|
HC BLOOD DRAW LT 3YRS FEM/JUGULAR
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
CPT 36400
|
| Hospital Charge Code |
900501687
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Adventist Health Commercial |
$35.00
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Central Health Plan Commercial |
$140.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$122.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.00
|
| Rate for Payer: EPIC Health Plan Senior |
$70.00
|
| Rate for Payer: Galaxy Health WC |
$148.75
|
| Rate for Payer: Global Benefits Group Commercial |
$105.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$157.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$111.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$103.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.00
|
| Rate for Payer: Multiplan Commercial |
$131.25
|
| Rate for Payer: Networks By Design Commercial |
$113.75
|
| Rate for Payer: Prime Health Services Commercial |
$148.75
|
|
|
HC BLOOD GAS
|
Facility
|
OP
|
$1,077.00
|
|
|
Service Code
|
CPT 82803
|
| Hospital Charge Code |
900801107
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.38 |
| Max. Negotiated Rate |
$969.30 |
| Rate for Payer: Adventist Health Commercial |
$215.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$26.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$141.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$39.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$140.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$195.69
|
| Rate for Payer: Blue Shield of California Commercial |
$678.51
|
| Rate for Payer: Blue Shield of California EPN |
$427.57
|
| Rate for Payer: Cash Price |
$484.65
|
| Rate for Payer: Cash Price |
$484.65
|
| Rate for Payer: Central Health Plan Commercial |
$861.60
|
| Rate for Payer: Cigna of CA HMO |
$689.28
|
| Rate for Payer: Cigna of CA PPO |
$796.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$753.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.02
|
| Rate for Payer: EPIC Health Plan Senior |
$28.68
|
| Rate for Payer: Galaxy Health WC |
$915.45
|
| Rate for Payer: Global Benefits Group Commercial |
$646.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$969.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$42.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$26.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$683.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$36.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$215.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$34.93
|
| Rate for Payer: Multiplan Commercial |
$807.75
|
| Rate for Payer: Networks By Design Commercial |
$700.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$26.07
|
| Rate for Payer: Prime Health Services Commercial |
$915.45
|
| Rate for Payer: Prime Health Services Medicare |
$27.63
|
| Rate for Payer: Riverside University Health System MISP |
$28.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$646.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$646.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.11
|
| Rate for Payer: United Healthcare All Other HMO |
$21.11
|
| Rate for Payer: United Healthcare HMO Rider |
$21.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.11
|
| Rate for Payer: Upland Medical Group Pediatric |
$26.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$39.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.68
|
| Rate for Payer: Vantage Medical Group Senior |
$26.07
|
|
|
HC BLOOD GAS
|
Facility
|
IP
|
$1,077.00
|
|
|
Service Code
|
CPT 82803
|
| Hospital Charge Code |
900801107
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$215.40 |
| Max. Negotiated Rate |
$969.30 |
| Rate for Payer: Adventist Health Commercial |
$215.40
|
| Rate for Payer: Cash Price |
$484.65
|
| Rate for Payer: Central Health Plan Commercial |
$861.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$753.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$430.80
|
| Rate for Payer: EPIC Health Plan Senior |
$430.80
|
| Rate for Payer: Galaxy Health WC |
$915.45
|
| Rate for Payer: Global Benefits Group Commercial |
$646.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$969.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$683.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$635.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$215.40
|
| Rate for Payer: Multiplan Commercial |
$807.75
|
| Rate for Payer: Networks By Design Commercial |
$700.05
|
| Rate for Payer: Prime Health Services Commercial |
$915.45
|
|
|
HC BLOOD GAS AND COOXIMETRY
|
Facility
|
IP
|
$1,571.00
|
|
|
Service Code
|
CPT 82805
|
| Hospital Charge Code |
900801109
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$314.20 |
| Max. Negotiated Rate |
$1,413.90 |
| Rate for Payer: Adventist Health Commercial |
$314.20
|
| Rate for Payer: Cash Price |
$706.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,256.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,099.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$628.40
|
| Rate for Payer: EPIC Health Plan Senior |
$628.40
|
| Rate for Payer: Galaxy Health WC |
$1,335.35
|
| Rate for Payer: Global Benefits Group Commercial |
$942.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,413.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$997.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$926.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$314.20
|
| Rate for Payer: Multiplan Commercial |
$1,178.25
|
| Rate for Payer: Networks By Design Commercial |
$1,021.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,335.35
|
|
|
HC BLOOD GAS AND COOXIMETRY
|
Facility
|
OP
|
$1,571.00
|
|
|
Service Code
|
CPT 82805
|
| Hospital Charge Code |
900801109
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$41.80 |
| Max. Negotiated Rate |
$1,413.90 |
| Rate for Payer: Adventist Health Commercial |
$314.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$78.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$208.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$118.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$86.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$78.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$204.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$284.34
|
| Rate for Payer: Blue Shield of California Commercial |
$989.73
|
| Rate for Payer: Blue Shield of California EPN |
$623.69
|
| Rate for Payer: Cash Price |
$706.95
|
| Rate for Payer: Cash Price |
$706.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,256.80
|
| Rate for Payer: Cigna of CA HMO |
$1,005.44
|
| Rate for Payer: Cigna of CA PPO |
$1,162.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$118.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$86.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$78.77
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,099.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$129.97
|
| Rate for Payer: EPIC Health Plan Senior |
$86.65
|
| Rate for Payer: Galaxy Health WC |
$1,335.35
|
| Rate for Payer: Global Benefits Group Commercial |
$942.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,413.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$129.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$41.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$78.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$997.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$46.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$110.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$314.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$105.55
|
| Rate for Payer: Multiplan Commercial |
$1,178.25
|
| Rate for Payer: Networks By Design Commercial |
$1,021.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$78.77
|
| Rate for Payer: Prime Health Services Commercial |
$1,335.35
|
| Rate for Payer: Prime Health Services Medicare |
$83.50
|
| Rate for Payer: Riverside University Health System MISP |
$86.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$942.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$942.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$63.80
|
| Rate for Payer: United Healthcare All Other HMO |
$63.80
|
| Rate for Payer: United Healthcare HMO Rider |
$63.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$63.80
|
| Rate for Payer: Upland Medical Group Pediatric |
$78.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$118.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$86.65
|
| Rate for Payer: Vantage Medical Group Senior |
$78.77
|
|
|
HC BLOOD GAS CHLORIDE
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
CPT 82435
|
| Hospital Charge Code |
900801121
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.73 |
| Max. Negotiated Rate |
$109.80 |
| Rate for Payer: Adventist Health Commercial |
$24.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$33.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$33.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.91
|
| Rate for Payer: Blue Shield of California Commercial |
$76.86
|
| Rate for Payer: Blue Shield of California EPN |
$48.43
|
| Rate for Payer: Cash Price |
$54.90
|
| Rate for Payer: Cash Price |
$54.90
|
| Rate for Payer: Central Health Plan Commercial |
$97.60
|
| Rate for Payer: Cigna of CA HMO |
$78.08
|
| Rate for Payer: Cigna of CA PPO |
$90.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$85.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.59
|
| Rate for Payer: EPIC Health Plan Senior |
$5.06
|
| Rate for Payer: Galaxy Health WC |
$103.70
|
| Rate for Payer: Global Benefits Group Commercial |
$73.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$109.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$77.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.16
|
| Rate for Payer: Multiplan Commercial |
$91.50
|
| Rate for Payer: Networks By Design Commercial |
$79.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.60
|
| Rate for Payer: Prime Health Services Commercial |
$103.70
|
| Rate for Payer: Prime Health Services Medicare |
$4.88
|
| Rate for Payer: Riverside University Health System MISP |
$5.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$73.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$73.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.73
|
| Rate for Payer: United Healthcare All Other HMO |
$3.73
|
| Rate for Payer: United Healthcare HMO Rider |
$3.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.73
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.06
|
| Rate for Payer: Vantage Medical Group Senior |
$4.60
|
|
|
HC BLOOD GAS CHLORIDE
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
CPT 82435
|
| Hospital Charge Code |
900801121
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$109.80 |
| Rate for Payer: Adventist Health Commercial |
$24.40
|
| Rate for Payer: Cash Price |
$54.90
|
| Rate for Payer: Central Health Plan Commercial |
$97.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$85.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.80
|
| Rate for Payer: EPIC Health Plan Senior |
$48.80
|
| Rate for Payer: Galaxy Health WC |
$103.70
|
| Rate for Payer: Global Benefits Group Commercial |
$73.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$109.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$77.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.40
|
| Rate for Payer: Multiplan Commercial |
$91.50
|
| Rate for Payer: Networks By Design Commercial |
$79.30
|
| Rate for Payer: Prime Health Services Commercial |
$103.70
|
|
|
HC BLOOD GAS POTASSIUM
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
900801122
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$109.80 |
| Rate for Payer: Adventist Health Commercial |
$24.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$33.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.76
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$33.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.91
|
| Rate for Payer: Blue Shield of California Commercial |
$76.86
|
| Rate for Payer: Blue Shield of California EPN |
$48.43
|
| Rate for Payer: Cash Price |
$54.90
|
| Rate for Payer: Cash Price |
$54.90
|
| Rate for Payer: Central Health Plan Commercial |
$97.60
|
| Rate for Payer: Cigna of CA HMO |
$78.08
|
| Rate for Payer: Cigna of CA PPO |
$90.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$85.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.85
|
| Rate for Payer: EPIC Health Plan Senior |
$5.24
|
| Rate for Payer: Galaxy Health WC |
$103.70
|
| Rate for Payer: Global Benefits Group Commercial |
$73.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$109.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$77.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.38
|
| Rate for Payer: Multiplan Commercial |
$91.50
|
| Rate for Payer: Networks By Design Commercial |
$79.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.76
|
| Rate for Payer: Prime Health Services Commercial |
$103.70
|
| Rate for Payer: Prime Health Services Medicare |
$5.05
|
| Rate for Payer: Riverside University Health System MISP |
$5.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$73.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$73.20
|
| 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 HMO Rider |
$3.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.85
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.24
|
| Rate for Payer: Vantage Medical Group Senior |
$4.76
|
|
|
HC BLOOD GAS POTASSIUM
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
900801122
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$109.80 |
| Rate for Payer: Adventist Health Commercial |
$24.40
|
| Rate for Payer: Cash Price |
$54.90
|
| Rate for Payer: Central Health Plan Commercial |
$97.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$85.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.80
|
| Rate for Payer: EPIC Health Plan Senior |
$48.80
|
| Rate for Payer: Galaxy Health WC |
$103.70
|
| Rate for Payer: Global Benefits Group Commercial |
$73.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$109.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$77.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.40
|
| Rate for Payer: Multiplan Commercial |
$91.50
|
| Rate for Payer: Networks By Design Commercial |
$79.30
|
| Rate for Payer: Prime Health Services Commercial |
$103.70
|
|
|
HC BLOOD GAS SODIUM
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
CPT 84295
|
| Hospital Charge Code |
900801123
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$109.80 |
| Rate for Payer: Adventist Health Commercial |
$24.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$35.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.48
|
| Rate for Payer: Blue Shield of California Commercial |
$76.86
|
| Rate for Payer: Blue Shield of California EPN |
$48.43
|
| Rate for Payer: Cash Price |
$54.90
|
| Rate for Payer: Cash Price |
$54.90
|
| Rate for Payer: Central Health Plan Commercial |
$97.60
|
| Rate for Payer: Cigna of CA HMO |
$78.08
|
| Rate for Payer: Cigna of CA PPO |
$90.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$85.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.94
|
| Rate for Payer: EPIC Health Plan Senior |
$5.29
|
| Rate for Payer: Galaxy Health WC |
$103.70
|
| Rate for Payer: Global Benefits Group Commercial |
$73.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$109.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$77.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.45
|
| Rate for Payer: Multiplan Commercial |
$91.50
|
| Rate for Payer: Networks By Design Commercial |
$79.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.81
|
| Rate for Payer: Prime Health Services Commercial |
$103.70
|
| Rate for Payer: Prime Health Services Medicare |
$5.10
|
| Rate for Payer: Riverside University Health System MISP |
$5.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$73.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$73.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.90
|
| Rate for Payer: United Healthcare All Other HMO |
$3.90
|
| Rate for Payer: United Healthcare HMO Rider |
$3.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.90
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.29
|
| Rate for Payer: Vantage Medical Group Senior |
$4.81
|
|
|
HC BLOOD GAS SODIUM
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
CPT 84295
|
| Hospital Charge Code |
900801123
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$109.80 |
| Rate for Payer: Adventist Health Commercial |
$24.40
|
| Rate for Payer: Cash Price |
$54.90
|
| Rate for Payer: Central Health Plan Commercial |
$97.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$85.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.80
|
| Rate for Payer: EPIC Health Plan Senior |
$48.80
|
| Rate for Payer: Galaxy Health WC |
$103.70
|
| Rate for Payer: Global Benefits Group Commercial |
$73.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$109.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$77.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.40
|
| Rate for Payer: Multiplan Commercial |
$91.50
|
| Rate for Payer: Networks By Design Commercial |
$79.30
|
| Rate for Payer: Prime Health Services Commercial |
$103.70
|
|
|
HC BLOOD OCCULT FECES
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
CPT 82274
|
| Hospital Charge Code |
900911638
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.90 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$15.92
|
| Rate for Payer: Adventist Health Medi-Cal |
$15.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$116.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$116.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.92
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.40
|
| Rate for Payer: Blue Shield of California Commercial |
$37.80
|
| Rate for Payer: Blue Shield of California Commercial |
$85.05
|
| Rate for Payer: Blue Shield of California EPN |
$23.82
|
| Rate for Payer: Blue Shield of California EPN |
$53.59
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Central Health Plan Commercial |
$108.00
|
| Rate for Payer: Central Health Plan Commercial |
$48.00
|
| Rate for Payer: Cigna of CA HMO |
$38.40
|
| Rate for Payer: Cigna of CA HMO |
$86.40
|
| Rate for Payer: Cigna of CA PPO |
$44.40
|
| Rate for Payer: Cigna of CA PPO |
$99.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.92
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$94.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$42.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.27
|
| Rate for Payer: EPIC Health Plan Senior |
$17.51
|
| Rate for Payer: EPIC Health Plan Senior |
$17.51
|
| Rate for Payer: Galaxy Health WC |
$51.00
|
| Rate for Payer: Galaxy Health WC |
$114.75
|
| Rate for Payer: Global Benefits Group Commercial |
$36.00
|
| Rate for Payer: Global Benefits Group Commercial |
$81.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$121.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$26.11
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$26.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$85.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21.33
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
| Rate for Payer: Multiplan Commercial |
$101.25
|
| Rate for Payer: Networks By Design Commercial |
$87.75
|
| Rate for Payer: Networks By Design Commercial |
$39.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$15.92
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$15.92
|
| Rate for Payer: Prime Health Services Commercial |
$51.00
|
| Rate for Payer: Prime Health Services Commercial |
$114.75
|
| Rate for Payer: Prime Health Services Medicare |
$16.88
|
| Rate for Payer: Prime Health Services Medicare |
$16.88
|
| Rate for Payer: Riverside University Health System MISP |
$17.51
|
| Rate for Payer: Riverside University Health System MISP |
$17.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.90
|
| Rate for Payer: United Healthcare All Other HMO |
$12.90
|
| Rate for Payer: United Healthcare All Other HMO |
$12.90
|
| Rate for Payer: United Healthcare HMO Rider |
$12.90
|
| Rate for Payer: United Healthcare HMO Rider |
$12.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.90
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.92
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.51
|
| Rate for Payer: Vantage Medical Group Senior |
$15.92
|
| Rate for Payer: Vantage Medical Group Senior |
$15.92
|
|
|
HC BLOOD OCCULT FECES
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
CPT 82274
|
| Hospital Charge Code |
900911638
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Central Health Plan Commercial |
$108.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$94.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.00
|
| Rate for Payer: EPIC Health Plan Senior |
$54.00
|
| Rate for Payer: Galaxy Health WC |
$114.75
|
| Rate for Payer: Global Benefits Group Commercial |
$81.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$121.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$85.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$79.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.00
|
| Rate for Payer: Multiplan Commercial |
$101.25
|
| Rate for Payer: Networks By Design Commercial |
$87.75
|
| Rate for Payer: Prime Health Services Commercial |
$114.75
|
|
|
HC BLOOD PH PCO2 P02 (POC)
|
Facility
|
OP
|
$251.00
|
|
|
Service Code
|
CPT 82803
|
| Hospital Charge Code |
900912112
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.38 |
| Max. Negotiated Rate |
$225.90 |
| Rate for Payer: Adventist Health Commercial |
$50.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$26.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$141.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$39.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$140.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$195.69
|
| Rate for Payer: Blue Shield of California Commercial |
$158.13
|
| Rate for Payer: Blue Shield of California EPN |
$99.65
|
| Rate for Payer: Cash Price |
$112.95
|
| Rate for Payer: Cash Price |
$112.95
|
| Rate for Payer: Central Health Plan Commercial |
$200.80
|
| Rate for Payer: Cigna of CA HMO |
$160.64
|
| Rate for Payer: Cigna of CA PPO |
$185.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$175.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.02
|
| Rate for Payer: EPIC Health Plan Senior |
$28.68
|
| Rate for Payer: Galaxy Health WC |
$213.35
|
| Rate for Payer: Global Benefits Group Commercial |
$150.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$225.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$42.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$26.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$159.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$36.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$34.93
|
| Rate for Payer: Multiplan Commercial |
$188.25
|
| Rate for Payer: Networks By Design Commercial |
$163.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$26.07
|
| Rate for Payer: Prime Health Services Commercial |
$213.35
|
| Rate for Payer: Prime Health Services Medicare |
$27.63
|
| Rate for Payer: Riverside University Health System MISP |
$28.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$150.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$150.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.11
|
| Rate for Payer: United Healthcare All Other HMO |
$21.11
|
| Rate for Payer: United Healthcare HMO Rider |
$21.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.11
|
| Rate for Payer: Upland Medical Group Pediatric |
$26.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$39.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.68
|
| Rate for Payer: Vantage Medical Group Senior |
$26.07
|
|
|
HC BLOOD PH PCO2 P02 (POC)
|
Facility
|
IP
|
$251.00
|
|
|
Service Code
|
CPT 82803
|
| Hospital Charge Code |
900912112
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.20 |
| Max. Negotiated Rate |
$225.90 |
| Rate for Payer: Adventist Health Commercial |
$50.20
|
| Rate for Payer: Cash Price |
$112.95
|
| Rate for Payer: Central Health Plan Commercial |
$200.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$175.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.40
|
| Rate for Payer: EPIC Health Plan Senior |
$100.40
|
| Rate for Payer: Galaxy Health WC |
$213.35
|
| Rate for Payer: Global Benefits Group Commercial |
$150.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$225.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$159.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$148.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.20
|
| Rate for Payer: Multiplan Commercial |
$188.25
|
| Rate for Payer: Networks By Design Commercial |
$163.15
|
| Rate for Payer: Prime Health Services Commercial |
$213.35
|
|
|
HC BLOOD/PLASMA VOLUME
|
Facility
|
OP
|
$1,311.00
|
|
|
Service Code
|
CPT 78111
|
| Hospital Charge Code |
909301331
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$90.15 |
| Max. Negotiated Rate |
$2,747.46 |
| Rate for Payer: Adventist Health Commercial |
$262.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,665.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$488.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,497.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,831.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,665.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$469.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$762.61
|
| Rate for Payer: Blue Shield of California Commercial |
$825.93
|
| Rate for Payer: Blue Shield of California EPN |
$520.47
|
| Rate for Payer: Cash Price |
$589.95
|
| Rate for Payer: Cash Price |
$589.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,048.80
|
| Rate for Payer: Cigna of CA HMO |
$839.04
|
| Rate for Payer: Cigna of CA PPO |
$970.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,497.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,831.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,665.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$917.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,747.46
|
| Rate for Payer: EPIC Health Plan Senior |
$1,831.64
|
| Rate for Payer: Galaxy Health WC |
$1,114.35
|
| Rate for Payer: Global Benefits Group Commercial |
$786.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,179.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,730.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$90.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,665.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$832.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$99.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,331.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$262.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,231.27
|
| Rate for Payer: Multiplan Commercial |
$983.25
|
| Rate for Payer: Networks By Design Commercial |
$852.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,665.13
|
| Rate for Payer: Prime Health Services Commercial |
$1,114.35
|
| Rate for Payer: Prime Health Services Medicare |
$1,765.04
|
| Rate for Payer: Riverside University Health System MISP |
$1,831.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$786.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$786.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,174.62
|
| Rate for Payer: United Healthcare All Other HMO |
$1,174.62
|
| Rate for Payer: United Healthcare HMO Rider |
$1,174.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,174.62
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,665.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,497.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,831.64
|
| Rate for Payer: Vantage Medical Group Senior |
$1,665.13
|
|
|
HC BLOOD/PLASMA VOLUME
|
Facility
|
IP
|
$1,311.00
|
|
|
Service Code
|
CPT 78111
|
| Hospital Charge Code |
909301331
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$262.20 |
| Max. Negotiated Rate |
$1,179.90 |
| Rate for Payer: Adventist Health Commercial |
$262.20
|
| Rate for Payer: Cash Price |
$589.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,048.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$917.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$524.40
|
| Rate for Payer: EPIC Health Plan Senior |
$524.40
|
| Rate for Payer: Galaxy Health WC |
$1,114.35
|
| Rate for Payer: Global Benefits Group Commercial |
$786.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,179.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$832.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$773.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$262.20
|
| Rate for Payer: Multiplan Commercial |
$983.25
|
| Rate for Payer: Networks By Design Commercial |
$852.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,114.35
|
|
|
HC BLUE RHINO TRAY TRACH 7.5MM
|
Facility
|
OP
|
$1,869.00
|
|
| Hospital Charge Code |
900831707
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$373.80 |
| Max. Negotiated Rate |
$1,682.10 |
| Rate for Payer: Adventist Health Commercial |
$373.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,135.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,588.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,027.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,401.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$904.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,087.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,184.95
|
| Rate for Payer: Blue Shield of California EPN |
$745.73
|
| Rate for Payer: Cash Price |
$841.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,495.20
|
| Rate for Payer: Cigna of CA HMO |
$1,196.16
|
| Rate for Payer: Cigna of CA PPO |
$1,383.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,588.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,588.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,588.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,308.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$747.60
|
| Rate for Payer: EPIC Health Plan Senior |
$747.60
|
| Rate for Payer: Galaxy Health WC |
$1,588.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,121.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,682.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,186.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$678.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,102.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$373.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,308.30
|
| Rate for Payer: Multiplan Commercial |
$1,401.75
|
| Rate for Payer: Networks By Design Commercial |
$1,214.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,588.65
|
| Rate for Payer: Riverside University Health System MISP |
$747.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,121.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,121.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$934.50
|
| Rate for Payer: United Healthcare All Other HMO |
$934.50
|
| Rate for Payer: United Healthcare HMO Rider |
$934.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$934.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,588.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,588.65
|
| Rate for Payer: Vantage Medical Group Senior |
$1,588.65
|
|
|
HC BLUE RHINO TRAY TRACH 7.5MM
|
Facility
|
IP
|
$1,869.00
|
|
| Hospital Charge Code |
900831707
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$373.80 |
| Max. Negotiated Rate |
$1,682.10 |
| Rate for Payer: Adventist Health Commercial |
$373.80
|
| Rate for Payer: Cash Price |
$841.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,495.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,308.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$747.60
|
| Rate for Payer: EPIC Health Plan Senior |
$747.60
|
| Rate for Payer: Galaxy Health WC |
$1,588.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,121.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,682.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,186.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,102.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$373.80
|
| Rate for Payer: Multiplan Commercial |
$1,401.75
|
| Rate for Payer: Networks By Design Commercial |
$1,214.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,588.65
|
|
|
HC BLUE RHINO TRAY TRACH 8.5MM
|
Facility
|
OP
|
$1,869.00
|
|
| Hospital Charge Code |
900831708
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$373.80 |
| Max. Negotiated Rate |
$1,682.10 |
| Rate for Payer: Adventist Health Commercial |
$373.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,135.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,588.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,027.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,401.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$904.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,087.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,184.95
|
| Rate for Payer: Blue Shield of California EPN |
$745.73
|
| Rate for Payer: Cash Price |
$841.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,495.20
|
| Rate for Payer: Cigna of CA HMO |
$1,196.16
|
| Rate for Payer: Cigna of CA PPO |
$1,383.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,588.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,588.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,588.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,308.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$747.60
|
| Rate for Payer: EPIC Health Plan Senior |
$747.60
|
| Rate for Payer: Galaxy Health WC |
$1,588.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,121.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,682.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,186.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$678.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,102.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$373.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,308.30
|
| Rate for Payer: Multiplan Commercial |
$1,401.75
|
| Rate for Payer: Networks By Design Commercial |
$1,214.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,588.65
|
| Rate for Payer: Riverside University Health System MISP |
$747.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,121.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,121.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$934.50
|
| Rate for Payer: United Healthcare All Other HMO |
$934.50
|
| Rate for Payer: United Healthcare HMO Rider |
$934.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$934.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,588.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,588.65
|
| Rate for Payer: Vantage Medical Group Senior |
$1,588.65
|
|
|
HC BLUE RHINO TRAY TRACH 8.5MM
|
Facility
|
IP
|
$1,869.00
|
|
| Hospital Charge Code |
900831708
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$373.80 |
| Max. Negotiated Rate |
$1,682.10 |
| Rate for Payer: Adventist Health Commercial |
$373.80
|
| Rate for Payer: Cash Price |
$841.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,495.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,308.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$747.60
|
| Rate for Payer: EPIC Health Plan Senior |
$747.60
|
| Rate for Payer: Galaxy Health WC |
$1,588.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,121.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,682.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,186.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,102.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$373.80
|
| Rate for Payer: Multiplan Commercial |
$1,401.75
|
| Rate for Payer: Networks By Design Commercial |
$1,214.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,588.65
|
|
|
HC BNDG BULKEE II ROLL 3.4"X3.6YD
|
Facility
|
IP
|
$4.35
|
|
|
Service Code
|
CPT A6446
|
| Hospital Charge Code |
901607953
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$3.92 |
| Rate for Payer: Adventist Health Commercial |
$0.87
|
| Rate for Payer: Cash Price |
$1.96
|
| Rate for Payer: Central Health Plan Commercial |
$3.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.74
|
| Rate for Payer: EPIC Health Plan Senior |
$1.74
|
| Rate for Payer: Galaxy Health WC |
$3.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.87
|
| Rate for Payer: Multiplan Commercial |
$3.26
|
| Rate for Payer: Networks By Design Commercial |
$2.83
|
| Rate for Payer: Prime Health Services Commercial |
$3.70
|
|
|
HC BNDG BULKEE II ROLL 3.4"X3.6YD
|
Facility
|
OP
|
$4.35
|
|
|
Service Code
|
CPT A6446
|
| Hospital Charge Code |
901607953
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$3.92 |
| Rate for Payer: Adventist Health Commercial |
$0.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.53
|
| Rate for Payer: Blue Shield of California Commercial |
$2.76
|
| Rate for Payer: Blue Shield of California EPN |
$1.74
|
| Rate for Payer: Cash Price |
$1.96
|
| Rate for Payer: Cash Price |
$1.96
|
| Rate for Payer: Central Health Plan Commercial |
$3.48
|
| Rate for Payer: Cigna of CA HMO |
$2.78
|
| Rate for Payer: Cigna of CA PPO |
$3.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.74
|
| Rate for Payer: EPIC Health Plan Senior |
$1.74
|
| Rate for Payer: Galaxy Health WC |
$3.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.04
|
| Rate for Payer: Multiplan Commercial |
$3.26
|
| Rate for Payer: Networks By Design Commercial |
$2.83
|
| Rate for Payer: Prime Health Services Commercial |
$3.70
|
| Rate for Payer: Riverside University Health System MISP |
$1.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.17
|
| Rate for Payer: United Healthcare All Other HMO |
$2.17
|
| Rate for Payer: United Healthcare HMO Rider |
$2.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.70
|
| Rate for Payer: Vantage Medical Group Senior |
$3.70
|
|
|
HC BNDG BULKEE ROLL 6 X 6.75"
|
Facility
|
OP
|
$1.56
|
|
|
Service Code
|
CPT A6403
|
| Hospital Charge Code |
901607952
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$1.40 |
| Rate for Payer: Adventist Health Commercial |
$0.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.91
|
| Rate for Payer: Blue Shield of California Commercial |
$0.99
|
| Rate for Payer: Blue Shield of California EPN |
$0.62
|
| Rate for Payer: Cash Price |
$0.70
|
| Rate for Payer: Cash Price |
$0.70
|
| Rate for Payer: Central Health Plan Commercial |
$1.25
|
| Rate for Payer: Cigna of CA HMO |
$1.00
|
| Rate for Payer: Cigna of CA PPO |
$1.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.33
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.62
|
| Rate for Payer: EPIC Health Plan Senior |
$0.62
|
| Rate for Payer: Galaxy Health WC |
$1.33
|
| Rate for Payer: Global Benefits Group Commercial |
$0.94
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.09
|
| Rate for Payer: Multiplan Commercial |
$1.17
|
| Rate for Payer: Networks By Design Commercial |
$1.01
|
| Rate for Payer: Prime Health Services Commercial |
$1.33
|
| Rate for Payer: Riverside University Health System MISP |
$0.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.94
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.78
|
| Rate for Payer: United Healthcare All Other HMO |
$0.78
|
| Rate for Payer: United Healthcare HMO Rider |
$0.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.33
|
| Rate for Payer: Vantage Medical Group Senior |
$1.33
|
|
|
HC BNDG BULKEE ROLL 6 X 6.75"
|
Facility
|
IP
|
$1.56
|
|
|
Service Code
|
CPT A6403
|
| Hospital Charge Code |
901607952
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$1.40 |
| Rate for Payer: Adventist Health Commercial |
$0.31
|
| Rate for Payer: Cash Price |
$0.70
|
| Rate for Payer: Central Health Plan Commercial |
$1.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.62
|
| Rate for Payer: EPIC Health Plan Senior |
$0.62
|
| Rate for Payer: Galaxy Health WC |
$1.33
|
| Rate for Payer: Global Benefits Group Commercial |
$0.94
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.31
|
| Rate for Payer: Multiplan Commercial |
$1.17
|
| Rate for Payer: Networks By Design Commercial |
$1.01
|
| Rate for Payer: Prime Health Services Commercial |
$1.33
|
|
