|
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 |
$6,338.75
|
| Rate for Payer: Central Health Plan Commercial |
$9,220.00
|
| 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 Permanente of CA Commercial/Self Funded |
$7,687.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,391.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,133.98
|
| 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
|
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 |
$1,744.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,536.80
|
| 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 Permanente of CA Commercial/Self Funded |
$2,115.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,208.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,962.85
|
| 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 |
$2,901.00 |
| 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 |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$893.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,424.40
|
| Rate for Payer: Cash Price |
$1,744.05
|
| Rate for Payer: Cash Price |
$1,744.05
|
| Rate for Payer: Cash Price |
$1,744.05
|
| Rate for Payer: Cash Price |
$1,744.05
|
| 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 |
$1,340.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$983.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$893.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,206.87
|
| Rate for Payer: EPIC Health Plan Senior |
$893.98
|
| 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 |
$1,466.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$893.98
|
| Rate for Payer: InnovAge PACE Commercial |
$1,340.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,115.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$893.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$634.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,197.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,197.93
|
| 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 |
$893.98
|
| 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 |
$947.62
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Riverside University Health System MISP |
$983.38
|
| 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 |
$893.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Vantage Medical Group Senior |
$893.98
|
|
|
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 |
$1,744.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,536.80
|
| 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 Permanente of CA Commercial/Self Funded |
$2,115.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,208.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,962.85
|
| 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 |
$4,460.00 |
| Rate for Payer: Adventist Health Commercial |
$634.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$893.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$893.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,535.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,862.33
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,424.40
|
| Rate for Payer: Blue Shield of California Commercial |
$979.68
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$1,744.05
|
| Rate for Payer: Cash Price |
$1,744.05
|
| Rate for Payer: Cash Price |
$1,744.05
|
| 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 |
$1,340.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$983.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$893.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,206.87
|
| Rate for Payer: EPIC Health Plan Senior |
$893.98
|
| 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 |
$1,466.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$86.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$893.98
|
| Rate for Payer: InnovAge PACE Commercial |
$1,340.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,115.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$893.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$634.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,197.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,197.93
|
| 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 |
$893.98
|
| 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 |
$947.62
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Riverside University Health System MISP |
$983.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,902.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| 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 |
$893.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Vantage Medical Group Senior |
$893.98
|
|
|
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 |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$1,164.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,058.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,280.13
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$3,203.20
|
| Rate for Payer: Cash Price |
$3,203.20
|
| Rate for Payer: Cash Price |
$3,203.20
|
| 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 |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,779.22
|
| Rate for Payer: EPIC Health Plan Senior |
$2,058.68
|
| 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 |
$3,376.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$144.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: InnovAge PACE Commercial |
$3,088.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,884.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$159.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,058.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,164.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,758.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,758.63
|
| 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 |
$2,058.68
|
| 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 |
$2,182.20
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Riverside University Health System MISP |
$2,264.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,494.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| 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 |
$2,058.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
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 |
$3,203.20
|
| Rate for Payer: Central Health Plan Commercial |
$4,659.20
|
| 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 Permanente of CA Commercial/Self Funded |
$3,884.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,218.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,605.06
|
| 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
|
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 |
$284.22
|
| 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 |
$274.86
|
| Rate for Payer: Blue Shield of California Commercial |
$284.08
|
| Rate for Payer: Blue Shield of California EPN |
$185.80
|
| Rate for Payer: Cash Price |
$257.40
|
| Rate for Payer: Cash Price |
$257.40
|
| 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: EPIC Health Plan Commercial |
$14.93
|
| Rate for Payer: EPIC Health Plan Senior |
$11.06
|
| 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: InnovAge PACE Commercial |
$16.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$312.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$178.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.82
|
| Rate for Payer: Molina Healthcare of CA 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 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 |
$257.40
|
| Rate for Payer: Central Health Plan Commercial |
$374.40
|
| 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 Permanente of CA Commercial/Self Funded |
$312.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$178.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$289.69
|
| 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 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 |
$465.38 |
| 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 |
$275.71
|
| 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 |
$266.63
|
| Rate for Payer: Blue Shield of California Commercial |
$275.58
|
| Rate for Payer: Blue Shield of California EPN |
$180.24
|
| Rate for Payer: Cash Price |
$249.70
|
| Rate for Payer: Cash Price |
$249.70
|
| 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: EPIC Health Plan Commercial |
$127.45
|
| Rate for Payer: EPIC Health Plan Senior |
$94.41
|
| 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: InnovAge PACE Commercial |
$141.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$302.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$172.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$94.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$126.51
|
| Rate for Payer: Molina Healthcare of CA 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 |
$249.70
|
| Rate for Payer: Central Health Plan Commercial |
$363.20
|
| 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 Permanente of CA Commercial/Self Funded |
$302.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$172.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$281.03
|
| 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
|
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 |
$354.20
|
| Rate for Payer: Central Health Plan Commercial |
$515.20
|
| 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 Permanente of CA Commercial/Self Funded |
$429.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$245.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$398.64
|
| 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 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 |
$378.22
|
| Rate for Payer: Blue Shield of California Commercial |
$393.48
|
| Rate for Payer: Blue Shield of California EPN |
$256.96
|
| Rate for Payer: Cash Price |
$354.20
|
| 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: 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: InnovAge PACE Commercial |
$322.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$429.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$245.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$398.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$450.80
|
| Rate for Payer: Molina Healthcare of CA 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 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 |
$531.30
|
| Rate for Payer: Central Health Plan Commercial |
$772.80
|
| 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 Permanente of CA Commercial/Self Funded |
$644.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$368.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$597.95
|
| 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 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 |
$567.33
|
| Rate for Payer: Blue Shield of California Commercial |
$590.23
|
| Rate for Payer: Blue Shield of California EPN |
$385.43
|
| Rate for Payer: Cash Price |
$531.30
|
| 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: 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: InnovAge PACE Commercial |
$483.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$644.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$368.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$597.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$193.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$676.20
|
| Rate for Payer: Molina Healthcare of CA 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 CA CALCIUM IONIZED
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT 82330
|
| Hospital Charge Code |
900910502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Central Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Senior |
$40.00
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$61.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.00
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
| Rate for Payer: Networks By Design Commercial |
$65.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
|
|
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 |
$99.42 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$60.73
|
| 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 |
$20.18
|
| Rate for Payer: Blue Shield of California Commercial |
$60.70
|
| Rate for Payer: Blue Shield of California EPN |
$39.70
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Central Health Plan Commercial |
$80.00
|
| Rate for Payer: Cigna of CA HMO |
$64.00
|
| Rate for Payer: Cigna of CA PPO |
$74.00
|
| 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: EPIC Health Plan Commercial |
$18.47
|
| Rate for Payer: EPIC Health Plan Senior |
$13.68
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.00
|
| 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: InnovAge PACE Commercial |
$20.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.33
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
| Rate for Payer: Networks By Design Commercial |
$65.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.68
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
| 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 |
$60.00
|
| 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 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 CAFFEINE SERUM
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900910538
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.20 |
| Max. Negotiated Rate |
$105.94 |
| Rate for Payer: Adventist Health Commercial |
$9.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$18.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.94
|
| 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 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 HMO/PPO |
$21.50
|
| Rate for Payer: Blue Shield of California Commercial |
$27.92
|
| Rate for Payer: Blue Shield of California EPN |
$18.26
|
| Rate for Payer: Cash Price |
$25.30
|
| Rate for Payer: Cash Price |
$25.30
|
| Rate for Payer: Central Health Plan Commercial |
$36.80
|
| Rate for Payer: Cigna of CA HMO |
$29.44
|
| Rate for Payer: Cigna of CA PPO |
$34.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.16
|
| Rate for Payer: EPIC Health Plan Senior |
$18.64
|
| Rate for Payer: Galaxy Health WC |
$39.10
|
| Rate for Payer: Global Benefits Group Commercial |
$27.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$41.40
|
| 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) Medicare Advantage |
$18.64
|
| Rate for Payer: InnovAge PACE Commercial |
$27.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.98
|
| Rate for Payer: Multiplan Commercial |
$34.50
|
| Rate for Payer: Networks By Design Commercial |
$29.90
|
| 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 Medicare |
$19.76
|
| Rate for Payer: Riverside University Health System MISP |
$20.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.60
|
| 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 HMO Rider |
$15.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.10
|
| 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 Medi-Cal |
$20.50
|
| Rate for Payer: Vantage Medical Group Senior |
$18.64
|
|
|
HC CAFFEINE SERUM
|
Facility
|
IP
|
$46.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900910538
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.20 |
| Max. Negotiated Rate |
$41.40 |
| Rate for Payer: Adventist Health Commercial |
$9.20
|
| Rate for Payer: Cash Price |
$25.30
|
| Rate for Payer: Central Health Plan Commercial |
$36.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.40
|
| Rate for Payer: EPIC Health Plan Senior |
$18.40
|
| Rate for Payer: Galaxy Health WC |
$39.10
|
| Rate for Payer: Global Benefits Group Commercial |
$27.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$41.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.20
|
| Rate for Payer: Multiplan Commercial |
$34.50
|
| Rate for Payer: Networks By Design Commercial |
$29.90
|
| Rate for Payer: Prime Health Services Commercial |
$39.10
|
|
|
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 |
$196.16
|
| 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 |
$20.18
|
| Rate for Payer: Blue Shield of California Commercial |
$196.06
|
| Rate for Payer: Blue Shield of California EPN |
$128.23
|
| Rate for Payer: Cash Price |
$177.65
|
| Rate for Payer: Cash Price |
$177.65
|
| 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: EPIC Health Plan Commercial |
$18.47
|
| Rate for Payer: EPIC Health Plan Senior |
$13.68
|
| 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: InnovAge PACE Commercial |
$20.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$215.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.33
|
| Rate for Payer: Molina Healthcare of CA 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 |
$177.65
|
| Rate for Payer: Central Health Plan Commercial |
$258.40
|
| 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 Permanente of CA Commercial/Self Funded |
$215.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$199.94
|
| 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
|
$76.00
|
|
|
Service Code
|
CPT 87481
|
| Hospital Charge Code |
900912492
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$15.20 |
| Max. Negotiated Rate |
$247.04 |
| Rate for Payer: Adventist Health Commercial |
$15.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$35.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$46.15
|
| 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 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 HMO/PPO |
$50.14
|
| Rate for Payer: Blue Shield of California Commercial |
$46.13
|
| Rate for Payer: Blue Shield of California EPN |
$30.17
|
| Rate for Payer: Cash Price |
$41.80
|
| Rate for Payer: Cash Price |
$41.80
|
| Rate for Payer: Central Health Plan Commercial |
$60.80
|
| Rate for Payer: Cigna of CA HMO |
$48.64
|
| Rate for Payer: Cigna of CA PPO |
$56.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.37
|
| Rate for Payer: EPIC Health Plan Senior |
$35.09
|
| Rate for Payer: Galaxy Health WC |
$64.60
|
| Rate for Payer: Global Benefits Group Commercial |
$45.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$68.40
|
| 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) Medicare Advantage |
$35.09
|
| Rate for Payer: InnovAge PACE Commercial |
$52.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$57.00
|
| Rate for Payer: Networks By Design Commercial |
$49.40
|
| 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 Medicare |
$37.20
|
| Rate for Payer: Riverside University Health System MISP |
$38.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$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 Select/Navigate/Core |
$28.42
|
| 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 Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC C ALBICANS OR C TROPICALIS NAT
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
CPT 87481
|
| Hospital Charge Code |
900912492
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$15.20 |
| Max. Negotiated Rate |
$68.40 |
| Rate for Payer: Adventist Health Commercial |
$15.20
|
| Rate for Payer: Cash Price |
$41.80
|
| Rate for Payer: Central Health Plan Commercial |
$60.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.40
|
| Rate for Payer: EPIC Health Plan Senior |
$30.40
|
| Rate for Payer: Galaxy Health WC |
$64.60
|
| Rate for Payer: Global Benefits Group Commercial |
$45.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$68.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.20
|
| Rate for Payer: Multiplan Commercial |
$57.00
|
| Rate for Payer: Networks By Design Commercial |
$49.40
|
| Rate for Payer: Prime Health Services Commercial |
$64.60
|
|
|
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 |
$37.42 |
| Rate for Payer: Adventist Health Commercial |
$6.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$20.65
|
| 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 |
$7.59
|
| Rate for Payer: Blue Shield of California Commercial |
$20.64
|
| Rate for Payer: Blue Shield of California EPN |
$13.50
|
| Rate for Payer: Cash Price |
$18.70
|
| Rate for Payer: Cash Price |
$18.70
|
| Rate for Payer: Central Health Plan Commercial |
$27.20
|
| Rate for Payer: Cigna of CA HMO |
$21.76
|
| Rate for Payer: Cigna of CA PPO |
$25.16
|
| 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: EPIC Health Plan Commercial |
$6.97
|
| Rate for Payer: EPIC Health Plan Senior |
$5.16
|
| Rate for Payer: Galaxy Health WC |
$28.90
|
| Rate for Payer: Global Benefits Group Commercial |
$20.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.60
|
| 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: InnovAge PACE Commercial |
$7.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.91
|
| Rate for Payer: Multiplan Commercial |
$25.50
|
| Rate for Payer: Networks By Design Commercial |
$22.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.16
|
| Rate for Payer: Prime Health Services Commercial |
$28.90
|
| 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 |
$20.40
|
| 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 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 TOTAL
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
CPT 82310
|
| Hospital Charge Code |
900910239
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Adventist Health Commercial |
$6.80
|
| Rate for Payer: Cash Price |
$18.70
|
| Rate for Payer: Central Health Plan Commercial |
$27.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.60
|
| Rate for Payer: EPIC Health Plan Senior |
$13.60
|
| Rate for Payer: Galaxy Health WC |
$28.90
|
| Rate for Payer: Global Benefits Group Commercial |
$20.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.80
|
| Rate for Payer: Multiplan Commercial |
$25.50
|
| Rate for Payer: Networks By Design Commercial |
$22.10
|
| Rate for Payer: Prime Health Services Commercial |
$28.90
|
|
