|
HC BX OF PLEURA PERC NEEDLE
|
Facility
|
OP
|
$6,395.00
|
|
|
Service Code
|
CPT 32400
|
| Hospital Charge Code |
900831706
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$230.53 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,279.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,124.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,280.13
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$2,877.75
|
| Rate for Payer: Cash Price |
$2,877.75
|
| Rate for Payer: Cash Price |
$2,877.75
|
| Rate for Payer: Central Health Plan Commercial |
$5,116.00
|
| Rate for Payer: Cigna of CA HMO |
$4,092.80
|
| Rate for Payer: Cigna of CA PPO |
$4,732.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,476.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,504.98
|
| Rate for Payer: EPIC Health Plan Senior |
$2,336.65
|
| Rate for Payer: Galaxy Health WC |
$5,435.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,837.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,755.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,483.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$230.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,060.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$254.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,973.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,279.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,846.47
|
| Rate for Payer: Multiplan Commercial |
$4,796.25
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$4,156.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Preferred Health Network WC |
$3,347.07
|
| Rate for Payer: Prime Health Services Commercial |
$5,435.75
|
| Rate for Payer: Prime Health Services Medicare |
$2,251.68
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Riverside University Health System MISP |
$2,336.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,837.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,197.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,124.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
|
HC BX OR EXC OF LN OPEN, INGFEM NODES
|
Facility
|
OP
|
$11,525.00
|
|
|
Service Code
|
CPT 38531
|
| Hospital Charge Code |
909008531
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$647.41 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$2,305.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$5,035.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,553.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,539.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,035.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$7,752.28
|
| Rate for Payer: Blue Shield of California Commercial |
$6,228.07
|
| Rate for Payer: Blue Shield of California EPN |
$3,914.40
|
| Rate for Payer: Cash Price |
$5,186.25
|
| Rate for Payer: Cash Price |
$5,186.25
|
| Rate for Payer: Cash Price |
$5,186.25
|
| Rate for Payer: Central Health Plan Commercial |
$9,220.00
|
| Rate for Payer: Cigna of CA HMO |
$7,376.00
|
| Rate for Payer: Cigna of CA PPO |
$8,528.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,553.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,539.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,035.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,067.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,309.24
|
| Rate for Payer: EPIC Health Plan Senior |
$5,539.49
|
| Rate for Payer: Galaxy Health WC |
$9,796.25
|
| Rate for Payer: Global Benefits Group Commercial |
$6,915.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,372.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8,258.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$647.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5,035.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,318.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$715.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,050.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,305.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,748.11
|
| Rate for Payer: Multiplan Commercial |
$8,643.75
|
| Rate for Payer: Multiplan WC |
$7,752.28
|
| Rate for Payer: Networks By Design Commercial |
$7,491.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5,035.90
|
| Rate for Payer: Preferred Health Network WC |
$7,910.49
|
| Rate for Payer: Prime Health Services Commercial |
$9,796.25
|
| Rate for Payer: Prime Health Services Medicare |
$5,338.05
|
| Rate for Payer: Prime Health Services WC |
$7,673.18
|
| Rate for Payer: Riverside University Health System MISP |
$5,539.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,915.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,762.50
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$5,035.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,553.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,539.49
|
| Rate for Payer: Vantage Medical Group Senior |
$5,035.90
|
|
|
HC BX OR EXC OF LN OPEN, INGFEM NODES
|
Facility
|
IP
|
$11,525.00
|
|
|
Service Code
|
CPT 38531
|
| Hospital Charge Code |
909008531
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,305.00 |
| Max. Negotiated Rate |
$10,372.50 |
| Rate for Payer: Adventist Health Commercial |
$2,305.00
|
| Rate for Payer: Cash Price |
$5,186.25
|
| Rate for Payer: Central Health Plan Commercial |
$9,220.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,067.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,610.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,610.00
|
| Rate for Payer: Galaxy Health WC |
$9,796.25
|
| Rate for Payer: Global Benefits Group Commercial |
$6,915.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,372.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,318.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,799.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,305.00
|
| Rate for Payer: Multiplan Commercial |
$8,643.75
|
| Rate for Payer: Networks By Design Commercial |
$7,491.25
|
| Rate for Payer: Prime Health Services Commercial |
$9,796.25
|
|
|
HC BX SALIVARY GLAND; NEEDLE
|
Facility
|
IP
|
$3,171.00
|
|
|
Service Code
|
CPT 42400
|
| Hospital Charge Code |
900501748
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$634.20 |
| Max. Negotiated Rate |
$2,853.90 |
| Rate for Payer: Adventist Health Commercial |
$634.20
|
| Rate for Payer: Cash Price |
$1,426.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,536.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,219.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,268.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,268.40
|
| Rate for Payer: Galaxy Health WC |
$2,695.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,902.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,853.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,013.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,870.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$634.20
|
| Rate for Payer: Multiplan Commercial |
$2,378.25
|
| Rate for Payer: Networks By Design Commercial |
$2,061.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,695.35
|
|
|
HC BX SALIVARY GLAND; NEEDLE
|
Facility
|
OP
|
$3,171.00
|
|
|
Service Code
|
CPT 42400
|
| Hospital Charge Code |
900501748
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$95.49 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$634.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$910.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,424.40
|
| Rate for Payer: Cash Price |
$1,426.95
|
| Rate for Payer: Cash Price |
$1,426.95
|
| Rate for Payer: Cash Price |
$1,426.95
|
| Rate for Payer: Cash Price |
$1,426.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,536.80
|
| Rate for Payer: Cigna of CA HMO |
$2,029.44
|
| Rate for Payer: Cigna of CA PPO |
$2,346.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,001.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$910.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,219.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,502.79
|
| Rate for Payer: EPIC Health Plan Senior |
$1,001.86
|
| Rate for Payer: Galaxy Health WC |
$2,695.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,902.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,853.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,493.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$910.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,013.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$95.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$979.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$634.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,220.45
|
| Rate for Payer: Multiplan Commercial |
$2,378.25
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$2,061.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$910.78
|
| Rate for Payer: Preferred Health Network WC |
$1,453.47
|
| Rate for Payer: Prime Health Services Commercial |
$2,695.35
|
| Rate for Payer: Prime Health Services Medicare |
$965.43
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Riverside University Health System MISP |
$1,001.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,902.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,585.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,585.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,585.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,585.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$910.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Vantage Medical Group Senior |
$910.78
|
|
|
HC BX SALIVARY GLAND; NEEDLE
|
Facility
|
IP
|
$3,171.00
|
|
|
Service Code
|
CPT 42400
|
| Hospital Charge Code |
900501748
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$634.20 |
| Max. Negotiated Rate |
$2,853.90 |
| Rate for Payer: Adventist Health Commercial |
$634.20
|
| Rate for Payer: Cash Price |
$1,426.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,536.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,219.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,268.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,268.40
|
| Rate for Payer: Galaxy Health WC |
$2,695.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,902.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,853.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,013.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,870.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$634.20
|
| Rate for Payer: Multiplan Commercial |
$2,378.25
|
| Rate for Payer: Networks By Design Commercial |
$2,061.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,695.35
|
|
|
HC BX SALIVARY GLAND; NEEDLE
|
Facility
|
OP
|
$3,171.00
|
|
|
Service Code
|
CPT 42400
|
| Hospital Charge Code |
900501748
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$86.45 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$634.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$910.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$910.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,424.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$1,426.95
|
| Rate for Payer: Cash Price |
$1,426.95
|
| Rate for Payer: Cash Price |
$1,426.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,536.80
|
| Rate for Payer: Cigna of CA HMO |
$2,029.44
|
| Rate for Payer: Cigna of CA PPO |
$2,346.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,001.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$910.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,219.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,502.79
|
| Rate for Payer: EPIC Health Plan Senior |
$1,001.86
|
| Rate for Payer: Galaxy Health WC |
$2,695.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,902.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,853.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,493.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$86.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$910.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,013.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$95.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,275.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$634.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,220.45
|
| Rate for Payer: Multiplan Commercial |
$2,378.25
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$2,061.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$910.78
|
| Rate for Payer: Preferred Health Network WC |
$1,453.47
|
| Rate for Payer: Prime Health Services Commercial |
$2,695.35
|
| Rate for Payer: Prime Health Services Medicare |
$965.43
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Riverside University Health System MISP |
$1,001.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,902.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,585.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$910.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Vantage Medical Group Senior |
$910.78
|
|
|
HC BX SOFT TISSUE SHLDR AREA; SUPERFICIAL
|
Facility
|
OP
|
$5,824.00
|
|
|
Service Code
|
CPT 23065
|
| Hospital Charge Code |
906601065
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$144.72 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,164.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,124.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,280.13
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$2,620.80
|
| Rate for Payer: Cash Price |
$2,620.80
|
| Rate for Payer: Cash Price |
$2,620.80
|
| Rate for Payer: Central Health Plan Commercial |
$4,659.20
|
| Rate for Payer: Cigna of CA HMO |
$3,727.36
|
| Rate for Payer: Cigna of CA PPO |
$4,309.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,076.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,504.98
|
| Rate for Payer: EPIC Health Plan Senior |
$2,336.65
|
| Rate for Payer: Galaxy Health WC |
$4,950.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,494.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,241.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,483.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$144.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,698.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$159.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,973.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,164.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,846.47
|
| Rate for Payer: Multiplan Commercial |
$4,368.00
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$3,785.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Preferred Health Network WC |
$3,347.07
|
| Rate for Payer: Prime Health Services Commercial |
$4,950.40
|
| Rate for Payer: Prime Health Services Medicare |
$2,251.68
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Riverside University Health System MISP |
$2,336.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,494.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,912.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,124.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
|
HC BX SOFT TISSUE SHLDR AREA; SUPERFICIAL
|
Facility
|
IP
|
$5,824.00
|
|
|
Service Code
|
CPT 23065
|
| Hospital Charge Code |
906601065
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,164.80 |
| Max. Negotiated Rate |
$5,241.60 |
| Rate for Payer: Adventist Health Commercial |
$1,164.80
|
| Rate for Payer: Cash Price |
$2,620.80
|
| Rate for Payer: Central Health Plan Commercial |
$4,659.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,076.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,329.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,329.60
|
| Rate for Payer: Galaxy Health WC |
$4,950.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,494.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,241.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,698.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,436.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,164.80
|
| Rate for Payer: Multiplan Commercial |
$4,368.00
|
| Rate for Payer: Networks By Design Commercial |
$3,785.60
|
| Rate for Payer: Prime Health Services Commercial |
$4,950.40
|
|
|
HC C-14 UREA BREATH TEST ACQ
|
Facility
|
IP
|
$468.00
|
|
|
Service Code
|
CPT 78267
|
| Hospital Charge Code |
909301257
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$93.60 |
| Max. Negotiated Rate |
$421.20 |
| Rate for Payer: Adventist Health Commercial |
$93.60
|
| Rate for Payer: Cash Price |
$210.60
|
| Rate for Payer: Central Health Plan Commercial |
$374.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$327.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$187.20
|
| Rate for Payer: EPIC Health Plan Senior |
$187.20
|
| Rate for Payer: Galaxy Health WC |
$397.80
|
| Rate for Payer: Global Benefits Group Commercial |
$280.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$421.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$297.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$276.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.60
|
| Rate for Payer: Multiplan Commercial |
$351.00
|
| Rate for Payer: Networks By Design Commercial |
$304.20
|
| Rate for Payer: Prime Health Services Commercial |
$397.80
|
|
|
HC C-14 UREA BREATH TEST ACQ
|
Facility
|
OP
|
$468.00
|
|
|
Service Code
|
CPT 78267
|
| Hospital Charge Code |
909301257
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$11.06 |
| Max. Negotiated Rate |
$421.20 |
| Rate for Payer: Adventist Health Commercial |
$93.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$11.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$71.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$56.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$272.24
|
| Rate for Payer: Blue Shield of California Commercial |
$294.84
|
| Rate for Payer: Blue Shield of California EPN |
$185.80
|
| Rate for Payer: Cash Price |
$210.60
|
| Rate for Payer: Cash Price |
$210.60
|
| Rate for Payer: Central Health Plan Commercial |
$374.40
|
| Rate for Payer: Cigna of CA HMO |
$299.52
|
| Rate for Payer: Cigna of CA PPO |
$346.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$327.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.25
|
| Rate for Payer: EPIC Health Plan Senior |
$12.17
|
| Rate for Payer: Galaxy Health WC |
$397.80
|
| Rate for Payer: Global Benefits Group Commercial |
$280.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$421.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$297.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$169.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14.82
|
| Rate for Payer: Multiplan Commercial |
$351.00
|
| Rate for Payer: Networks By Design Commercial |
$304.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11.06
|
| Rate for Payer: Prime Health Services Commercial |
$397.80
|
| Rate for Payer: Prime Health Services Medicare |
$11.72
|
| Rate for Payer: Riverside University Health System MISP |
$12.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$280.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$280.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.51
|
| Rate for Payer: United Healthcare All Other HMO |
$28.51
|
| Rate for Payer: United Healthcare HMO Rider |
$28.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.51
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.17
|
| Rate for Payer: Vantage Medical Group Senior |
$11.06
|
|
|
HC C-14 UREA BREATH TEST ANAL
|
Facility
|
OP
|
$454.00
|
|
|
Service Code
|
CPT 78268
|
| Hospital Charge Code |
909301258
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$90.80 |
| Max. Negotiated Rate |
$603.14 |
| Rate for Payer: Adventist Health Commercial |
$90.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$94.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$603.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$141.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$103.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$94.41
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$465.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$264.09
|
| Rate for Payer: Blue Shield of California Commercial |
$286.02
|
| Rate for Payer: Blue Shield of California EPN |
$180.24
|
| Rate for Payer: Cash Price |
$204.30
|
| Rate for Payer: Cash Price |
$204.30
|
| Rate for Payer: Central Health Plan Commercial |
$363.20
|
| Rate for Payer: Cigna of CA HMO |
$290.56
|
| Rate for Payer: Cigna of CA PPO |
$335.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$141.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$103.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$94.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$317.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$155.78
|
| Rate for Payer: EPIC Health Plan Senior |
$103.85
|
| Rate for Payer: Galaxy Health WC |
$385.90
|
| Rate for Payer: Global Benefits Group Commercial |
$272.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$408.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$154.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$94.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$288.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$164.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$132.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$126.51
|
| Rate for Payer: Multiplan Commercial |
$340.50
|
| Rate for Payer: Networks By Design Commercial |
$295.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$94.41
|
| Rate for Payer: Prime Health Services Commercial |
$385.90
|
| Rate for Payer: Prime Health Services Medicare |
$100.07
|
| Rate for Payer: Riverside University Health System MISP |
$103.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$272.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$272.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$244.22
|
| Rate for Payer: United Healthcare All Other HMO |
$244.22
|
| Rate for Payer: United Healthcare HMO Rider |
$244.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$244.22
|
| Rate for Payer: Upland Medical Group Pediatric |
$94.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$141.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$103.85
|
| Rate for Payer: Vantage Medical Group Senior |
$94.41
|
|
|
HC C-14 UREA BREATH TEST ANAL
|
Facility
|
IP
|
$454.00
|
|
|
Service Code
|
CPT 78268
|
| Hospital Charge Code |
909301258
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$90.80 |
| Max. Negotiated Rate |
$408.60 |
| Rate for Payer: Adventist Health Commercial |
$90.80
|
| Rate for Payer: Cash Price |
$204.30
|
| Rate for Payer: Central Health Plan Commercial |
$363.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$317.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$181.60
|
| Rate for Payer: EPIC Health Plan Senior |
$181.60
|
| Rate for Payer: Galaxy Health WC |
$385.90
|
| Rate for Payer: Global Benefits Group Commercial |
$272.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$408.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$288.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$267.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.80
|
| Rate for Payer: Multiplan Commercial |
$340.50
|
| Rate for Payer: Networks By Design Commercial |
$295.10
|
| Rate for Payer: Prime Health Services Commercial |
$385.90
|
|
|
HC CABLE MED COAXIAL UMBILICAL
|
Facility
|
OP
|
$644.00
|
|
| Hospital Charge Code |
906812449
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$128.80 |
| Max. Negotiated Rate |
$579.60 |
| Rate for Payer: Adventist Health Commercial |
$128.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$391.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$547.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$354.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$483.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$311.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$374.61
|
| Rate for Payer: Blue Shield of California Commercial |
$408.30
|
| Rate for Payer: Blue Shield of California EPN |
$256.96
|
| Rate for Payer: Cash Price |
$289.80
|
| Rate for Payer: Central Health Plan Commercial |
$515.20
|
| Rate for Payer: Cigna of CA HMO |
$412.16
|
| Rate for Payer: Cigna of CA PPO |
$476.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$547.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$547.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$547.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$450.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$257.60
|
| Rate for Payer: EPIC Health Plan Senior |
$257.60
|
| Rate for Payer: Galaxy Health WC |
$547.40
|
| Rate for Payer: Global Benefits Group Commercial |
$386.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$579.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$408.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$233.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$379.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$450.80
|
| Rate for Payer: Multiplan Commercial |
$483.00
|
| Rate for Payer: Networks By Design Commercial |
$418.60
|
| Rate for Payer: Prime Health Services Commercial |
$547.40
|
| Rate for Payer: Riverside University Health System MISP |
$257.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$386.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$386.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$322.00
|
| Rate for Payer: United Healthcare All Other HMO |
$322.00
|
| Rate for Payer: United Healthcare HMO Rider |
$322.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$322.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$547.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$547.40
|
| Rate for Payer: Vantage Medical Group Senior |
$547.40
|
|
|
HC CABLE MED COAXIAL UMBILICAL
|
Facility
|
IP
|
$644.00
|
|
| Hospital Charge Code |
906812449
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$128.80 |
| Max. Negotiated Rate |
$579.60 |
| Rate for Payer: Adventist Health Commercial |
$128.80
|
| Rate for Payer: Cash Price |
$289.80
|
| Rate for Payer: Central Health Plan Commercial |
$515.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$450.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$257.60
|
| Rate for Payer: EPIC Health Plan Senior |
$257.60
|
| Rate for Payer: Galaxy Health WC |
$547.40
|
| Rate for Payer: Global Benefits Group Commercial |
$386.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$579.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$408.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$379.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.80
|
| Rate for Payer: Multiplan Commercial |
$483.00
|
| Rate for Payer: Networks By Design Commercial |
$418.60
|
| Rate for Payer: Prime Health Services Commercial |
$547.40
|
|
|
HC CABLE MED ELECTRICAL UMBILICAL
|
Facility
|
OP
|
$966.00
|
|
| Hospital Charge Code |
906812448
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$193.20 |
| Max. Negotiated Rate |
$869.40 |
| Rate for Payer: Adventist Health Commercial |
$193.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$586.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$821.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$531.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$724.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$467.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$561.92
|
| Rate for Payer: Blue Shield of California Commercial |
$612.44
|
| Rate for Payer: Blue Shield of California EPN |
$385.43
|
| Rate for Payer: Cash Price |
$434.70
|
| Rate for Payer: Central Health Plan Commercial |
$772.80
|
| Rate for Payer: Cigna of CA HMO |
$618.24
|
| Rate for Payer: Cigna of CA PPO |
$714.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$821.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$821.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$821.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$676.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$386.40
|
| Rate for Payer: EPIC Health Plan Senior |
$386.40
|
| Rate for Payer: Galaxy Health WC |
$821.10
|
| Rate for Payer: Global Benefits Group Commercial |
$579.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$869.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$613.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$350.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$569.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$193.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$676.20
|
| Rate for Payer: Multiplan Commercial |
$724.50
|
| Rate for Payer: Networks By Design Commercial |
$627.90
|
| Rate for Payer: Prime Health Services Commercial |
$821.10
|
| Rate for Payer: Riverside University Health System MISP |
$386.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$579.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$579.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$483.00
|
| Rate for Payer: United Healthcare All Other HMO |
$483.00
|
| Rate for Payer: United Healthcare HMO Rider |
$483.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$483.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$821.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$821.10
|
| Rate for Payer: Vantage Medical Group Senior |
$821.10
|
|
|
HC CABLE MED ELECTRICAL UMBILICAL
|
Facility
|
IP
|
$966.00
|
|
| Hospital Charge Code |
906812448
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$193.20 |
| Max. Negotiated Rate |
$869.40 |
| Rate for Payer: Adventist Health Commercial |
$193.20
|
| Rate for Payer: Cash Price |
$434.70
|
| Rate for Payer: Central Health Plan Commercial |
$772.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$676.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$386.40
|
| Rate for Payer: EPIC Health Plan Senior |
$386.40
|
| Rate for Payer: Galaxy Health WC |
$821.10
|
| Rate for Payer: Global Benefits Group Commercial |
$579.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$869.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$613.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$569.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$193.20
|
| Rate for Payer: Multiplan Commercial |
$724.50
|
| Rate for Payer: Networks By Design Commercial |
$627.90
|
| Rate for Payer: Prime Health Services Commercial |
$821.10
|
|
|
HC CA CALCIUM IONIZED
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 82330
|
| Hospital Charge Code |
900910502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$138.22 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Adventist Health Commercial |
$75.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.68
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$100.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$100.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$99.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$99.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$138.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$138.22
|
| Rate for Payer: Blue Shield of California Commercial |
$238.14
|
| Rate for Payer: Blue Shield of California Commercial |
$63.00
|
| Rate for Payer: Blue Shield of California EPN |
$150.07
|
| Rate for Payer: Blue Shield of California EPN |
$39.70
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Central Health Plan Commercial |
$80.00
|
| Rate for Payer: Central Health Plan Commercial |
$302.40
|
| Rate for Payer: Cigna of CA HMO |
$241.92
|
| Rate for Payer: Cigna of CA HMO |
$64.00
|
| Rate for Payer: Cigna of CA PPO |
$279.72
|
| Rate for Payer: Cigna of CA PPO |
$74.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$70.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$264.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.57
|
| Rate for Payer: EPIC Health Plan Senior |
$15.05
|
| Rate for Payer: EPIC Health Plan Senior |
$15.05
|
| Rate for Payer: Galaxy Health WC |
$321.30
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$226.80
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$340.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.44
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$63.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$240.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.33
|
| Rate for Payer: Multiplan Commercial |
$283.50
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
| Rate for Payer: Networks By Design Commercial |
$65.00
|
| Rate for Payer: Networks By Design Commercial |
$245.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.68
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.68
|
| Rate for Payer: Prime Health Services Commercial |
$321.30
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
| Rate for Payer: Prime Health Services Medicare |
$14.50
|
| Rate for Payer: Prime Health Services Medicare |
$14.50
|
| Rate for Payer: Riverside University Health System MISP |
$15.05
|
| Rate for Payer: Riverside University Health System MISP |
$15.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$226.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$226.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.08
|
| Rate for Payer: United Healthcare All Other HMO |
$11.08
|
| Rate for Payer: United Healthcare All Other HMO |
$11.08
|
| Rate for Payer: United Healthcare HMO Rider |
$11.08
|
| Rate for Payer: United Healthcare HMO Rider |
$11.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.08
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.68
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.05
|
| Rate for Payer: Vantage Medical Group Senior |
$13.68
|
| Rate for Payer: Vantage Medical Group Senior |
$13.68
|
|
|
HC CA CALCIUM IONIZED
|
Facility
|
IP
|
$378.00
|
|
|
Service Code
|
CPT 82330
|
| Hospital Charge Code |
900910502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$75.60 |
| Max. Negotiated Rate |
$340.20 |
| Rate for Payer: Adventist Health Commercial |
$75.60
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Central Health Plan Commercial |
$302.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$264.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.20
|
| Rate for Payer: EPIC Health Plan Senior |
$151.20
|
| Rate for Payer: Galaxy Health WC |
$321.30
|
| Rate for Payer: Global Benefits Group Commercial |
$226.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$340.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$240.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$223.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.60
|
| Rate for Payer: Multiplan Commercial |
$283.50
|
| Rate for Payer: Networks By Design Commercial |
$245.70
|
| Rate for Payer: Prime Health Services Commercial |
$321.30
|
|
|
HC CAFFEINE SERUM
|
Facility
|
OP
|
$158.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900910538
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.10 |
| Max. Negotiated Rate |
$147.28 |
| Rate for Payer: Adventist Health Commercial |
$31.60
|
| Rate for Payer: Adventist Health Commercial |
$9.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$18.64
|
| Rate for Payer: Adventist Health Medi-Cal |
$18.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$97.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$97.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$105.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$105.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.28
|
| Rate for Payer: Blue Shield of California Commercial |
$28.98
|
| Rate for Payer: Blue Shield of California Commercial |
$99.54
|
| Rate for Payer: Blue Shield of California EPN |
$18.26
|
| Rate for Payer: Blue Shield of California EPN |
$62.73
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Central Health Plan Commercial |
$126.40
|
| Rate for Payer: Central Health Plan Commercial |
$36.80
|
| Rate for Payer: Cigna of CA HMO |
$29.44
|
| Rate for Payer: Cigna of CA HMO |
$101.12
|
| Rate for Payer: Cigna of CA PPO |
$34.04
|
| Rate for Payer: Cigna of CA PPO |
$116.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$110.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$32.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.76
|
| Rate for Payer: EPIC Health Plan Senior |
$20.50
|
| Rate for Payer: EPIC Health Plan Senior |
$20.50
|
| Rate for Payer: Galaxy Health WC |
$39.10
|
| Rate for Payer: Galaxy Health WC |
$134.30
|
| Rate for Payer: Global Benefits Group Commercial |
$27.60
|
| Rate for Payer: Global Benefits Group Commercial |
$94.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$41.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$142.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.57
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$100.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$29.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.98
|
| Rate for Payer: Multiplan Commercial |
$34.50
|
| Rate for Payer: Multiplan Commercial |
$118.50
|
| Rate for Payer: Networks By Design Commercial |
$102.70
|
| Rate for Payer: Networks By Design Commercial |
$29.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18.64
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18.64
|
| Rate for Payer: Prime Health Services Commercial |
$39.10
|
| Rate for Payer: Prime Health Services Commercial |
$134.30
|
| Rate for Payer: Prime Health Services Medicare |
$19.76
|
| Rate for Payer: Prime Health Services Medicare |
$19.76
|
| Rate for Payer: Riverside University Health System MISP |
$20.50
|
| Rate for Payer: Riverside University Health System MISP |
$20.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$94.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$94.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.10
|
| Rate for Payer: United Healthcare All Other HMO |
$15.10
|
| Rate for Payer: United Healthcare All Other HMO |
$15.10
|
| Rate for Payer: United Healthcare HMO Rider |
$15.10
|
| Rate for Payer: United Healthcare HMO Rider |
$15.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.10
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.64
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Vantage Medical Group Senior |
$18.64
|
| Rate for Payer: Vantage Medical Group Senior |
$18.64
|
|
|
HC CAFFEINE SERUM
|
Facility
|
IP
|
$158.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900910538
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.60 |
| Max. Negotiated Rate |
$142.20 |
| Rate for Payer: Adventist Health Commercial |
$31.60
|
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Central Health Plan Commercial |
$126.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$110.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.20
|
| Rate for Payer: EPIC Health Plan Senior |
$63.20
|
| Rate for Payer: Galaxy Health WC |
$134.30
|
| Rate for Payer: Global Benefits Group Commercial |
$94.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$142.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$100.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$93.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.60
|
| Rate for Payer: Multiplan Commercial |
$118.50
|
| Rate for Payer: Networks By Design Commercial |
$102.70
|
| Rate for Payer: Prime Health Services Commercial |
$134.30
|
|
|
HC CA IONIZED (POC)
|
Facility
|
OP
|
$323.00
|
|
|
Service Code
|
CPT 82330
|
| Hospital Charge Code |
900912118
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$290.70 |
| Rate for Payer: Adventist Health Commercial |
$64.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$100.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$99.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$138.22
|
| Rate for Payer: Blue Shield of California Commercial |
$203.49
|
| Rate for Payer: Blue Shield of California EPN |
$128.23
|
| Rate for Payer: Cash Price |
$145.35
|
| Rate for Payer: Cash Price |
$145.35
|
| Rate for Payer: Central Health Plan Commercial |
$258.40
|
| Rate for Payer: Cigna of CA HMO |
$206.72
|
| Rate for Payer: Cigna of CA PPO |
$239.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$226.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.57
|
| Rate for Payer: EPIC Health Plan Senior |
$15.05
|
| Rate for Payer: Galaxy Health WC |
$274.55
|
| Rate for Payer: Global Benefits Group Commercial |
$193.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$290.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$205.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.33
|
| Rate for Payer: Multiplan Commercial |
$242.25
|
| Rate for Payer: Networks By Design Commercial |
$209.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.68
|
| Rate for Payer: Prime Health Services Commercial |
$274.55
|
| Rate for Payer: Prime Health Services Medicare |
$14.50
|
| Rate for Payer: Riverside University Health System MISP |
$15.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$193.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$193.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.08
|
| Rate for Payer: United Healthcare All Other HMO |
$11.08
|
| Rate for Payer: United Healthcare HMO Rider |
$11.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.08
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.05
|
| Rate for Payer: Vantage Medical Group Senior |
$13.68
|
|
|
HC CA IONIZED (POC)
|
Facility
|
IP
|
$323.00
|
|
|
Service Code
|
CPT 82330
|
| Hospital Charge Code |
900912118
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$64.60 |
| Max. Negotiated Rate |
$290.70 |
| Rate for Payer: Adventist Health Commercial |
$64.60
|
| Rate for Payer: Cash Price |
$145.35
|
| Rate for Payer: Central Health Plan Commercial |
$258.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$226.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$129.20
|
| Rate for Payer: EPIC Health Plan Senior |
$129.20
|
| Rate for Payer: Galaxy Health WC |
$274.55
|
| Rate for Payer: Global Benefits Group Commercial |
$193.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$290.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$205.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$190.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.60
|
| Rate for Payer: Multiplan Commercial |
$242.25
|
| Rate for Payer: Networks By Design Commercial |
$209.95
|
| Rate for Payer: Prime Health Services Commercial |
$274.55
|
|
|
HC C ALBICANS OR C TROPICALIS NAT
|
Facility
|
OP
|
$106.00
|
|
|
Service Code
|
CPT 87481
|
| Hospital Charge Code |
900912492
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$21.20 |
| Max. Negotiated Rate |
$343.45 |
| Rate for Payer: Adventist Health Commercial |
$21.20
|
| Rate for Payer: Adventist Health Commercial |
$15.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$35.09
|
| Rate for Payer: Adventist Health Medi-Cal |
$35.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$257.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$257.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$247.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$247.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$343.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$343.45
|
| Rate for Payer: Blue Shield of California Commercial |
$47.88
|
| Rate for Payer: Blue Shield of California Commercial |
$66.78
|
| Rate for Payer: Blue Shield of California EPN |
$30.17
|
| Rate for Payer: Blue Shield of California EPN |
$42.08
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Central Health Plan Commercial |
$84.80
|
| Rate for Payer: Central Health Plan Commercial |
$60.80
|
| Rate for Payer: Cigna of CA HMO |
$48.64
|
| Rate for Payer: Cigna of CA HMO |
$67.84
|
| Rate for Payer: Cigna of CA PPO |
$56.24
|
| Rate for Payer: Cigna of CA PPO |
$78.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$74.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$53.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.90
|
| Rate for Payer: EPIC Health Plan Senior |
$38.60
|
| Rate for Payer: EPIC Health Plan Senior |
$38.60
|
| Rate for Payer: Galaxy Health WC |
$64.60
|
| Rate for Payer: Galaxy Health WC |
$90.10
|
| Rate for Payer: Global Benefits Group Commercial |
$45.60
|
| Rate for Payer: Global Benefits Group Commercial |
$63.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$68.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$95.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.55
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$53.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$53.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$67.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$48.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$59.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$59.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$47.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$57.00
|
| Rate for Payer: Multiplan Commercial |
$79.50
|
| Rate for Payer: Networks By Design Commercial |
$68.90
|
| Rate for Payer: Networks By Design Commercial |
$49.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$35.09
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$35.09
|
| Rate for Payer: Prime Health Services Commercial |
$64.60
|
| Rate for Payer: Prime Health Services Commercial |
$90.10
|
| Rate for Payer: Prime Health Services Medicare |
$37.20
|
| Rate for Payer: Prime Health Services Medicare |
$37.20
|
| Rate for Payer: Riverside University Health System MISP |
$38.60
|
| Rate for Payer: Riverside University Health System MISP |
$38.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$63.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$63.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$35.09
|
| Rate for Payer: Upland Medical Group Pediatric |
$35.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC C ALBICANS OR C TROPICALIS NAT
|
Facility
|
IP
|
$106.00
|
|
|
Service Code
|
CPT 87481
|
| Hospital Charge Code |
900912492
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$21.20 |
| Max. Negotiated Rate |
$95.40 |
| Rate for Payer: Adventist Health Commercial |
$21.20
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Central Health Plan Commercial |
$84.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$74.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.40
|
| Rate for Payer: EPIC Health Plan Senior |
$42.40
|
| Rate for Payer: Galaxy Health WC |
$90.10
|
| Rate for Payer: Global Benefits Group Commercial |
$63.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$95.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$67.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$62.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.20
|
| Rate for Payer: Multiplan Commercial |
$79.50
|
| Rate for Payer: Networks By Design Commercial |
$68.90
|
| Rate for Payer: Prime Health Services Commercial |
$90.10
|
|
