|
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 |
$45.00 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$6.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.36
|
| 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 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 HMO/PPO |
$8.91
|
| Rate for Payer: Blue Shield of California Commercial |
$30.35
|
| Rate for Payer: Blue Shield of California EPN |
$19.85
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cash Price |
$27.50
|
| 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 |
$9.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.14
|
| Rate for Payer: EPIC Health Plan Senior |
$6.03
|
| 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 |
$9.89
|
| 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: InnovAge PACE Commercial |
$9.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.08
|
| 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 |
$6.03
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Prime Health Services Medicare |
$6.39
|
| Rate for Payer: Riverside University Health System MISP |
$6.63
|
| 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 |
$4.89
|
| Rate for Payer: United Healthcare All Other HMO |
$4.89
|
| Rate for Payer: United Healthcare HMO Rider |
$4.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.89
|
| 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 Medi-Cal |
$6.63
|
| Rate for Payer: Vantage Medical Group Senior |
$6.03
|
|
|
HC CALCIUM URINE 24 HOURS
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 82340
|
| Hospital Charge Code |
900912198
|
|
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 |
$27.50
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| 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 Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.95
|
| 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 URINE RANDOM
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 82340
|
| Hospital Charge Code |
900912197
|
|
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 |
$27.50
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| 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 Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.95
|
| 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 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 |
$45.00 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$6.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.36
|
| 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 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 HMO/PPO |
$8.91
|
| Rate for Payer: Blue Shield of California Commercial |
$30.35
|
| Rate for Payer: Blue Shield of California EPN |
$19.85
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cash Price |
$27.50
|
| 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 |
$9.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.14
|
| Rate for Payer: EPIC Health Plan Senior |
$6.03
|
| 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 |
$9.89
|
| 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: InnovAge PACE Commercial |
$9.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.08
|
| 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 |
$6.03
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Prime Health Services Medicare |
$6.39
|
| Rate for Payer: Riverside University Health System MISP |
$6.63
|
| 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 |
$4.89
|
| Rate for Payer: United Healthcare All Other HMO |
$4.89
|
| Rate for Payer: United Healthcare HMO Rider |
$4.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.89
|
| 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 Medi-Cal |
$6.63
|
| Rate for Payer: Vantage Medical Group Senior |
$6.03
|
|
|
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 |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$88.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$130.57
|
| 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 |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$118.25
|
| Rate for Payer: Cash Price |
$118.25
|
| Rate for Payer: Cash Price |
$118.25
|
| 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: 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: InnovAge PACE Commercial |
$107.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$143.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$133.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$150.50
|
| Rate for Payer: Molina Healthcare of CA 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 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 |
$118.25
|
| Rate for Payer: Central Health Plan Commercial |
$172.00
|
| 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 Permanente of CA Commercial/Self Funded |
$143.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$133.09
|
| 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 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 |
$247.04 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$35.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.33
|
| 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 |
$27.32
|
| Rate for Payer: Blue Shield of California EPN |
$17.86
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Central Health Plan Commercial |
$36.00
|
| Rate for Payer: Cigna of CA HMO |
$28.80
|
| Rate for Payer: Cigna of CA PPO |
$33.30
|
| 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 |
$38.25
|
| Rate for Payer: Global Benefits Group Commercial |
$27.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.50
|
| 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 |
$30.02
|
| 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 |
$9.00
|
| 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 |
$33.75
|
| Rate for Payer: Networks By Design Commercial |
$29.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$35.09
|
| Rate for Payer: Prime Health Services Commercial |
$38.25
|
| 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 |
$27.00
|
| 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 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 CANDIDA AURIS PCR
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
CPT 87481
|
| Hospital Charge Code |
900913697
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Central Health Plan Commercial |
$36.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.00
|
| Rate for Payer: EPIC Health Plan Senior |
$18.00
|
| Rate for Payer: Galaxy Health WC |
$38.25
|
| Rate for Payer: Global Benefits Group Commercial |
$27.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.00
|
| Rate for Payer: Multiplan Commercial |
$33.75
|
| Rate for Payer: Networks By Design Commercial |
$29.25
|
| Rate for Payer: Prime Health Services Commercial |
$38.25
|
|
|
HC CANNABINOIDS SEMI-QUANTITATIVE
|
Facility
|
IP
|
$99.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900910380
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.80 |
| Max. Negotiated Rate |
$89.10 |
| Rate for Payer: Adventist Health Commercial |
$19.80
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Central Health Plan Commercial |
$79.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.60
|
| Rate for Payer: EPIC Health Plan Senior |
$39.60
|
| Rate for Payer: Galaxy Health WC |
$84.15
|
| Rate for Payer: Global Benefits Group Commercial |
$59.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$89.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$61.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.80
|
| Rate for Payer: Multiplan Commercial |
$74.25
|
| Rate for Payer: Networks By Design Commercial |
$64.35
|
| Rate for Payer: Prime Health Services Commercial |
$84.15
|
|
|
HC CANNABINOIDS SEMI-QUANTITATIVE
|
Facility
|
OP
|
$99.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900910380
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.10 |
| Max. Negotiated Rate |
$105.94 |
| Rate for Payer: Adventist Health Commercial |
$19.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$18.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$60.12
|
| 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 |
$60.09
|
| Rate for Payer: Blue Shield of California EPN |
$39.30
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Central Health Plan Commercial |
$79.20
|
| Rate for Payer: Cigna of CA HMO |
$63.36
|
| Rate for Payer: Cigna of CA PPO |
$73.26
|
| 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 |
$84.15
|
| Rate for Payer: Global Benefits Group Commercial |
$59.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$89.10
|
| 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 |
$66.03
|
| 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 |
$19.80
|
| 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 |
$74.25
|
| Rate for Payer: Networks By Design Commercial |
$64.35
|
| 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 Medicare |
$19.76
|
| Rate for Payer: Riverside University Health System MISP |
$20.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$59.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$59.40
|
| 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 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 |
$32.82
|
| 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 |
$31.74
|
| Rate for Payer: Blue Shield of California Commercial |
$33.02
|
| Rate for Payer: Blue Shield of California EPN |
$21.56
|
| Rate for Payer: Cash Price |
$29.72
|
| 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: 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: InnovAge PACE Commercial |
$27.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37.83
|
| Rate for Payer: Molina Healthcare of CA 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 #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 |
$29.72
|
| Rate for Payer: Central Health Plan Commercial |
$43.23
|
| 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 Permanente of CA Commercial/Self Funded |
$36.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.45
|
| 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 |
$32.82
|
| 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 |
$31.74
|
| Rate for Payer: Blue Shield of California Commercial |
$33.02
|
| Rate for Payer: Blue Shield of California EPN |
$21.56
|
| Rate for Payer: Cash Price |
$29.72
|
| 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: 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: InnovAge PACE Commercial |
$27.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37.83
|
| Rate for Payer: Molina Healthcare of CA 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 |
$29.72
|
| Rate for Payer: Central Health Plan Commercial |
$43.23
|
| 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 Permanente of CA Commercial/Self Funded |
$36.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.45
|
| 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
|
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 |
$29.72
|
| Rate for Payer: Central Health Plan Commercial |
$43.23
|
| 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 Permanente of CA Commercial/Self Funded |
$36.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.45
|
| 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 |
$32.82
|
| 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 |
$31.74
|
| Rate for Payer: Blue Shield of California Commercial |
$33.02
|
| Rate for Payer: Blue Shield of California EPN |
$21.56
|
| Rate for Payer: Cash Price |
$29.72
|
| 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: 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: InnovAge PACE Commercial |
$27.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37.83
|
| Rate for Payer: Molina Healthcare of CA 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
|
Facility
|
IP
|
$23.78
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
901698126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.76 |
| Max. Negotiated Rate |
$21.40 |
| Rate for Payer: Adventist Health Commercial |
$4.76
|
| Rate for Payer: Cash Price |
$13.08
|
| Rate for Payer: Central Health Plan Commercial |
$19.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.51
|
| Rate for Payer: EPIC Health Plan Senior |
$9.51
|
| Rate for Payer: Galaxy Health WC |
$20.21
|
| Rate for Payer: Global Benefits Group Commercial |
$14.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.76
|
| Rate for Payer: Multiplan Commercial |
$17.84
|
| Rate for Payer: Networks By Design Commercial |
$15.46
|
| Rate for Payer: Prime Health Services Commercial |
$20.21
|
|
|
HC CANN TRACH SHILEY
|
Facility
|
OP
|
$23.78
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
901698126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.76 |
| Max. Negotiated Rate |
$21.40 |
| Rate for Payer: Adventist Health Commercial |
$4.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.97
|
| Rate for Payer: Blue Shield of California Commercial |
$14.53
|
| Rate for Payer: Blue Shield of California EPN |
$9.49
|
| Rate for Payer: Cash Price |
$13.08
|
| Rate for Payer: Central Health Plan Commercial |
$19.02
|
| Rate for Payer: Cigna of CA HMO |
$15.22
|
| Rate for Payer: Cigna of CA PPO |
$17.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.51
|
| Rate for Payer: EPIC Health Plan Senior |
$9.51
|
| Rate for Payer: Galaxy Health WC |
$20.21
|
| Rate for Payer: Global Benefits Group Commercial |
$14.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.40
|
| Rate for Payer: InnovAge PACE Commercial |
$11.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.65
|
| Rate for Payer: Multiplan Commercial |
$17.84
|
| Rate for Payer: Networks By Design Commercial |
$15.46
|
| Rate for Payer: Prime Health Services Commercial |
$20.21
|
| Rate for Payer: Riverside University Health System MISP |
$9.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.89
|
| Rate for Payer: United Healthcare All Other HMO |
$11.89
|
| Rate for Payer: United Healthcare HMO Rider |
$11.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.21
|
| Rate for Payer: Vantage Medical Group Senior |
$20.21
|
|
|
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 |
$15.14
|
| 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 |
$14.64
|
| Rate for Payer: Blue Shield of California Commercial |
$15.23
|
| Rate for Payer: Blue Shield of California EPN |
$9.95
|
| Rate for Payer: Cash Price |
$13.71
|
| 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: 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: InnovAge PACE Commercial |
$12.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.45
|
| Rate for Payer: Molina Healthcare of CA 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 |
$13.71
|
| Rate for Payer: Central Health Plan Commercial |
$19.94
|
| 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 Permanente of CA Commercial/Self Funded |
$16.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.43
|
| 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
|
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 |
$13.71
|
| Rate for Payer: Central Health Plan Commercial |
$19.94
|
| 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 Permanente of CA Commercial/Self Funded |
$16.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.43
|
| 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 |
$15.14
|
| 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 |
$14.64
|
| Rate for Payer: Blue Shield of California Commercial |
$15.23
|
| Rate for Payer: Blue Shield of California EPN |
$9.95
|
| Rate for Payer: Cash Price |
$13.71
|
| 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: 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: InnovAge PACE Commercial |
$12.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.45
|
| Rate for Payer: Molina Healthcare of CA 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 8
|
Facility
|
IP
|
$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: Cash Price |
$18.08
|
| Rate for Payer: Central Health Plan Commercial |
$26.30
|
| 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 Permanente of CA Commercial/Self Funded |
$21.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.58
|
| 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
|
|
|
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 |
$19.97
|
| 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 |
$19.31
|
| Rate for Payer: Blue Shield of California Commercial |
$20.09
|
| Rate for Payer: Blue Shield of California EPN |
$13.12
|
| Rate for Payer: Cash Price |
$18.08
|
| 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: 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: InnovAge PACE Commercial |
$16.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.02
|
| Rate for Payer: Molina Healthcare of CA 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
|
|
|
HC CANNULATION, THORACIC DUCT
|
Facility
|
OP
|
$872.00
|
|
|
Service Code
|
CPT 38794
|
| Hospital Charge Code |
909008794
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$174.40 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$174.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$741.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$479.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$654.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$422.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$512.13
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$479.60
|
| Rate for Payer: Cash Price |
$479.60
|
| Rate for Payer: Cash Price |
$479.60
|
| Rate for Payer: Central Health Plan Commercial |
$697.60
|
| Rate for Payer: Cigna of CA HMO |
$558.08
|
| Rate for Payer: Cigna of CA PPO |
$645.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$741.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$741.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$741.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$348.80
|
| Rate for Payer: EPIC Health Plan Senior |
$348.80
|
| Rate for Payer: Galaxy Health WC |
$741.20
|
| Rate for Payer: Global Benefits Group Commercial |
$523.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$784.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$290.08
|
| Rate for Payer: InnovAge PACE Commercial |
$436.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$581.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$320.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$539.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$174.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$610.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$610.40
|
| Rate for Payer: Multiplan Commercial |
$654.00
|
| Rate for Payer: Networks By Design Commercial |
$566.80
|
| Rate for Payer: Prime Health Services Commercial |
$741.20
|
| Rate for Payer: Riverside University Health System MISP |
$348.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$523.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$741.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$741.20
|
| Rate for Payer: Vantage Medical Group Senior |
$741.20
|
|
