|
HC CALCIUM TOTAL
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
CPT 82310
|
| Hospital Charge Code |
900910239
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.18 |
| Max. Negotiated Rate |
$52.02 |
| Rate for Payer: Adventist Health Commercial |
$6.80
|
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.16
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$37.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$37.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$37.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$37.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52.02
|
| Rate for Payer: Blue Shield of California Commercial |
$61.74
|
| Rate for Payer: Blue Shield of California Commercial |
$21.42
|
| Rate for Payer: Blue Shield of California EPN |
$38.91
|
| Rate for Payer: Blue Shield of California EPN |
$13.50
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Central Health Plan Commercial |
$27.20
|
| Rate for Payer: Central Health Plan Commercial |
$78.40
|
| Rate for Payer: Cigna of CA HMO |
$62.72
|
| Rate for Payer: Cigna of CA HMO |
$21.76
|
| Rate for Payer: Cigna of CA PPO |
$72.52
|
| Rate for Payer: Cigna of CA PPO |
$25.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$68.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.51
|
| Rate for Payer: EPIC Health Plan Senior |
$5.68
|
| Rate for Payer: EPIC Health Plan Senior |
$5.68
|
| Rate for Payer: Galaxy Health WC |
$83.30
|
| Rate for Payer: Galaxy Health WC |
$28.90
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Global Benefits Group Commercial |
$20.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$88.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.46
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$62.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.91
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
| Rate for Payer: Multiplan Commercial |
$25.50
|
| Rate for Payer: Networks By Design Commercial |
$22.10
|
| Rate for Payer: Networks By Design Commercial |
$63.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.16
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.16
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
| Rate for Payer: Prime Health Services Commercial |
$28.90
|
| Rate for Payer: Prime Health Services Medicare |
$5.47
|
| Rate for Payer: Prime Health Services Medicare |
$5.47
|
| Rate for Payer: Riverside University Health System MISP |
$5.68
|
| Rate for Payer: Riverside University Health System MISP |
$5.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.18
|
| Rate for Payer: United Healthcare All Other HMO |
$4.18
|
| Rate for Payer: United Healthcare All Other HMO |
$4.18
|
| Rate for Payer: United Healthcare HMO Rider |
$4.18
|
| Rate for Payer: United Healthcare HMO Rider |
$4.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.18
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.16
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.68
|
| Rate for Payer: Vantage Medical Group Senior |
$5.16
|
| Rate for Payer: Vantage Medical Group Senior |
$5.16
|
|
|
HC CALCIUM TOTAL
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 82310
|
| Hospital Charge Code |
900910239
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$88.20 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Central Health Plan Commercial |
$78.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$68.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.20
|
| Rate for Payer: EPIC Health Plan Senior |
$39.20
|
| Rate for Payer: Galaxy Health WC |
$83.30
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$88.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$62.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$57.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.60
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
| Rate for Payer: Networks By Design Commercial |
$63.70
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
|
|
HC CALCIUM TOTAL INDIVIDUAL
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 82310
|
| Hospital Charge Code |
900910494
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
|
|
HC CALCIUM TOTAL INDIVIDUAL
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 82310
|
| Hospital Charge Code |
900910494
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.18 |
| Max. Negotiated Rate |
$52.02 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$37.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$37.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52.02
|
| Rate for Payer: Blue Shield of California Commercial |
$31.50
|
| Rate for Payer: Blue Shield of California EPN |
$19.85
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: Cigna of CA HMO |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.51
|
| Rate for Payer: EPIC Health Plan Senior |
$5.68
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.91
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.16
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Prime Health Services Medicare |
$5.47
|
| Rate for Payer: Riverside University Health System MISP |
$5.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.18
|
| Rate for Payer: United Healthcare All Other HMO |
$4.18
|
| Rate for Payer: United Healthcare HMO Rider |
$4.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.18
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.68
|
| Rate for Payer: Vantage Medical Group Senior |
$5.16
|
|
|
HC CALCIUM URINE 24 HOURS
|
Facility
|
IP
|
$59.00
|
|
|
Service Code
|
CPT 82340
|
| Hospital Charge Code |
900912198
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.80 |
| Max. Negotiated Rate |
$53.10 |
| Rate for Payer: Adventist Health Commercial |
$11.80
|
| Rate for Payer: Cash Price |
$26.55
|
| Rate for Payer: Central Health Plan Commercial |
$47.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$41.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.60
|
| Rate for Payer: EPIC Health Plan Senior |
$23.60
|
| Rate for Payer: Galaxy Health WC |
$50.15
|
| Rate for Payer: Global Benefits Group Commercial |
$35.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$37.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$34.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.80
|
| Rate for Payer: Multiplan Commercial |
$44.25
|
| Rate for Payer: Networks By Design Commercial |
$38.35
|
| Rate for Payer: Prime Health Services Commercial |
$50.15
|
|
|
HC CALCIUM URINE 24 HOURS
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 82340
|
| Hospital Charge Code |
900912198
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.89 |
| Max. Negotiated Rate |
$61.01 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Adventist Health Commercial |
$11.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$6.03
|
| Rate for Payer: Adventist Health Medi-Cal |
$6.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$44.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$44.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$43.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$43.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.01
|
| Rate for Payer: Blue Shield of California Commercial |
$37.17
|
| Rate for Payer: Blue Shield of California Commercial |
$31.50
|
| Rate for Payer: Blue Shield of California EPN |
$23.42
|
| Rate for Payer: Blue Shield of California EPN |
$19.85
|
| Rate for Payer: Cash Price |
$26.55
|
| Rate for Payer: Cash Price |
$26.55
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: Central Health Plan Commercial |
$47.20
|
| Rate for Payer: Cigna of CA HMO |
$37.76
|
| Rate for Payer: Cigna of CA HMO |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$43.66
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$41.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.95
|
| Rate for Payer: EPIC Health Plan Senior |
$6.63
|
| Rate for Payer: EPIC Health Plan Senior |
$6.63
|
| Rate for Payer: Galaxy Health WC |
$50.15
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$35.40
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.89
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$37.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.08
|
| Rate for Payer: Multiplan Commercial |
$44.25
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Networks By Design Commercial |
$38.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6.03
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6.03
|
| Rate for Payer: Prime Health Services Commercial |
$50.15
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Prime Health Services Medicare |
$6.39
|
| Rate for Payer: Prime Health Services Medicare |
$6.39
|
| Rate for Payer: Riverside University Health System MISP |
$6.63
|
| Rate for Payer: Riverside University Health System MISP |
$6.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.89
|
| Rate for Payer: United Healthcare All Other HMO |
$4.89
|
| Rate for Payer: United Healthcare All Other HMO |
$4.89
|
| Rate for Payer: United Healthcare HMO Rider |
$4.89
|
| Rate for Payer: United Healthcare HMO Rider |
$4.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.89
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.03
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.63
|
| Rate for Payer: Vantage Medical Group Senior |
$6.03
|
| Rate for Payer: Vantage Medical Group Senior |
$6.03
|
|
|
HC CALCIUM URINE RANDOM
|
Facility
|
IP
|
$59.00
|
|
|
Service Code
|
CPT 82340
|
| Hospital Charge Code |
900912197
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.80 |
| Max. Negotiated Rate |
$53.10 |
| Rate for Payer: Adventist Health Commercial |
$11.80
|
| Rate for Payer: Cash Price |
$26.55
|
| Rate for Payer: Central Health Plan Commercial |
$47.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$41.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.60
|
| Rate for Payer: EPIC Health Plan Senior |
$23.60
|
| Rate for Payer: Galaxy Health WC |
$50.15
|
| Rate for Payer: Global Benefits Group Commercial |
$35.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$37.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$34.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.80
|
| Rate for Payer: Multiplan Commercial |
$44.25
|
| Rate for Payer: Networks By Design Commercial |
$38.35
|
| Rate for Payer: Prime Health Services Commercial |
$50.15
|
|
|
HC CALCIUM URINE RANDOM
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 82340
|
| Hospital Charge Code |
900912197
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.89 |
| Max. Negotiated Rate |
$61.01 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Adventist Health Commercial |
$11.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$6.03
|
| Rate for Payer: Adventist Health Medi-Cal |
$6.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$44.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$44.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$43.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$43.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.01
|
| Rate for Payer: Blue Shield of California Commercial |
$37.17
|
| Rate for Payer: Blue Shield of California Commercial |
$31.50
|
| Rate for Payer: Blue Shield of California EPN |
$23.42
|
| Rate for Payer: Blue Shield of California EPN |
$19.85
|
| Rate for Payer: Cash Price |
$26.55
|
| Rate for Payer: Cash Price |
$26.55
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: Central Health Plan Commercial |
$47.20
|
| Rate for Payer: Cigna of CA HMO |
$37.76
|
| Rate for Payer: Cigna of CA HMO |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$43.66
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$41.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.95
|
| Rate for Payer: EPIC Health Plan Senior |
$6.63
|
| Rate for Payer: EPIC Health Plan Senior |
$6.63
|
| Rate for Payer: Galaxy Health WC |
$50.15
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$35.40
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.89
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$37.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.08
|
| Rate for Payer: Multiplan Commercial |
$44.25
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Networks By Design Commercial |
$38.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6.03
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6.03
|
| Rate for Payer: Prime Health Services Commercial |
$50.15
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Prime Health Services Medicare |
$6.39
|
| Rate for Payer: Prime Health Services Medicare |
$6.39
|
| Rate for Payer: Riverside University Health System MISP |
$6.63
|
| Rate for Payer: Riverside University Health System MISP |
$6.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.89
|
| Rate for Payer: United Healthcare All Other HMO |
$4.89
|
| Rate for Payer: United Healthcare All Other HMO |
$4.89
|
| Rate for Payer: United Healthcare HMO Rider |
$4.89
|
| Rate for Payer: United Healthcare HMO Rider |
$4.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.89
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.03
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.63
|
| Rate for Payer: Vantage Medical Group Senior |
$6.03
|
| Rate for Payer: Vantage Medical Group Senior |
$6.03
|
|
|
HC CANALITH REPOSITIONING PROC
|
Facility
|
IP
|
$215.00
|
|
|
Service Code
|
CPT 95992
|
| Hospital Charge Code |
905103410
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$43.00 |
| Max. Negotiated Rate |
$193.50 |
| Rate for Payer: Adventist Health Commercial |
$43.00
|
| Rate for Payer: Cash Price |
$96.75
|
| Rate for Payer: Central Health Plan Commercial |
$172.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$150.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.00
|
| Rate for Payer: EPIC Health Plan Senior |
$86.00
|
| Rate for Payer: Galaxy Health WC |
$182.75
|
| Rate for Payer: Global Benefits Group Commercial |
$129.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$193.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$136.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$126.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.00
|
| Rate for Payer: Multiplan Commercial |
$161.25
|
| Rate for Payer: Networks By Design Commercial |
$139.75
|
| Rate for Payer: Prime Health Services Commercial |
$182.75
|
|
|
HC CANALITH REPOSITIONING PROC
|
Facility
|
OP
|
$215.00
|
|
|
Service Code
|
CPT 95992
|
| Hospital Charge Code |
905103410
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$86.00 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$88.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$218.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$182.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$118.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$161.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$96.75
|
| Rate for Payer: Cash Price |
$96.75
|
| Rate for Payer: Cash Price |
$96.75
|
| Rate for Payer: Central Health Plan Commercial |
$172.00
|
| Rate for Payer: Cigna of CA HMO |
$137.60
|
| Rate for Payer: Cigna of CA PPO |
$159.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$182.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$182.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$182.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$150.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.00
|
| Rate for Payer: EPIC Health Plan Senior |
$86.00
|
| Rate for Payer: Galaxy Health WC |
$182.75
|
| Rate for Payer: Global Benefits Group Commercial |
$129.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$193.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$136.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$126.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$150.50
|
| Rate for Payer: Multiplan Commercial |
$161.25
|
| Rate for Payer: Networks By Design Commercial |
$139.75
|
| Rate for Payer: Prime Health Services Commercial |
$182.75
|
| Rate for Payer: Riverside University Health System MISP |
$86.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$129.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$129.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$182.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$182.75
|
| Rate for Payer: Vantage Medical Group Senior |
$182.75
|
|
|
HC CANDIDA AURIS PCR
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT 87481
|
| Hospital Charge Code |
900913697
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$343.45 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| 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 |
$34.02
|
| Rate for Payer: Blue Shield of California Commercial |
$28.35
|
| Rate for Payer: Blue Shield of California EPN |
$21.44
|
| Rate for Payer: Blue Shield of California EPN |
$17.86
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Central Health Plan Commercial |
$36.00
|
| Rate for Payer: Central Health Plan Commercial |
$43.20
|
| Rate for Payer: Cigna of CA HMO |
$34.56
|
| Rate for Payer: Cigna of CA HMO |
$28.80
|
| Rate for Payer: Cigna of CA PPO |
$39.96
|
| Rate for Payer: Cigna of CA PPO |
$33.30
|
| 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 |
$31.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.80
|
| 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 |
$45.90
|
| Rate for Payer: Galaxy Health WC |
$38.25
|
| Rate for Payer: Global Benefits Group Commercial |
$32.40
|
| Rate for Payer: Global Benefits Group Commercial |
$27.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.50
|
| 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 |
$28.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.29
|
| 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 |
$9.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.80
|
| 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 |
$40.50
|
| Rate for Payer: Multiplan Commercial |
$33.75
|
| Rate for Payer: Networks By Design Commercial |
$29.25
|
| Rate for Payer: Networks By Design Commercial |
$35.10
|
| 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 |
$45.90
|
| Rate for Payer: Prime Health Services Commercial |
$38.25
|
| 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 |
$27.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.00
|
| 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 CANDIDA AURIS PCR
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
CPT 87481
|
| Hospital Charge Code |
900913697
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$48.60 |
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Central Health Plan Commercial |
$43.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.60
|
| Rate for Payer: EPIC Health Plan Senior |
$21.60
|
| Rate for Payer: Galaxy Health WC |
$45.90
|
| Rate for Payer: Global Benefits Group Commercial |
$32.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.80
|
| Rate for Payer: Multiplan Commercial |
$40.50
|
| Rate for Payer: Networks By Design Commercial |
$35.10
|
| Rate for Payer: Prime Health Services Commercial |
$45.90
|
|
|
HC CANNABINOIDS SEMI-QUANTITATIVE
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900910380
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.10 |
| Max. Negotiated Rate |
$147.28 |
| Rate for Payer: Adventist Health Commercial |
$23.80
|
| Rate for Payer: Adventist Health Commercial |
$19.80
|
| 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 |
$62.37
|
| Rate for Payer: Blue Shield of California Commercial |
$74.97
|
| Rate for Payer: Blue Shield of California EPN |
$39.30
|
| Rate for Payer: Blue Shield of California EPN |
$47.24
|
| Rate for Payer: Cash Price |
$44.55
|
| Rate for Payer: Cash Price |
$44.55
|
| Rate for Payer: Cash Price |
$53.55
|
| Rate for Payer: Cash Price |
$53.55
|
| Rate for Payer: Central Health Plan Commercial |
$95.20
|
| Rate for Payer: Central Health Plan Commercial |
$79.20
|
| Rate for Payer: Cigna of CA HMO |
$63.36
|
| Rate for Payer: Cigna of CA HMO |
$76.16
|
| Rate for Payer: Cigna of CA PPO |
$73.26
|
| Rate for Payer: Cigna of CA PPO |
$88.06
|
| 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 |
$83.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$69.30
|
| 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 |
$84.15
|
| Rate for Payer: Galaxy Health WC |
$101.15
|
| Rate for Payer: Global Benefits Group Commercial |
$59.40
|
| Rate for Payer: Global Benefits Group Commercial |
$71.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$89.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$107.10
|
| 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 |
$75.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$62.87
|
| 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 |
$23.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.80
|
| 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 |
$74.25
|
| Rate for Payer: Multiplan Commercial |
$89.25
|
| Rate for Payer: Networks By Design Commercial |
$77.35
|
| Rate for Payer: Networks By Design Commercial |
$64.35
|
| 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 |
$84.15
|
| Rate for Payer: Prime Health Services Commercial |
$101.15
|
| 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 |
$71.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$59.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$59.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$71.40
|
| 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 CANNABINOIDS SEMI-QUANTITATIVE
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900910380
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.80 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: Adventist Health Commercial |
$23.80
|
| Rate for Payer: Cash Price |
$53.55
|
| Rate for Payer: Central Health Plan Commercial |
$95.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$83.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.60
|
| Rate for Payer: EPIC Health Plan Senior |
$47.60
|
| Rate for Payer: Galaxy Health WC |
$101.15
|
| Rate for Payer: Global Benefits Group Commercial |
$71.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$107.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$75.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$70.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.80
|
| Rate for Payer: Multiplan Commercial |
$89.25
|
| Rate for Payer: Networks By Design Commercial |
$77.35
|
| Rate for Payer: Prime Health Services Commercial |
$101.15
|
|
|
HC CANN INNER #6 EXT LENGTH
|
Facility
|
IP
|
$54.04
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
901604685
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.81 |
| Max. Negotiated Rate |
$48.64 |
| Rate for Payer: Adventist Health Commercial |
$10.81
|
| Rate for Payer: Cash Price |
$24.32
|
| Rate for Payer: Central Health Plan Commercial |
$43.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.62
|
| Rate for Payer: EPIC Health Plan Senior |
$21.62
|
| Rate for Payer: Galaxy Health WC |
$45.93
|
| Rate for Payer: Global Benefits Group Commercial |
$32.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.81
|
| Rate for Payer: Multiplan Commercial |
$40.53
|
| Rate for Payer: Networks By Design Commercial |
$35.13
|
| Rate for Payer: Prime Health Services Commercial |
$45.93
|
|
|
HC CANN INNER #6 EXT LENGTH
|
Facility
|
OP
|
$54.04
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
901604685
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.81 |
| Max. Negotiated Rate |
$48.64 |
| Rate for Payer: Adventist Health Commercial |
$10.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$45.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$26.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.44
|
| Rate for Payer: Blue Shield of California Commercial |
$34.26
|
| Rate for Payer: Blue Shield of California EPN |
$21.56
|
| Rate for Payer: Cash Price |
$24.32
|
| Rate for Payer: Cash Price |
$24.32
|
| Rate for Payer: Central Health Plan Commercial |
$43.23
|
| Rate for Payer: Cigna of CA HMO |
$34.59
|
| Rate for Payer: Cigna of CA PPO |
$39.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$45.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.62
|
| Rate for Payer: EPIC Health Plan Senior |
$21.62
|
| Rate for Payer: Galaxy Health WC |
$45.93
|
| Rate for Payer: Global Benefits Group Commercial |
$32.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$37.83
|
| Rate for Payer: Multiplan Commercial |
$40.53
|
| Rate for Payer: Networks By Design Commercial |
$35.13
|
| Rate for Payer: Prime Health Services Commercial |
$45.93
|
| Rate for Payer: Riverside University Health System MISP |
$21.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.02
|
| Rate for Payer: United Healthcare All Other HMO |
$27.02
|
| Rate for Payer: United Healthcare HMO Rider |
$27.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$45.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.93
|
| Rate for Payer: Vantage Medical Group Senior |
$45.93
|
|
|
HC CANN INNER #7 EXT LENGTH
|
Facility
|
IP
|
$54.04
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
901604683
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.81 |
| Max. Negotiated Rate |
$48.64 |
| Rate for Payer: Adventist Health Commercial |
$10.81
|
| Rate for Payer: Cash Price |
$24.32
|
| Rate for Payer: Central Health Plan Commercial |
$43.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.62
|
| Rate for Payer: EPIC Health Plan Senior |
$21.62
|
| Rate for Payer: Galaxy Health WC |
$45.93
|
| Rate for Payer: Global Benefits Group Commercial |
$32.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.81
|
| Rate for Payer: Multiplan Commercial |
$40.53
|
| Rate for Payer: Networks By Design Commercial |
$35.13
|
| Rate for Payer: Prime Health Services Commercial |
$45.93
|
|
|
HC CANN INNER #7 EXT LENGTH
|
Facility
|
OP
|
$54.04
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
901604683
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.81 |
| Max. Negotiated Rate |
$48.64 |
| Rate for Payer: Adventist Health Commercial |
$10.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$45.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$26.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.44
|
| Rate for Payer: Blue Shield of California Commercial |
$34.26
|
| Rate for Payer: Blue Shield of California EPN |
$21.56
|
| Rate for Payer: Cash Price |
$24.32
|
| Rate for Payer: Cash Price |
$24.32
|
| Rate for Payer: Central Health Plan Commercial |
$43.23
|
| Rate for Payer: Cigna of CA HMO |
$34.59
|
| Rate for Payer: Cigna of CA PPO |
$39.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$45.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.62
|
| Rate for Payer: EPIC Health Plan Senior |
$21.62
|
| Rate for Payer: Galaxy Health WC |
$45.93
|
| Rate for Payer: Global Benefits Group Commercial |
$32.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$37.83
|
| Rate for Payer: Multiplan Commercial |
$40.53
|
| Rate for Payer: Networks By Design Commercial |
$35.13
|
| Rate for Payer: Prime Health Services Commercial |
$45.93
|
| Rate for Payer: Riverside University Health System MISP |
$21.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.02
|
| Rate for Payer: United Healthcare All Other HMO |
$27.02
|
| Rate for Payer: United Healthcare HMO Rider |
$27.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$45.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.93
|
| Rate for Payer: Vantage Medical Group Senior |
$45.93
|
|
|
HC CANN INNER #8 EXT LENGTH
|
Facility
|
IP
|
$54.04
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
901604682
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.81 |
| Max. Negotiated Rate |
$48.64 |
| Rate for Payer: Adventist Health Commercial |
$10.81
|
| Rate for Payer: Cash Price |
$24.32
|
| Rate for Payer: Central Health Plan Commercial |
$43.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.62
|
| Rate for Payer: EPIC Health Plan Senior |
$21.62
|
| Rate for Payer: Galaxy Health WC |
$45.93
|
| Rate for Payer: Global Benefits Group Commercial |
$32.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.81
|
| Rate for Payer: Multiplan Commercial |
$40.53
|
| Rate for Payer: Networks By Design Commercial |
$35.13
|
| Rate for Payer: Prime Health Services Commercial |
$45.93
|
|
|
HC CANN INNER #8 EXT LENGTH
|
Facility
|
OP
|
$54.04
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
901604682
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.81 |
| Max. Negotiated Rate |
$48.64 |
| Rate for Payer: Adventist Health Commercial |
$10.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$45.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$26.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.44
|
| Rate for Payer: Blue Shield of California Commercial |
$34.26
|
| Rate for Payer: Blue Shield of California EPN |
$21.56
|
| Rate for Payer: Cash Price |
$24.32
|
| Rate for Payer: Cash Price |
$24.32
|
| Rate for Payer: Central Health Plan Commercial |
$43.23
|
| Rate for Payer: Cigna of CA HMO |
$34.59
|
| Rate for Payer: Cigna of CA PPO |
$39.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$45.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.62
|
| Rate for Payer: EPIC Health Plan Senior |
$21.62
|
| Rate for Payer: Galaxy Health WC |
$45.93
|
| Rate for Payer: Global Benefits Group Commercial |
$32.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$37.83
|
| Rate for Payer: Multiplan Commercial |
$40.53
|
| Rate for Payer: Networks By Design Commercial |
$35.13
|
| Rate for Payer: Prime Health Services Commercial |
$45.93
|
| Rate for Payer: Riverside University Health System MISP |
$21.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.02
|
| Rate for Payer: United Healthcare All Other HMO |
$27.02
|
| Rate for Payer: United Healthcare HMO Rider |
$27.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$45.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.93
|
| Rate for Payer: Vantage Medical Group Senior |
$45.93
|
|
|
HC CANN TRACH SHILEY SIZE 4
|
Facility
|
OP
|
$24.93
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
901600953
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.99 |
| Max. Negotiated Rate |
$22.44 |
| Rate for Payer: Adventist Health Commercial |
$4.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.50
|
| Rate for Payer: Blue Shield of California Commercial |
$15.81
|
| Rate for Payer: Blue Shield of California EPN |
$9.95
|
| Rate for Payer: Cash Price |
$11.22
|
| Rate for Payer: Cash Price |
$11.22
|
| Rate for Payer: Central Health Plan Commercial |
$19.94
|
| Rate for Payer: Cigna of CA HMO |
$15.96
|
| Rate for Payer: Cigna of CA PPO |
$18.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.97
|
| Rate for Payer: EPIC Health Plan Senior |
$9.97
|
| Rate for Payer: Galaxy Health WC |
$21.19
|
| Rate for Payer: Global Benefits Group Commercial |
$14.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.45
|
| Rate for Payer: Multiplan Commercial |
$18.70
|
| Rate for Payer: Networks By Design Commercial |
$16.20
|
| Rate for Payer: Prime Health Services Commercial |
$21.19
|
| Rate for Payer: Riverside University Health System MISP |
$9.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.46
|
| Rate for Payer: United Healthcare All Other HMO |
$12.46
|
| Rate for Payer: United Healthcare HMO Rider |
$12.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.19
|
| Rate for Payer: Vantage Medical Group Senior |
$21.19
|
|
|
HC CANN TRACH SHILEY SIZE 4
|
Facility
|
IP
|
$24.93
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
901600953
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.99 |
| Max. Negotiated Rate |
$22.44 |
| Rate for Payer: Adventist Health Commercial |
$4.99
|
| Rate for Payer: Cash Price |
$11.22
|
| Rate for Payer: Central Health Plan Commercial |
$19.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.97
|
| Rate for Payer: EPIC Health Plan Senior |
$9.97
|
| Rate for Payer: Galaxy Health WC |
$21.19
|
| Rate for Payer: Global Benefits Group Commercial |
$14.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.99
|
| Rate for Payer: Multiplan Commercial |
$18.70
|
| Rate for Payer: Networks By Design Commercial |
$16.20
|
| Rate for Payer: Prime Health Services Commercial |
$21.19
|
|
|
HC CANN TRACH SHILEY SIZE 6
|
Facility
|
OP
|
$24.93
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
901600966
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.99 |
| Max. Negotiated Rate |
$22.44 |
| Rate for Payer: Adventist Health Commercial |
$4.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.50
|
| Rate for Payer: Blue Shield of California Commercial |
$15.81
|
| Rate for Payer: Blue Shield of California EPN |
$9.95
|
| Rate for Payer: Cash Price |
$11.22
|
| Rate for Payer: Cash Price |
$11.22
|
| Rate for Payer: Central Health Plan Commercial |
$19.94
|
| Rate for Payer: Cigna of CA HMO |
$15.96
|
| Rate for Payer: Cigna of CA PPO |
$18.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.97
|
| Rate for Payer: EPIC Health Plan Senior |
$9.97
|
| Rate for Payer: Galaxy Health WC |
$21.19
|
| Rate for Payer: Global Benefits Group Commercial |
$14.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.45
|
| Rate for Payer: Multiplan Commercial |
$18.70
|
| Rate for Payer: Networks By Design Commercial |
$16.20
|
| Rate for Payer: Prime Health Services Commercial |
$21.19
|
| Rate for Payer: Riverside University Health System MISP |
$9.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.46
|
| Rate for Payer: United Healthcare All Other HMO |
$12.46
|
| Rate for Payer: United Healthcare HMO Rider |
$12.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.19
|
| Rate for Payer: Vantage Medical Group Senior |
$21.19
|
|
|
HC CANN TRACH SHILEY SIZE 6
|
Facility
|
IP
|
$24.93
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
901600966
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.99 |
| Max. Negotiated Rate |
$22.44 |
| Rate for Payer: Adventist Health Commercial |
$4.99
|
| Rate for Payer: Cash Price |
$11.22
|
| Rate for Payer: Central Health Plan Commercial |
$19.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.97
|
| Rate for Payer: EPIC Health Plan Senior |
$9.97
|
| Rate for Payer: Galaxy Health WC |
$21.19
|
| Rate for Payer: Global Benefits Group Commercial |
$14.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.99
|
| Rate for Payer: Multiplan Commercial |
$18.70
|
| Rate for Payer: Networks By Design Commercial |
$16.20
|
| Rate for Payer: Prime Health Services Commercial |
$21.19
|
|
|
HC CANN TRACH SHILEY SIZE 8
|
Facility
|
OP
|
$32.88
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
901600967
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.58 |
| Max. Negotiated Rate |
$29.59 |
| Rate for Payer: Adventist Health Commercial |
$6.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.13
|
| Rate for Payer: Blue Shield of California Commercial |
$20.85
|
| Rate for Payer: Blue Shield of California EPN |
$13.12
|
| Rate for Payer: Cash Price |
$14.80
|
| Rate for Payer: Cash Price |
$14.80
|
| Rate for Payer: Central Health Plan Commercial |
$26.30
|
| Rate for Payer: Cigna of CA HMO |
$21.04
|
| Rate for Payer: Cigna of CA PPO |
$24.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.15
|
| Rate for Payer: EPIC Health Plan Senior |
$13.15
|
| Rate for Payer: Galaxy Health WC |
$27.95
|
| Rate for Payer: Global Benefits Group Commercial |
$19.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$29.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.02
|
| Rate for Payer: Multiplan Commercial |
$24.66
|
| Rate for Payer: Networks By Design Commercial |
$21.37
|
| Rate for Payer: Prime Health Services Commercial |
$27.95
|
| Rate for Payer: Riverside University Health System MISP |
$13.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.44
|
| Rate for Payer: United Healthcare All Other HMO |
$16.44
|
| Rate for Payer: United Healthcare HMO Rider |
$16.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.95
|
| Rate for Payer: Vantage Medical Group Senior |
$27.95
|
|
