|
HC 59 FE CHLORIDE
|
Facility
|
IP
|
$1,217.00
|
|
|
Service Code
|
CPT A4641
|
| Hospital Charge Code |
909301497
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$243.40 |
| Max. Negotiated Rate |
$1,095.30 |
| Rate for Payer: Blue Shield of California Commercial |
$912.75
|
| Rate for Payer: Blue Shield of California EPN |
$649.88
|
| Rate for Payer: Cash Price |
$547.65
|
| Rate for Payer: Central Health Plan Commercial |
$973.60
|
| Rate for Payer: Cigna of CA HMO |
$851.90
|
| Rate for Payer: Cigna of CA PPO |
$851.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$486.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$486.80
|
| Rate for Payer: Galaxy Health WC |
$1,034.45
|
| Rate for Payer: Global Benefits Group Commercial |
$730.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,095.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$811.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$463.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$243.40
|
| Rate for Payer: Multiplan Commercial |
$912.75
|
| Rate for Payer: Networks By Design Commercial |
$608.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,034.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$459.54
|
| Rate for Payer: United Healthcare All Other HMO |
$448.83
|
| Rate for Payer: United Healthcare HMO Rider |
$439.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$401.61
|
|
|
HC 59 FE CHLORIDE
|
Facility
|
OP
|
$1,217.00
|
|
|
Service Code
|
CPT A4641
|
| Hospital Charge Code |
909301497
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$243.40 |
| Max. Negotiated Rate |
$1,095.30 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,034.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$669.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$669.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$589.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$719.00
|
| Rate for Payer: Blue Distinction Transplant |
$730.20
|
| Rate for Payer: Blue Shield of California Commercial |
$765.49
|
| Rate for Payer: Blue Shield of California EPN |
$595.11
|
| Rate for Payer: Cash Price |
$547.65
|
| Rate for Payer: Central Health Plan Commercial |
$973.60
|
| Rate for Payer: Cigna of CA HMO |
$851.90
|
| Rate for Payer: Cigna of CA PPO |
$851.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,034.45
|
| Rate for Payer: Dignity Health Media |
$1,034.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,034.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$486.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$486.80
|
| Rate for Payer: Galaxy Health WC |
$1,034.45
|
| Rate for Payer: Global Benefits Group Commercial |
$730.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,095.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$912.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$425.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$811.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$243.40
|
| Rate for Payer: Multiplan Commercial |
$912.75
|
| Rate for Payer: Networks By Design Commercial |
$608.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,034.45
|
| Rate for Payer: Riverside University Health System MISP |
$486.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$730.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$730.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$608.50
|
| Rate for Payer: United Healthcare All Other HMO |
$608.50
|
| Rate for Payer: United Healthcare HMO Rider |
$608.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$608.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,034.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1,034.45
|
|
|
HC 5-HIAA BY HPLC
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
CPT 83497
|
| Hospital Charge Code |
900910535
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Central Health Plan Commercial |
$104.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.00
|
| Rate for Payer: Galaxy Health WC |
$110.50
|
| Rate for Payer: Global Benefits Group Commercial |
$78.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$117.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$86.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.00
|
| Rate for Payer: Multiplan Commercial |
$97.50
|
| Rate for Payer: Networks By Design Commercial |
$84.50
|
| Rate for Payer: Prime Health Services Commercial |
$110.50
|
|
|
HC 5-HIAA BY HPLC
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
CPT 83497
|
| Hospital Charge Code |
900910535
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$114.46 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$93.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.46
|
| Rate for Payer: Blue Distinction Transplant |
$29.40
|
| Rate for Payer: Blue Shield of California Commercial |
$30.28
|
| Rate for Payer: Blue Shield of California EPN |
$23.81
|
| Rate for Payer: Caremore Medicare Advantage |
$12.90
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Central Health Plan Commercial |
$39.20
|
| Rate for Payer: Cigna of CA HMO |
$31.36
|
| Rate for Payer: Cigna of CA PPO |
$36.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.35
|
| Rate for Payer: Dignity Health Media |
$12.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.42
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.90
|
| Rate for Payer: Galaxy Health WC |
$41.65
|
| Rate for Payer: Global Benefits Group Commercial |
$29.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$36.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.90
|
| Rate for Payer: InnovAge PACE Commercial |
$19.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.29
|
| Rate for Payer: Multiplan Commercial |
$36.75
|
| Rate for Payer: Networks By Design Commercial |
$31.85
|
| Rate for Payer: Prime Health Services Commercial |
$41.65
|
| Rate for Payer: Prime Health Services Medicare |
$13.67
|
| Rate for Payer: Riverside University Health System MISP |
$14.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.45
|
| Rate for Payer: United Healthcare All Other HMO |
$10.45
|
| Rate for Payer: United Healthcare HMO Rider |
$10.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.19
|
| Rate for Payer: Vantage Medical Group Senior |
$12.90
|
|
|
HC 5-HYDROXYINDOLACETIC ACID URINE 24 HOURS
|
Facility
|
OP
|
$58.00
|
|
|
Service Code
|
CPT 83497
|
| Hospital Charge Code |
900912191
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.45 |
| Max. Negotiated Rate |
$114.46 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$93.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.46
|
| Rate for Payer: Blue Distinction Transplant |
$34.80
|
| Rate for Payer: Blue Shield of California Commercial |
$35.84
|
| Rate for Payer: Blue Shield of California EPN |
$28.19
|
| Rate for Payer: Caremore Medicare Advantage |
$12.90
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Central Health Plan Commercial |
$46.40
|
| Rate for Payer: Cigna of CA HMO |
$37.12
|
| Rate for Payer: Cigna of CA PPO |
$42.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.35
|
| Rate for Payer: Dignity Health Media |
$12.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.42
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.90
|
| Rate for Payer: Galaxy Health WC |
$49.30
|
| Rate for Payer: Global Benefits Group Commercial |
$34.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$52.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$43.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.90
|
| Rate for Payer: InnovAge PACE Commercial |
$19.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.29
|
| Rate for Payer: Multiplan Commercial |
$43.50
|
| Rate for Payer: Networks By Design Commercial |
$37.70
|
| Rate for Payer: Prime Health Services Commercial |
$49.30
|
| Rate for Payer: Prime Health Services Medicare |
$13.67
|
| Rate for Payer: Riverside University Health System MISP |
$14.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$34.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.45
|
| Rate for Payer: United Healthcare All Other HMO |
$10.45
|
| Rate for Payer: United Healthcare HMO Rider |
$10.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.19
|
| Rate for Payer: Vantage Medical Group Senior |
$12.90
|
|
|
HC 5-HYDROXYINDOLACETIC ACID URINE 24 HOURS
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
CPT 83497
|
| Hospital Charge Code |
900912191
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.60 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Cash Price |
$68.85
|
| Rate for Payer: Central Health Plan Commercial |
$122.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.20
|
| Rate for Payer: Galaxy Health WC |
$130.05
|
| Rate for Payer: Global Benefits Group Commercial |
$91.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$137.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$102.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.60
|
| Rate for Payer: Multiplan Commercial |
$114.75
|
| Rate for Payer: Networks By Design Commercial |
$99.45
|
| Rate for Payer: Prime Health Services Commercial |
$130.05
|
|
|
HC 5-HYDROXYINDOLACETIC ACID URINE RANDOM
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
CPT 83497
|
| Hospital Charge Code |
900912190
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Central Health Plan Commercial |
$104.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.00
|
| Rate for Payer: Galaxy Health WC |
$110.50
|
| Rate for Payer: Global Benefits Group Commercial |
$78.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$117.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$86.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.00
|
| Rate for Payer: Multiplan Commercial |
$97.50
|
| Rate for Payer: Networks By Design Commercial |
$84.50
|
| Rate for Payer: Prime Health Services Commercial |
$110.50
|
|
|
HC 5-HYDROXYINDOLACETIC ACID URINE RANDOM
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
CPT 83497
|
| Hospital Charge Code |
900912190
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$114.46 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$93.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.46
|
| Rate for Payer: Blue Distinction Transplant |
$29.40
|
| Rate for Payer: Blue Shield of California Commercial |
$30.28
|
| Rate for Payer: Blue Shield of California EPN |
$23.81
|
| Rate for Payer: Caremore Medicare Advantage |
$12.90
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Central Health Plan Commercial |
$39.20
|
| Rate for Payer: Cigna of CA HMO |
$31.36
|
| Rate for Payer: Cigna of CA PPO |
$36.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.35
|
| Rate for Payer: Dignity Health Media |
$12.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.42
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.90
|
| Rate for Payer: Galaxy Health WC |
$41.65
|
| Rate for Payer: Global Benefits Group Commercial |
$29.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$36.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.90
|
| Rate for Payer: InnovAge PACE Commercial |
$19.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.29
|
| Rate for Payer: Multiplan Commercial |
$36.75
|
| Rate for Payer: Networks By Design Commercial |
$31.85
|
| Rate for Payer: Prime Health Services Commercial |
$41.65
|
| Rate for Payer: Prime Health Services Medicare |
$13.67
|
| Rate for Payer: Riverside University Health System MISP |
$14.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.45
|
| Rate for Payer: United Healthcare All Other HMO |
$10.45
|
| Rate for Payer: United Healthcare HMO Rider |
$10.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.19
|
| Rate for Payer: Vantage Medical Group Senior |
$12.90
|
|
|
HC ABCESS CATH EXCHANGE
|
Facility
|
OP
|
$2,187.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
909001859
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$198.59 |
| Max. Negotiated Rate |
$2,364.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,858.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,202.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,202.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$651.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$795.26
|
| Rate for Payer: Blue Distinction Transplant |
$1,312.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,351.57
|
| Rate for Payer: Blue Shield of California EPN |
$1,062.88
|
| Rate for Payer: Cash Price |
$984.15
|
| Rate for Payer: Cash Price |
$984.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,749.60
|
| Rate for Payer: Cigna of CA HMO |
$1,399.68
|
| Rate for Payer: Cigna of CA PPO |
$1,618.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,858.95
|
| Rate for Payer: Dignity Health Media |
$1,858.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,858.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$874.80
|
| Rate for Payer: Galaxy Health WC |
$1,858.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,312.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,968.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,640.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$765.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,458.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$437.40
|
| Rate for Payer: Multiplan Commercial |
$1,640.25
|
| Rate for Payer: Networks By Design Commercial |
$1,421.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,858.95
|
| Rate for Payer: Riverside University Health System MISP |
$874.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,312.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,312.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,093.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,093.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,093.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,858.95
|
| Rate for Payer: Vantage Medical Group Senior |
$1,858.95
|
|
|
HC ABCESS CATH EXCHANGE
|
Facility
|
IP
|
$2,187.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
909001859
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$437.40 |
| Max. Negotiated Rate |
$1,968.30 |
| Rate for Payer: Cash Price |
$984.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,749.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.80
|
| Rate for Payer: Galaxy Health WC |
$1,858.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,312.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,968.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,458.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$833.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$437.40
|
| Rate for Payer: Multiplan Commercial |
$1,640.25
|
| Rate for Payer: Networks By Design Commercial |
$1,421.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,858.95
|
|
|
HC ABDOMEN KUB SUPINE
|
Facility
|
OP
|
$539.00
|
|
|
Service Code
|
CPT 74018
|
| Hospital Charge Code |
909001702
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.80 |
| Max. Negotiated Rate |
$485.10 |
| Rate for Payer: Adventist Health Medi-Cal |
$113.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$102.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$143.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$174.74
|
| Rate for Payer: Blue Distinction Transplant |
$323.40
|
| Rate for Payer: Blue Shield of California Commercial |
$333.10
|
| Rate for Payer: Blue Shield of California EPN |
$261.95
|
| Rate for Payer: Caremore Medicare Advantage |
$113.54
|
| Rate for Payer: Cash Price |
$242.55
|
| Rate for Payer: Cash Price |
$242.55
|
| Rate for Payer: Central Health Plan Commercial |
$431.20
|
| Rate for Payer: Cigna of CA HMO |
$344.96
|
| Rate for Payer: Cigna of CA PPO |
$398.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Media |
$113.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.54
|
| Rate for Payer: Galaxy Health WC |
$458.15
|
| Rate for Payer: Global Benefits Group Commercial |
$323.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$485.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$404.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$186.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$187.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$113.54
|
| Rate for Payer: InnovAge PACE Commercial |
$170.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$359.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$152.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$404.25
|
| Rate for Payer: Networks By Design Commercial |
$350.35
|
| Rate for Payer: Prime Health Services Commercial |
$458.15
|
| Rate for Payer: Prime Health Services Medicare |
$120.35
|
| Rate for Payer: Riverside University Health System MISP |
$124.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$323.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$323.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$159.01
|
| Rate for Payer: United Healthcare All Other HMO |
$159.01
|
| Rate for Payer: United Healthcare HMO Rider |
$159.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$159.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC ABDOMEN KUB SUPINE
|
Facility
|
IP
|
$539.00
|
|
|
Service Code
|
CPT 74018
|
| Hospital Charge Code |
909001702
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$107.80 |
| Max. Negotiated Rate |
$485.10 |
| Rate for Payer: Cash Price |
$242.55
|
| Rate for Payer: Central Health Plan Commercial |
$431.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.60
|
| Rate for Payer: Galaxy Health WC |
$458.15
|
| Rate for Payer: Global Benefits Group Commercial |
$323.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$485.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$359.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.80
|
| Rate for Payer: Multiplan Commercial |
$404.25
|
| Rate for Payer: Networks By Design Commercial |
$350.35
|
| Rate for Payer: Prime Health Services Commercial |
$458.15
|
|
|
HC ABDOMEN/RETROPERIT PERC BIO
|
Facility
|
IP
|
$4,233.00
|
|
|
Service Code
|
CPT 49180
|
| Hospital Charge Code |
909000161
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$846.60 |
| Max. Negotiated Rate |
$3,809.70 |
| Rate for Payer: Cash Price |
$1,904.85
|
| Rate for Payer: Central Health Plan Commercial |
$3,386.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,693.20
|
| Rate for Payer: Galaxy Health WC |
$3,598.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,539.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,809.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,823.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,612.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$846.60
|
| Rate for Payer: Multiplan Commercial |
$3,174.75
|
| Rate for Payer: Networks By Design Commercial |
$2,751.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,598.05
|
|
|
HC ABDOMEN/RETROPERIT PERC BIO
|
Facility
|
OP
|
$4,233.00
|
|
|
Service Code
|
CPT 49180
|
| Hospital Charge Code |
909000161
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$474.64 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,025.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,539.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$2,025.69
|
| Rate for Payer: Cash Price |
$1,904.85
|
| Rate for Payer: Cash Price |
$1,904.85
|
| Rate for Payer: Central Health Plan Commercial |
$3,386.40
|
| Rate for Payer: Cigna of CA PPO |
$3,132.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Media |
$2,025.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,734.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,025.69
|
| Rate for Payer: Galaxy Health WC |
$3,598.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,539.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,809.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,174.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,322.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,342.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,025.69
|
| Rate for Payer: InnovAge PACE Commercial |
$3,038.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,823.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$474.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$846.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,714.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,714.42
|
| Rate for Payer: Multiplan Commercial |
$3,174.75
|
| Rate for Payer: Networks By Design Commercial |
$2,751.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,598.05
|
| Rate for Payer: Prime Health Services Medicare |
$2,147.23
|
| Rate for Payer: Riverside University Health System MISP |
$2,228.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,539.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC ABDOMEN SINGLE AP VIEW
|
Facility
|
IP
|
$539.00
|
|
|
Service Code
|
CPT 74018
|
| Hospital Charge Code |
909001175
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$107.80 |
| Max. Negotiated Rate |
$485.10 |
| Rate for Payer: Cash Price |
$242.55
|
| Rate for Payer: Central Health Plan Commercial |
$431.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.60
|
| Rate for Payer: Galaxy Health WC |
$458.15
|
| Rate for Payer: Global Benefits Group Commercial |
$323.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$485.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$359.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.80
|
| Rate for Payer: Multiplan Commercial |
$404.25
|
| Rate for Payer: Networks By Design Commercial |
$350.35
|
| Rate for Payer: Prime Health Services Commercial |
$458.15
|
|
|
HC ABDOMEN SINGLE AP VIEW
|
Facility
|
OP
|
$539.00
|
|
|
Service Code
|
CPT 74018
|
| Hospital Charge Code |
909001175
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.80 |
| Max. Negotiated Rate |
$485.10 |
| Rate for Payer: Adventist Health Medi-Cal |
$113.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$102.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$143.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$174.74
|
| Rate for Payer: Blue Distinction Transplant |
$323.40
|
| Rate for Payer: Blue Shield of California Commercial |
$333.10
|
| Rate for Payer: Blue Shield of California EPN |
$261.95
|
| Rate for Payer: Caremore Medicare Advantage |
$113.54
|
| Rate for Payer: Cash Price |
$242.55
|
| Rate for Payer: Cash Price |
$242.55
|
| Rate for Payer: Central Health Plan Commercial |
$431.20
|
| Rate for Payer: Cigna of CA HMO |
$344.96
|
| Rate for Payer: Cigna of CA PPO |
$398.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Media |
$113.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.54
|
| Rate for Payer: Galaxy Health WC |
$458.15
|
| Rate for Payer: Global Benefits Group Commercial |
$323.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$485.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$404.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$186.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$187.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$113.54
|
| Rate for Payer: InnovAge PACE Commercial |
$170.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$359.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$152.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$404.25
|
| Rate for Payer: Networks By Design Commercial |
$350.35
|
| Rate for Payer: Prime Health Services Commercial |
$458.15
|
| Rate for Payer: Prime Health Services Medicare |
$120.35
|
| Rate for Payer: Riverside University Health System MISP |
$124.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$323.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$323.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$159.01
|
| Rate for Payer: United Healthcare All Other HMO |
$159.01
|
| Rate for Payer: United Healthcare HMO Rider |
$159.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$159.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC ABDOMEN THREE OR MORE VIEWS
|
Facility
|
OP
|
$842.00
|
|
|
Service Code
|
CPT 74021
|
| Hospital Charge Code |
909074021
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$66.73 |
| Max. Negotiated Rate |
$757.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$137.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$142.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$200.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$244.34
|
| Rate for Payer: Blue Distinction Transplant |
$505.20
|
| Rate for Payer: Blue Shield of California Commercial |
$520.36
|
| Rate for Payer: Blue Shield of California EPN |
$409.21
|
| Rate for Payer: Caremore Medicare Advantage |
$137.36
|
| Rate for Payer: Cash Price |
$378.90
|
| Rate for Payer: Cash Price |
$378.90
|
| Rate for Payer: Central Health Plan Commercial |
$673.60
|
| Rate for Payer: Cigna of CA HMO |
$538.88
|
| Rate for Payer: Cigna of CA PPO |
$623.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$715.70
|
| Rate for Payer: Global Benefits Group Commercial |
$505.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$757.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$631.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$226.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: InnovAge PACE Commercial |
$206.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$561.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$631.50
|
| Rate for Payer: Networks By Design Commercial |
$547.30
|
| Rate for Payer: Prime Health Services Commercial |
$715.70
|
| Rate for Payer: Prime Health Services Medicare |
$145.60
|
| Rate for Payer: Riverside University Health System MISP |
$151.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$505.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$505.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$303.97
|
| Rate for Payer: United Healthcare All Other HMO |
$303.97
|
| Rate for Payer: United Healthcare HMO Rider |
$303.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$303.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC ABDOMEN THREE OR MORE VIEWS
|
Facility
|
IP
|
$842.00
|
|
|
Service Code
|
CPT 74021
|
| Hospital Charge Code |
909074021
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$168.40 |
| Max. Negotiated Rate |
$757.80 |
| Rate for Payer: Cash Price |
$378.90
|
| Rate for Payer: Central Health Plan Commercial |
$673.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$336.80
|
| Rate for Payer: Galaxy Health WC |
$715.70
|
| Rate for Payer: Global Benefits Group Commercial |
$505.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$757.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$561.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$320.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.40
|
| Rate for Payer: Multiplan Commercial |
$631.50
|
| Rate for Payer: Networks By Design Commercial |
$547.30
|
| Rate for Payer: Prime Health Services Commercial |
$715.70
|
|
|
HC ABDOMEN TWO VIEWS
|
Facility
|
IP
|
$674.00
|
|
|
Service Code
|
CPT 74019
|
| Hospital Charge Code |
909074019
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$134.80 |
| Max. Negotiated Rate |
$606.60 |
| Rate for Payer: Cash Price |
$303.30
|
| Rate for Payer: Central Health Plan Commercial |
$539.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$269.60
|
| Rate for Payer: Galaxy Health WC |
$572.90
|
| Rate for Payer: Global Benefits Group Commercial |
$404.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$606.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$449.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$256.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.80
|
| Rate for Payer: Multiplan Commercial |
$505.50
|
| Rate for Payer: Networks By Design Commercial |
$438.10
|
| Rate for Payer: Prime Health Services Commercial |
$572.90
|
|
|
HC ABDOMEN TWO VIEWS
|
Facility
|
OP
|
$674.00
|
|
|
Service Code
|
CPT 74019
|
| Hospital Charge Code |
909074019
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$57.19 |
| Max. Negotiated Rate |
$606.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$137.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$122.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$171.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$209.51
|
| Rate for Payer: Blue Distinction Transplant |
$404.40
|
| Rate for Payer: Blue Shield of California Commercial |
$416.53
|
| Rate for Payer: Blue Shield of California EPN |
$327.56
|
| Rate for Payer: Caremore Medicare Advantage |
$137.36
|
| Rate for Payer: Cash Price |
$303.30
|
| Rate for Payer: Cash Price |
$303.30
|
| Rate for Payer: Central Health Plan Commercial |
$539.20
|
| Rate for Payer: Cigna of CA HMO |
$431.36
|
| Rate for Payer: Cigna of CA PPO |
$498.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$572.90
|
| Rate for Payer: Global Benefits Group Commercial |
$404.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$606.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$505.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$226.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: InnovAge PACE Commercial |
$206.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$449.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$505.50
|
| Rate for Payer: Networks By Design Commercial |
$438.10
|
| Rate for Payer: Prime Health Services Commercial |
$572.90
|
| Rate for Payer: Prime Health Services Medicare |
$145.60
|
| Rate for Payer: Riverside University Health System MISP |
$151.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$404.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$404.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$303.97
|
| Rate for Payer: United Healthcare All Other HMO |
$303.97
|
| Rate for Payer: United Healthcare HMO Rider |
$303.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$303.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC ABD PARACENTESIS W IMAGE GUID
|
Facility
|
OP
|
$2,110.00
|
|
|
Service Code
|
CPT 49083
|
| Hospital Charge Code |
901200037
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$422.00 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,132.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,266.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$1,132.59
|
| Rate for Payer: Cash Price |
$949.50
|
| Rate for Payer: Cash Price |
$949.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,688.00
|
| Rate for Payer: Cigna of CA PPO |
$1,561.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Media |
$1,132.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,529.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,132.59
|
| Rate for Payer: Galaxy Health WC |
$1,793.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,266.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,899.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,582.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,857.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,868.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: InnovAge PACE Commercial |
$1,698.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,407.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$526.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$422.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,517.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,517.67
|
| Rate for Payer: Multiplan Commercial |
$1,582.50
|
| Rate for Payer: Networks By Design Commercial |
$1,371.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,793.50
|
| Rate for Payer: Prime Health Services Medicare |
$1,200.55
|
| Rate for Payer: Riverside University Health System MISP |
$1,245.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,266.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC ABD PARACENTESIS W IMAGE GUID
|
Facility
|
OP
|
$2,110.00
|
|
|
Service Code
|
CPT 49083
|
| Hospital Charge Code |
906749080
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$422.00 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,132.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,266.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$1,132.59
|
| Rate for Payer: Cash Price |
$949.50
|
| Rate for Payer: Cash Price |
$949.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,688.00
|
| Rate for Payer: Cigna of CA PPO |
$1,561.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Media |
$1,132.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,529.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,132.59
|
| Rate for Payer: Galaxy Health WC |
$1,793.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,266.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,899.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,582.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,857.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,868.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: InnovAge PACE Commercial |
$1,698.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,407.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$526.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$422.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,517.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,517.67
|
| Rate for Payer: Multiplan Commercial |
$1,582.50
|
| Rate for Payer: Networks By Design Commercial |
$1,371.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,793.50
|
| Rate for Payer: Prime Health Services Medicare |
$1,200.55
|
| Rate for Payer: Riverside University Health System MISP |
$1,245.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,266.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,359.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC ABD PARACENTESIS W IMAGE GUID
|
Facility
|
OP
|
$2,110.00
|
|
|
Service Code
|
CPT 49083
|
| Hospital Charge Code |
906749080
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$422.00 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,132.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,266.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,327.19
|
| Rate for Payer: Blue Shield of California EPN |
$1,031.79
|
| Rate for Payer: Caremore Medicare Advantage |
$1,132.59
|
| Rate for Payer: Cash Price |
$949.50
|
| Rate for Payer: Cash Price |
$949.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,688.00
|
| Rate for Payer: Cigna of CA HMO |
$1,350.40
|
| Rate for Payer: Cigna of CA PPO |
$1,561.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Media |
$1,132.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,529.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,132.59
|
| Rate for Payer: Galaxy Health WC |
$1,793.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,266.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,899.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,582.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,857.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,868.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: InnovAge PACE Commercial |
$1,698.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,407.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$526.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$422.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,517.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,517.67
|
| Rate for Payer: Multiplan Commercial |
$1,582.50
|
| Rate for Payer: Networks By Design Commercial |
$1,371.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,793.50
|
| Rate for Payer: Prime Health Services Medicare |
$1,200.55
|
| Rate for Payer: Riverside University Health System MISP |
$1,245.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,266.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,266.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,055.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,055.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,055.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,055.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC ABD PARACENTESIS W IMAGE GUID
|
Facility
|
IP
|
$2,110.00
|
|
|
Service Code
|
CPT 49083
|
| Hospital Charge Code |
906749080
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$422.00 |
| Max. Negotiated Rate |
$1,899.00 |
| Rate for Payer: Cash Price |
$949.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,688.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$844.00
|
| Rate for Payer: Galaxy Health WC |
$1,793.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,266.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,899.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,407.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$803.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$422.00
|
| Rate for Payer: Multiplan Commercial |
$1,582.50
|
| Rate for Payer: Networks By Design Commercial |
$1,371.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,793.50
|
|
|
HC ABD PARACENTESIS W IMAGE GUID
|
Facility
|
IP
|
$2,110.00
|
|
|
Service Code
|
CPT 49083
|
| Hospital Charge Code |
901200037
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$422.00 |
| Max. Negotiated Rate |
$1,899.00 |
| Rate for Payer: Cash Price |
$949.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,688.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$844.00
|
| Rate for Payer: Galaxy Health WC |
$1,793.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,266.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,899.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,407.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$803.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$422.00
|
| Rate for Payer: Multiplan Commercial |
$1,582.50
|
| Rate for Payer: Networks By Design Commercial |
$1,371.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,793.50
|
|
