Vantage Medical Group Commercial/Exchange |
$1,176.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,176.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,176.40
|
|
|
HC AORTA CATHETER (FEMORAL/AX
|
Facility
|
IP
|
$1,384.00
|
|
|
Service Code
|
CPT 36200
|
| Hospital Charge Code |
909081318
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$276.80 |
| Max. Negotiated Rate |
$1,245.60 |
| Rate for Payer: Adventist Health Commercial |
$276.80
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,107.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$968.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$553.60
|
| Rate for Payer: EPIC Health Plan Senior |
$553.60
|
| Rate for Payer: Galaxy Health WC |
$1,176.40
|
| Rate for Payer: Global Benefits Group Commercial |
$830.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,245.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$878.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$816.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$276.80
|
| Rate for Payer: Multiplan Commercial |
$1,038.00
|
| Rate for Payer: Networks By Design Commercial |
$899.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,176.40
|
|
|
HC AORTOGRAM/SUPRAVALVULAR
|
Facility
|
OP
|
$2,043.00
|
|
|
Service Code
|
CPT 93567
|
| Hospital Charge Code |
906811416
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$160.30 |
| Max. Negotiated Rate |
$8,136.21 |
| Rate for Payer: Adventist Health Commercial |
$408.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,736.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,123.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,532.25
|
| 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: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$919.35
|
| Rate for Payer: Cash Price |
$919.35
|
| Rate for Payer: Cash Price |
$919.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,634.40
|
| Rate for Payer: Cigna of CA HMO |
$1,327.95
|
| Rate for Payer: Cigna of CA PPO |
$1,511.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,736.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,736.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,736.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,430.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$817.20
|
| Rate for Payer: EPIC Health Plan Senior |
$817.20
|
| Rate for Payer: Galaxy Health WC |
$1,736.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,225.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,838.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$160.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,297.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$177.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,205.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$408.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,430.10
|
| Rate for Payer: Multiplan Commercial |
$1,532.25
|
| Rate for Payer: Networks By Design Commercial |
$1,327.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,736.55
|
| Rate for Payer: Riverside University Health System MISP |
$817.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,225.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,225.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,021.50
|
| 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: Vantage Medical Group Commercial/Exchange |
$1,736.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,736.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,736.55
|
|
|
HC AORTOGRAM/SUPRAVALVULAR
|
Facility
|
IP
|
$2,043.00
|
|
|
Service Code
|
CPT 93567
|
| Hospital Charge Code |
906811416
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$408.60 |
| Max. Negotiated Rate |
$1,838.70 |
| Rate for Payer: Adventist Health Commercial |
$408.60
|
| Rate for Payer: Cash Price |
$919.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,634.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,430.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$817.20
|
| Rate for Payer: EPIC Health Plan Senior |
$817.20
|
| Rate for Payer: Galaxy Health WC |
$1,736.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,225.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,838.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,297.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,205.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$408.60
|
| Rate for Payer: Multiplan Commercial |
$1,532.25
|
| Rate for Payer: Networks By Design Commercial |
$1,327.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,736.55
|
|
