|
HC ABLATION L/R ATRIUM AFIB
|
Facility
|
IP
|
$1,152.00
|
|
|
Service Code
|
CPT 93657
|
| Hospital Charge Code |
906820252
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$230.40 |
| Max. Negotiated Rate |
$1,036.80 |
| Rate for Payer: Cash Price |
$518.40
|
| Rate for Payer: Central Health Plan Commercial |
$921.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$460.80
|
| Rate for Payer: Galaxy Health WC |
$979.20
|
| Rate for Payer: Global Benefits Group Commercial |
$691.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,036.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$768.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$438.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$230.40
|
| Rate for Payer: Multiplan Commercial |
$864.00
|
| Rate for Payer: Networks By Design Commercial |
$748.80
|
| Rate for Payer: Prime Health Services Commercial |
$979.20
|
|
|
HC ABLATION SECONDARY ARRHYTHMIA
|
Facility
|
OP
|
$16,758.00
|
|
|
Service Code
|
CPT 93655
|
| Hospital Charge Code |
906811447
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$626.62 |
| Max. Negotiated Rate |
$15,082.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14,244.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,216.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,216.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,979.00
|
| Rate for Payer: Blue Distinction Transplant |
$10,054.80
|
| Rate for Payer: Blue Shield of California Commercial |
$9,194.24
|
| Rate for Payer: Blue Shield of California EPN |
$6,603.71
|
| Rate for Payer: Cash Price |
$7,541.10
|
| Rate for Payer: Cash Price |
$7,541.10
|
| Rate for Payer: Central Health Plan Commercial |
$13,406.40
|
| Rate for Payer: Cigna of CA PPO |
$12,400.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14,244.30
|
| Rate for Payer: Dignity Health Media |
$14,244.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,244.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,703.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,703.20
|
| Rate for Payer: Galaxy Health WC |
$14,244.30
|
| Rate for Payer: Global Benefits Group Commercial |
$10,054.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,082.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12,568.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5,865.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,177.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$626.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,351.60
|
| Rate for Payer: Multiplan Commercial |
$12,568.50
|
| Rate for Payer: Networks By Design Commercial |
$10,892.70
|
| Rate for Payer: Prime Health Services Commercial |
$14,244.30
|
| Rate for Payer: Riverside University Health System MISP |
$6,703.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,054.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10,054.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,244.30
|
| Rate for Payer: Vantage Medical Group Senior |
$14,244.30
|
|
|
HC ABLATION SECONDARY ARRHYTHMIA
|
Facility
|
IP
|
$16,758.00
|
|
|
Service Code
|
CPT 93655
|
| Hospital Charge Code |
906820250
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,351.60 |
| Max. Negotiated Rate |
$15,082.20 |
| Rate for Payer: Cash Price |
$7,541.10
|
| Rate for Payer: Central Health Plan Commercial |
$13,406.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,703.20
|
| Rate for Payer: Galaxy Health WC |
$14,244.30
|
| Rate for Payer: Global Benefits Group Commercial |
$10,054.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,082.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,177.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,384.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,351.60
|
| Rate for Payer: Multiplan Commercial |
$12,568.50
|
| Rate for Payer: Networks By Design Commercial |
$10,892.70
|
| Rate for Payer: Prime Health Services Commercial |
$14,244.30
|
|
|
HC ABLATION SECONDARY ARRHYTHMIA
|
Facility
|
OP
|
$16,758.00
|
|
|
Service Code
|
CPT 93655
|
| Hospital Charge Code |
906820250
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$626.62 |
| Max. Negotiated Rate |
$15,082.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14,244.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,216.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,216.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,979.00
|
| Rate for Payer: Blue Distinction Transplant |
$10,054.80
|
| Rate for Payer: Blue Shield of California Commercial |
$9,194.24
|
| Rate for Payer: Blue Shield of California EPN |
$6,603.71
|
| Rate for Payer: Cash Price |
$7,541.10
|
| Rate for Payer: Cash Price |
$7,541.10
|
| Rate for Payer: Central Health Plan Commercial |
$13,406.40
|
| Rate for Payer: Cigna of CA PPO |
$12,400.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14,244.30
|
| Rate for Payer: Dignity Health Media |
$14,244.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,244.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,703.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,703.20
|
| Rate for Payer: Galaxy Health WC |
$14,244.30
|
| Rate for Payer: Global Benefits Group Commercial |
$10,054.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,082.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12,568.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5,865.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,177.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$626.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,351.60
|
| Rate for Payer: Multiplan Commercial |
$12,568.50
|
| Rate for Payer: Networks By Design Commercial |
$10,892.70
|
| Rate for Payer: Prime Health Services Commercial |
$14,244.30
|
| Rate for Payer: Riverside University Health System MISP |
$6,703.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,054.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10,054.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,244.30
|
| Rate for Payer: Vantage Medical Group Senior |
$14,244.30
|
|
|
HC ABLATION SECONDARY ARRHYTHMIA
|
Facility
|
IP
|
$16,758.00
|
|
|
Service Code
|
CPT 93655
|
| Hospital Charge Code |
906811447
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,351.60 |
| Max. Negotiated Rate |
$15,082.20 |
| Rate for Payer: Cash Price |
$7,541.10
|
| Rate for Payer: Central Health Plan Commercial |
$13,406.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,703.20
|
| Rate for Payer: Galaxy Health WC |
$14,244.30
|
| Rate for Payer: Global Benefits Group Commercial |
$10,054.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,082.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,177.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,384.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,351.60
|
| Rate for Payer: Multiplan Commercial |
$12,568.50
|
| Rate for Payer: Networks By Design Commercial |
$10,892.70
|
| Rate for Payer: Prime Health Services Commercial |
$14,244.30
|
|
|
HC ABLATION SPINE OTHER
|
Facility
|
IP
|
$854.00
|
|
|
Service Code
|
CPT 22899
|
| Hospital Charge Code |
909022899
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$170.80 |
| Max. Negotiated Rate |
$768.60 |
| Rate for Payer: Cash Price |
$384.30
|
| Rate for Payer: Central Health Plan Commercial |
$683.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$341.60
|
| Rate for Payer: Galaxy Health WC |
$725.90
|
| Rate for Payer: Global Benefits Group Commercial |
$512.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$768.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$569.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$325.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.80
|
| Rate for Payer: Multiplan Commercial |
$640.50
|
| Rate for Payer: Networks By Design Commercial |
$555.10
|
| Rate for Payer: Prime Health Services Commercial |
$725.90
|
|
|
HC ABLATION SPINE OTHER
|
Facility
|
OP
|
$854.00
|
|
|
Service Code
|
CPT 22899
|
| Hospital Charge Code |
909022899
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$170.80 |
| Max. Negotiated Rate |
$3,079.84 |
| Rate for Payer: Adventist Health Medi-Cal |
$294.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$294.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$413.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$504.54
|
| Rate for Payer: Blue Distinction Transplant |
$512.40
|
| 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 |
$294.64
|
| Rate for Payer: Cash Price |
$384.30
|
| Rate for Payer: Cash Price |
$384.30
|
| Rate for Payer: Central Health Plan Commercial |
$683.20
|
| Rate for Payer: Cigna of CA PPO |
$631.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$441.96
|
| Rate for Payer: Dignity Health Media |
$294.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$397.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$294.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$294.64
|
| Rate for Payer: Galaxy Health WC |
$725.90
|
| Rate for Payer: Global Benefits Group Commercial |
$512.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$768.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$640.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$483.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$486.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$294.64
|
| Rate for Payer: InnovAge PACE Commercial |
$441.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$569.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$394.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$394.82
|
| Rate for Payer: Multiplan Commercial |
$640.50
|
| Rate for Payer: Networks By Design Commercial |
$555.10
|
| Rate for Payer: Prime Health Services Commercial |
$725.90
|
| Rate for Payer: Prime Health Services Medicare |
$312.32
|
| Rate for Payer: Riverside University Health System MISP |
$324.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$512.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Vantage Medical Group Senior |
$294.64
|
|
|
HC ABLAT LUM/SAC NERVE SNGL LEVEL
|
Facility
|
IP
|
$5,438.00
|
|
|
Service Code
|
CPT 64635
|
| Hospital Charge Code |
909000262
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,087.60 |
| Max. Negotiated Rate |
$4,894.20 |
| Rate for Payer: Cash Price |
$2,447.10
|
| Rate for Payer: Central Health Plan Commercial |
$4,350.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,175.20
|
| Rate for Payer: Galaxy Health WC |
$4,622.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,262.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,894.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,627.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,071.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,087.60
|
| Rate for Payer: Multiplan Commercial |
$4,078.50
|
| Rate for Payer: Networks By Design Commercial |
$3,534.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,622.30
|
|
|
HC ABLAT LUM/SAC NERVE SNGL LEVEL
|
Facility
|
OP
|
$5,438.00
|
|
|
Service Code
|
CPT 64635
|
| Hospital Charge Code |
909000262
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$371.15 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,412.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,653.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,412.38
|
| 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 |
$3,262.80
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$2,412.38
|
| Rate for Payer: Cash Price |
$2,447.10
|
| Rate for Payer: Cash Price |
$2,447.10
|
| Rate for Payer: Central Health Plan Commercial |
$4,350.40
|
| Rate for Payer: Cigna of CA PPO |
$4,024.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Dignity Health Media |
$2,412.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,653.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,256.71
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,412.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,412.38
|
| Rate for Payer: Galaxy Health WC |
$4,622.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,262.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,894.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,078.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,956.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,980.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,412.38
|
| Rate for Payer: InnovAge PACE Commercial |
$3,618.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,627.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$371.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,412.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,087.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,232.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,232.59
|
| Rate for Payer: Multiplan Commercial |
$4,078.50
|
| Rate for Payer: Networks By Design Commercial |
$3,534.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,622.30
|
| Rate for Payer: Prime Health Services Medicare |
$2,557.12
|
| Rate for Payer: Riverside University Health System MISP |
$2,653.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,262.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,653.62
|
| Rate for Payer: Vantage Medical Group Senior |
$2,412.38
|
|
|
HC ABL IE GT 1 TMR PER ORGN INC IG
|
Facility
|
OP
|
$33,258.00
|
|
|
Service Code
|
CPT 0600T
|
| Hospital Charge Code |
909000600
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$683.14 |
| Max. Negotiated Rate |
$29,932.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$12,861.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19,291.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,147.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12,861.31
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$17,583.26
|
| Rate for Payer: Blue Distinction Transplant |
$19,954.80
|
| Rate for Payer: Blue Shield of California Commercial |
$951.13
|
| Rate for Payer: Blue Shield of California EPN |
$683.14
|
| Rate for Payer: Caremore Medicare Advantage |
$12,861.31
|
| Rate for Payer: Cash Price |
$14,966.10
|
| Rate for Payer: Cash Price |
$14,966.10
|
| Rate for Payer: Central Health Plan Commercial |
$26,606.40
|
| Rate for Payer: Cigna of CA PPO |
$24,610.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19,291.96
|
| Rate for Payer: Dignity Health Media |
$12,861.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,147.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$17,362.77
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12,861.31
|
| Rate for Payer: EPIC Health Plan Transplant |
$12,861.31
|
| Rate for Payer: Galaxy Health WC |
$28,269.30
|
| Rate for Payer: Global Benefits Group Commercial |
$19,954.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$29,932.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$24,943.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21,092.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21,221.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12,861.31
|
| Rate for Payer: InnovAge PACE Commercial |
$19,291.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22,183.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,671.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,861.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,651.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,234.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,234.16
|
| Rate for Payer: Multiplan Commercial |
$24,943.50
|
| Rate for Payer: Multiplan WC |
$17,583.26
|
| Rate for Payer: Networks By Design Commercial |
$21,617.70
|
| Rate for Payer: Preferred Health Network WC |
$17,942.10
|
| Rate for Payer: Prime Health Services Commercial |
$28,269.30
|
| Rate for Payer: Prime Health Services Medicare |
$13,632.99
|
| Rate for Payer: Prime Health Services WC |
$17,403.84
|
| Rate for Payer: Riverside University Health System MISP |
$14,147.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19,954.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19,291.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,147.44
|
| Rate for Payer: Vantage Medical Group Senior |
$12,861.31
|
|
|
HC ABL IE GT 1 TMR PER ORGN INC IG
|
Facility
|
IP
|
$33,258.00
|
|
|
Service Code
|
CPT 0600T
|
| Hospital Charge Code |
909000600
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,651.60 |
| Max. Negotiated Rate |
$29,932.20 |
| Rate for Payer: Cash Price |
$14,966.10
|
| Rate for Payer: Central Health Plan Commercial |
$26,606.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,303.20
|
| Rate for Payer: Galaxy Health WC |
$28,269.30
|
| Rate for Payer: Global Benefits Group Commercial |
$19,954.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$29,932.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22,183.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,671.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,651.60
|
| Rate for Payer: Multiplan Commercial |
$24,943.50
|
| Rate for Payer: Networks By Design Commercial |
$21,617.70
|
| Rate for Payer: Prime Health Services Commercial |
$28,269.30
|
|
|
HC ABL IE GT 1 TMR PR ORG INC FL US
|
Facility
|
OP
|
$33,258.00
|
|
|
Service Code
|
CPT 0601T
|
| Hospital Charge Code |
909000601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$683.14 |
| Max. Negotiated Rate |
$29,932.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$12,861.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,071.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19,291.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,147.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12,861.31
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$17,583.26
|
| Rate for Payer: Blue Distinction Transplant |
$19,954.80
|
| Rate for Payer: Blue Shield of California Commercial |
$951.13
|
| Rate for Payer: Blue Shield of California EPN |
$683.14
|
| Rate for Payer: Caremore Medicare Advantage |
$12,861.31
|
| Rate for Payer: Cash Price |
$14,966.10
|
| Rate for Payer: Cash Price |
$14,966.10
|
| Rate for Payer: Central Health Plan Commercial |
$26,606.40
|
| Rate for Payer: Cigna of CA PPO |
$24,610.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19,291.96
|
| Rate for Payer: Dignity Health Media |
$12,861.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,147.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$17,362.77
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12,861.31
|
| Rate for Payer: EPIC Health Plan Transplant |
$12,861.31
|
| Rate for Payer: Galaxy Health WC |
$28,269.30
|
| Rate for Payer: Global Benefits Group Commercial |
$19,954.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$29,932.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$24,943.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21,092.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21,221.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12,861.31
|
| Rate for Payer: InnovAge PACE Commercial |
$19,291.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22,183.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,671.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,861.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,651.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,234.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,234.16
|
| Rate for Payer: Multiplan Commercial |
$24,943.50
|
| Rate for Payer: Multiplan WC |
$17,583.26
|
| Rate for Payer: Networks By Design Commercial |
$21,617.70
|
| Rate for Payer: Preferred Health Network WC |
$17,942.10
|
| Rate for Payer: Prime Health Services Commercial |
$28,269.30
|
| Rate for Payer: Prime Health Services Medicare |
$13,632.99
|
| Rate for Payer: Prime Health Services WC |
$17,403.84
|
| Rate for Payer: Riverside University Health System MISP |
$14,147.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19,954.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19,291.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,147.44
|
| Rate for Payer: Vantage Medical Group Senior |
$12,861.31
|
|
|
HC ABL IE GT 1 TMR PR ORG INC FL US
|
Facility
|
IP
|
$33,258.00
|
|
|
Service Code
|
CPT 0601T
|
| Hospital Charge Code |
909000601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,651.60 |
| Max. Negotiated Rate |
$29,932.20 |
| Rate for Payer: Cash Price |
$14,966.10
|
| Rate for Payer: Central Health Plan Commercial |
$26,606.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,303.20
|
| Rate for Payer: Galaxy Health WC |
$28,269.30
|
| Rate for Payer: Global Benefits Group Commercial |
$19,954.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$29,932.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22,183.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,671.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,651.60
|
| Rate for Payer: Multiplan Commercial |
$24,943.50
|
| Rate for Payer: Networks By Design Commercial |
$21,617.70
|
| Rate for Payer: Prime Health Services Commercial |
$28,269.30
|
|
|
HC ABO BLOOD GROUP
|
Facility
|
IP
|
$271.00
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
900904523
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$54.20 |
| Max. Negotiated Rate |
$243.90 |
| Rate for Payer: Cash Price |
$121.95
|
| Rate for Payer: Central Health Plan Commercial |
$216.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.40
|
| Rate for Payer: Galaxy Health WC |
$230.35
|
| Rate for Payer: Global Benefits Group Commercial |
$162.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$243.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$180.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$103.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.20
|
| Rate for Payer: Multiplan Commercial |
$203.25
|
| Rate for Payer: Networks By Design Commercial |
$176.15
|
| Rate for Payer: Prime Health Services Commercial |
$230.35
|
|
|
HC ABO BLOOD GROUP
|
Facility
|
OP
|
$271.00
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
900904523
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.42 |
| Max. Negotiated Rate |
$263.34 |
| Rate for Payer: Adventist Health Medi-Cal |
$159.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.46
|
| Rate for Payer: Blue Distinction Transplant |
$162.60
|
| Rate for Payer: Blue Shield of California Commercial |
$167.48
|
| Rate for Payer: Blue Shield of California EPN |
$131.71
|
| Rate for Payer: Caremore Medicare Advantage |
$159.60
|
| Rate for Payer: Cash Price |
$121.95
|
| Rate for Payer: Cash Price |
$121.95
|
| Rate for Payer: Central Health Plan Commercial |
$216.80
|
| Rate for Payer: Cigna of CA HMO |
$173.44
|
| Rate for Payer: Cigna of CA PPO |
$200.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.40
|
| Rate for Payer: Dignity Health Media |
$159.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.46
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$159.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$159.60
|
| Rate for Payer: Galaxy Health WC |
$230.35
|
| Rate for Payer: Global Benefits Group Commercial |
$162.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$243.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$203.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$261.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$263.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$159.60
|
| Rate for Payer: InnovAge PACE Commercial |
$239.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$180.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$159.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$213.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$213.86
|
| Rate for Payer: Multiplan Commercial |
$203.25
|
| Rate for Payer: Networks By Design Commercial |
$176.15
|
| Rate for Payer: Prime Health Services Commercial |
$230.35
|
| Rate for Payer: Prime Health Services Medicare |
$169.18
|
| Rate for Payer: Riverside University Health System MISP |
$175.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$162.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$162.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.42
|
| Rate for Payer: United Healthcare All Other HMO |
$2.42
|
| Rate for Payer: United Healthcare HMO Rider |
$2.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
HC ABO UNIT CONFIRMATION
|
Facility
|
IP
|
$271.00
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
900904524
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$54.20 |
| Max. Negotiated Rate |
$243.90 |
| Rate for Payer: Cash Price |
$121.95
|
| Rate for Payer: Central Health Plan Commercial |
$216.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.40
|
| Rate for Payer: Galaxy Health WC |
$230.35
|
| Rate for Payer: Global Benefits Group Commercial |
$162.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$243.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$180.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$103.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.20
|
| Rate for Payer: Multiplan Commercial |
$203.25
|
| Rate for Payer: Networks By Design Commercial |
$176.15
|
| Rate for Payer: Prime Health Services Commercial |
$230.35
|
|
|
HC ABO UNIT CONFIRMATION
|
Facility
|
OP
|
$271.00
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
900904524
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$642.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$159.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$160.11
|
| Rate for Payer: Blue Distinction Transplant |
$162.60
|
| Rate for Payer: Blue Shield of California Commercial |
$170.46
|
| Rate for Payer: Blue Shield of California EPN |
$132.52
|
| Rate for Payer: Caremore Medicare Advantage |
$159.60
|
| Rate for Payer: Cash Price |
$121.95
|
| Rate for Payer: Cash Price |
$121.95
|
| Rate for Payer: Cash Price |
$121.95
|
| Rate for Payer: Central Health Plan Commercial |
$216.80
|
| Rate for Payer: Cigna of CA HMO |
$173.44
|
| Rate for Payer: Cigna of CA PPO |
$200.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.40
|
| Rate for Payer: Dignity Health Media |
$159.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.46
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$159.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$159.60
|
| Rate for Payer: Galaxy Health WC |
$230.35
|
| Rate for Payer: Global Benefits Group Commercial |
$162.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$243.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$203.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$261.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$263.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$159.60
|
| Rate for Payer: InnovAge PACE Commercial |
$239.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$180.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$159.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$213.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$213.86
|
| Rate for Payer: Multiplan Commercial |
$203.25
|
| Rate for Payer: Networks By Design Commercial |
$176.15
|
| Rate for Payer: Prime Health Services Commercial |
$230.35
|
| Rate for Payer: Prime Health Services Medicare |
$169.18
|
| Rate for Payer: Riverside University Health System MISP |
$175.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$162.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$162.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$642.00
|
| Rate for Payer: United Healthcare All Other HMO |
$631.00
|
| Rate for Payer: United Healthcare HMO Rider |
$630.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$575.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
HC ABSORBNT SHEET 6X14",BAG OF 10
|
Facility
|
IP
|
$5.99
|
|
| Hospital Charge Code |
901607997
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$5.39 |
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Central Health Plan Commercial |
$4.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: Galaxy Health WC |
$5.09
|
| Rate for Payer: Global Benefits Group Commercial |
$3.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.20
|
| Rate for Payer: Multiplan Commercial |
$4.49
|
| Rate for Payer: Networks By Design Commercial |
$3.89
|
| Rate for Payer: Prime Health Services Commercial |
$5.09
|
|
|
HC ABSORBNT SHEET 6X14",BAG OF 10
|
Facility
|
OP
|
$5.99
|
|
| Hospital Charge Code |
901607997
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$5.39 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.54
|
| Rate for Payer: Blue Distinction Transplant |
$3.59
|
| Rate for Payer: Blue Shield of California Commercial |
$3.77
|
| Rate for Payer: Blue Shield of California EPN |
$2.93
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Central Health Plan Commercial |
$4.79
|
| Rate for Payer: Cigna of CA HMO |
$3.83
|
| Rate for Payer: Cigna of CA PPO |
$4.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.09
|
| Rate for Payer: Dignity Health Media |
$5.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.40
|
| Rate for Payer: Galaxy Health WC |
$5.09
|
| Rate for Payer: Global Benefits Group Commercial |
$3.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.39
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.20
|
| Rate for Payer: Multiplan Commercial |
$4.49
|
| Rate for Payer: Networks By Design Commercial |
$3.89
|
| Rate for Payer: Prime Health Services Commercial |
$5.09
|
| Rate for Payer: Riverside University Health System MISP |
$2.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.09
|
| Rate for Payer: Vantage Medical Group Senior |
$5.09
|
|
|
HC ACETAMINOPHEN (TYLENOL)
|
Facility
|
OP
|
$59.00
|
|
|
Service Code
|
CPT 80143
|
| Hospital Charge Code |
900911302
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.80 |
| Max. Negotiated Rate |
$97.19 |
| Rate for Payer: Adventist Health Medi-Cal |
$18.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$97.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Alpha Care Medical Group 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 |
$48.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$58.55
|
| Rate for Payer: Blue Distinction Transplant |
$35.40
|
| Rate for Payer: Blue Shield of California Commercial |
$36.46
|
| Rate for Payer: Blue Shield of California EPN |
$28.67
|
| Rate for Payer: Caremore Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$26.55
|
| Rate for Payer: Cash Price |
$26.55
|
| Rate for Payer: Central Health Plan Commercial |
$47.20
|
| Rate for Payer: Cigna of CA HMO |
$37.76
|
| Rate for Payer: Cigna of CA PPO |
$43.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Media |
$18.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.16
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$18.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.64
|
| Rate for Payer: Galaxy Health WC |
$50.15
|
| Rate for Payer: Global Benefits Group Commercial |
$35.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$44.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$30.76
|
| 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 |
$39.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.80
|
| 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 |
$44.25
|
| Rate for Payer: Networks By Design Commercial |
$38.35
|
| Rate for Payer: Prime Health Services Commercial |
$50.15
|
| 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 |
$35.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.40
|
| 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: 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 ACETAMINOPHEN (TYLENOL)
|
Facility
|
IP
|
$415.00
|
|
|
Service Code
|
CPT 80143
|
| Hospital Charge Code |
900911302
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$83.00 |
| Max. Negotiated Rate |
$373.50 |
| Rate for Payer: Cash Price |
$186.75
|
| Rate for Payer: Central Health Plan Commercial |
$332.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$166.00
|
| Rate for Payer: Galaxy Health WC |
$352.75
|
| Rate for Payer: Global Benefits Group Commercial |
$249.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$373.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$276.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$158.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.00
|
| Rate for Payer: Multiplan Commercial |
$311.25
|
| Rate for Payer: Networks By Design Commercial |
$269.75
|
| Rate for Payer: Prime Health Services Commercial |
$352.75
|
|
|
HC ACETOACETATE, SEMIQUANTITATIVE
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
CPT 82010
|
| Hospital Charge Code |
900910466
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.20 |
| Max. Negotiated Rate |
$72.11 |
| Rate for Payer: Adventist Health Medi-Cal |
$8.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$60.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$59.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$72.11
|
| Rate for Payer: Blue Distinction Transplant |
$18.60
|
| Rate for Payer: Blue Shield of California Commercial |
$19.16
|
| Rate for Payer: Blue Shield of California EPN |
$15.07
|
| Rate for Payer: Caremore Medicare Advantage |
$8.17
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Central Health Plan Commercial |
$24.80
|
| Rate for Payer: Cigna of CA HMO |
$19.84
|
| Rate for Payer: Cigna of CA PPO |
$22.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.26
|
| Rate for Payer: Dignity Health Media |
$8.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.03
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.17
|
| Rate for Payer: Galaxy Health WC |
$26.35
|
| Rate for Payer: Global Benefits Group Commercial |
$18.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$23.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.17
|
| Rate for Payer: InnovAge PACE Commercial |
$12.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.95
|
| Rate for Payer: Multiplan Commercial |
$23.25
|
| Rate for Payer: Networks By Design Commercial |
$20.15
|
| Rate for Payer: Prime Health Services Commercial |
$26.35
|
| Rate for Payer: Prime Health Services Medicare |
$8.66
|
| Rate for Payer: Riverside University Health System MISP |
$8.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.62
|
| Rate for Payer: United Healthcare All Other HMO |
$6.62
|
| Rate for Payer: United Healthcare HMO Rider |
$6.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.99
|
| Rate for Payer: Vantage Medical Group Senior |
$8.17
|
|
|
HC ACETOACETATE, SEMIQUANTITATIVE
|
Facility
|
IP
|
$221.00
|
|
|
Service Code
|
CPT 82010
|
| Hospital Charge Code |
900910466
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.20 |
| Max. Negotiated Rate |
$198.90 |
| Rate for Payer: Cash Price |
$99.45
|
| Rate for Payer: Central Health Plan Commercial |
$176.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.40
|
| Rate for Payer: Galaxy Health WC |
$187.85
|
| Rate for Payer: Global Benefits Group Commercial |
$132.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$198.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$147.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$84.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.20
|
| Rate for Payer: Multiplan Commercial |
$165.75
|
| Rate for Payer: Networks By Design Commercial |
$143.65
|
| Rate for Payer: Prime Health Services Commercial |
$187.85
|
|
|
HC ACETYLCHOLINESTERASE STAIN
|
Facility
|
OP
|
$531.00
|
|
|
Service Code
|
CPT 88319
|
| Hospital Charge Code |
903800020
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$52.16 |
| Max. Negotiated Rate |
$1,772.71 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,074.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$673.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,611.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,181.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,074.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$52.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63.62
|
| Rate for Payer: Blue Distinction Transplant |
$318.60
|
| Rate for Payer: Blue Shield of California Commercial |
$328.16
|
| Rate for Payer: Blue Shield of California EPN |
$258.07
|
| Rate for Payer: Caremore Medicare Advantage |
$1,074.37
|
| Rate for Payer: Cash Price |
$238.95
|
| Rate for Payer: Cash Price |
$238.95
|
| Rate for Payer: Central Health Plan Commercial |
$424.80
|
| Rate for Payer: Cigna of CA HMO |
$339.84
|
| Rate for Payer: Cigna of CA PPO |
$392.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,611.56
|
| Rate for Payer: Dignity Health Media |
$1,074.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,181.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,450.40
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,074.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,074.37
|
| Rate for Payer: Galaxy Health WC |
$451.35
|
| Rate for Payer: Global Benefits Group Commercial |
$318.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$477.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$398.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,761.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,772.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,074.37
|
| Rate for Payer: InnovAge PACE Commercial |
$1,611.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$354.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,074.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,439.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,439.66
|
| Rate for Payer: Multiplan Commercial |
$398.25
|
| Rate for Payer: Networks By Design Commercial |
$345.15
|
| Rate for Payer: Prime Health Services Commercial |
$451.35
|
| Rate for Payer: Prime Health Services Medicare |
$1,138.83
|
| Rate for Payer: Riverside University Health System MISP |
$1,181.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$318.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$318.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$542.12
|
| Rate for Payer: United Healthcare All Other HMO |
$542.12
|
| Rate for Payer: United Healthcare HMO Rider |
$542.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,611.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,181.81
|
| Rate for Payer: Vantage Medical Group Senior |
$1,074.37
|
|
|
HC ACETYLCHOLINESTERASE STAIN
|
Facility
|
IP
|
$1,080.00
|
|
|
Service Code
|
CPT 88319
|
| Hospital Charge Code |
903800020
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$216.00 |
| Max. Negotiated Rate |
$972.00 |
| Rate for Payer: Cash Price |
$486.00
|
| Rate for Payer: Central Health Plan Commercial |
$864.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$432.00
|
| Rate for Payer: Galaxy Health WC |
$918.00
|
| Rate for Payer: Global Benefits Group Commercial |
$648.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$972.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$720.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$411.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$216.00
|
| Rate for Payer: Multiplan Commercial |
$810.00
|
| Rate for Payer: Networks By Design Commercial |
$702.00
|
| Rate for Payer: Prime Health Services Commercial |
$918.00
|
|
