|
HC AK REPLACEMENT OF SHAPED COVER
|
Facility
|
OP
|
$1,720.00
|
|
|
Service Code
|
CPT L5705
|
| Hospital Charge Code |
905355705
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$602.00 |
| Max. Negotiated Rate |
$1,548.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,462.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$946.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$946.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$832.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,016.18
|
| Rate for Payer: Blue Distinction Transplant |
$1,032.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,290.00
|
| Rate for Payer: Blue Shield of California EPN |
$935.68
|
| Rate for Payer: Cash Price |
$774.00
|
| Rate for Payer: Cash Price |
$774.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,376.00
|
| Rate for Payer: Cigna of CA HMO |
$1,204.00
|
| Rate for Payer: Cigna of CA PPO |
$1,204.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,462.00
|
| Rate for Payer: Dignity Health Media |
$1,462.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,462.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$688.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$688.00
|
| Rate for Payer: Galaxy Health WC |
$1,462.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,032.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,548.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,290.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$602.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,147.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$846.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$705.20
|
| Rate for Payer: Multiplan Commercial |
$1,290.00
|
| Rate for Payer: Networks By Design Commercial |
$860.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,462.00
|
| Rate for Payer: Riverside University Health System MISP |
$688.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,032.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,032.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$860.00
|
| Rate for Payer: United Healthcare All Other HMO |
$860.00
|
| Rate for Payer: United Healthcare HMO Rider |
$860.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$860.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,462.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,462.00
|
|
|
HC AK REPLACEMENT OF SOCKET
|
Facility
|
IP
|
$7,788.00
|
|
|
Service Code
|
CPT L5701
|
| Hospital Charge Code |
905355701
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,557.60 |
| Max. Negotiated Rate |
$7,009.20 |
| Rate for Payer: Blue Shield of California EPN |
$4,158.79
|
| Rate for Payer: Cash Price |
$3,504.60
|
| Rate for Payer: Central Health Plan Commercial |
$6,230.40
|
| Rate for Payer: Cigna of CA HMO |
$5,451.60
|
| Rate for Payer: Cigna of CA PPO |
$5,451.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,115.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,115.20
|
| Rate for Payer: Galaxy Health WC |
$6,619.80
|
| Rate for Payer: Global Benefits Group Commercial |
$4,672.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,009.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,194.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,967.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,557.60
|
| Rate for Payer: Multiplan Commercial |
$5,841.00
|
| Rate for Payer: Networks By Design Commercial |
$3,894.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,619.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,940.75
|
| Rate for Payer: United Healthcare All Other HMO |
$2,872.21
|
| Rate for Payer: United Healthcare HMO Rider |
$2,809.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,570.04
|
|
|
HC AK REPLACEMENT OF SOCKET
|
Facility
|
OP
|
$7,788.00
|
|
|
Service Code
|
CPT L5701
|
| Hospital Charge Code |
905355701
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,725.80 |
| Max. Negotiated Rate |
$7,009.20 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,619.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,283.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,283.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,770.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,601.15
|
| Rate for Payer: Blue Distinction Transplant |
$4,672.80
|
| Rate for Payer: Blue Shield of California Commercial |
$5,841.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,236.67
|
| Rate for Payer: Cash Price |
$3,504.60
|
| Rate for Payer: Cash Price |
$3,504.60
|
| Rate for Payer: Central Health Plan Commercial |
$6,230.40
|
| Rate for Payer: Cigna of CA HMO |
$5,451.60
|
| Rate for Payer: Cigna of CA PPO |
$5,451.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,619.80
|
| Rate for Payer: Dignity Health Media |
$6,619.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,619.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,115.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,115.20
|
| Rate for Payer: Galaxy Health WC |
$6,619.80
|
| Rate for Payer: Global Benefits Group Commercial |
$4,672.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,009.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,841.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,725.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,194.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,833.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,193.08
|
| Rate for Payer: Multiplan Commercial |
$5,841.00
|
| Rate for Payer: Networks By Design Commercial |
$3,894.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,619.80
|
| Rate for Payer: Riverside University Health System MISP |
$3,115.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,672.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,672.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,894.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,894.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,894.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,894.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,619.80
|
| Rate for Payer: Vantage Medical Group Senior |
$6,619.80
|
|
|
HC AK STUBBIES
|
Facility
|
IP
|
$5,379.00
|
|
|
Service Code
|
CPT L5210
|
| Hospital Charge Code |
905355210
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,075.80 |
| Max. Negotiated Rate |
$4,841.10 |
| Rate for Payer: Blue Shield of California EPN |
$2,872.39
|
| Rate for Payer: Cash Price |
$2,420.55
|
| Rate for Payer: Central Health Plan Commercial |
$4,303.20
|
| Rate for Payer: Cigna of CA HMO |
$3,765.30
|
| Rate for Payer: Cigna of CA PPO |
$3,765.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,151.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,151.60
|
| Rate for Payer: Galaxy Health WC |
$4,572.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,227.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,841.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,587.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,049.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,075.80
|
| Rate for Payer: Multiplan Commercial |
$4,034.25
|
| Rate for Payer: Networks By Design Commercial |
$2,689.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,572.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,031.11
|
| Rate for Payer: United Healthcare All Other HMO |
$1,983.78
|
| Rate for Payer: United Healthcare HMO Rider |
$1,940.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,775.07
|
|
|
HC AK STUBBIES
|
Facility
|
OP
|
$5,379.00
|
|
|
Service Code
|
CPT L5210
|
| Hospital Charge Code |
905355210
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,882.65 |
| Max. Negotiated Rate |
$4,841.10 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,572.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,958.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,958.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,604.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,177.91
|
| Rate for Payer: Blue Distinction Transplant |
$3,227.40
|
| Rate for Payer: Blue Shield of California Commercial |
$4,034.25
|
| Rate for Payer: Blue Shield of California EPN |
$2,926.18
|
| Rate for Payer: Cash Price |
$2,420.55
|
| Rate for Payer: Cash Price |
$2,420.55
|
| Rate for Payer: Central Health Plan Commercial |
$4,303.20
|
| Rate for Payer: Cigna of CA HMO |
$3,765.30
|
| Rate for Payer: Cigna of CA PPO |
$3,765.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,572.15
|
| Rate for Payer: Dignity Health Media |
$4,572.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,572.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,151.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,151.60
|
| Rate for Payer: Galaxy Health WC |
$4,572.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,227.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,841.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,034.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,882.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,587.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,015.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,205.39
|
| Rate for Payer: Multiplan Commercial |
$4,034.25
|
| Rate for Payer: Networks By Design Commercial |
$2,689.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,572.15
|
| Rate for Payer: Riverside University Health System MISP |
$2,151.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,227.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,227.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,689.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,689.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,689.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,689.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,572.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,572.15
|
|
|
HC AK STUBBIES W/ ARTICULTD ANKLE
|
Facility
|
IP
|
$8,217.00
|
|
|
Service Code
|
CPT L5220
|
| Hospital Charge Code |
905355220
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,643.40 |
| Max. Negotiated Rate |
$7,395.30 |
| Rate for Payer: Blue Shield of California EPN |
$4,387.88
|
| Rate for Payer: Cash Price |
$3,697.65
|
| Rate for Payer: Central Health Plan Commercial |
$6,573.60
|
| Rate for Payer: Cigna of CA HMO |
$5,751.90
|
| Rate for Payer: Cigna of CA PPO |
$5,751.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,286.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,286.80
|
| Rate for Payer: Galaxy Health WC |
$6,984.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,930.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,395.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,480.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,130.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,643.40
|
| Rate for Payer: Multiplan Commercial |
$6,162.75
|
| Rate for Payer: Networks By Design Commercial |
$4,108.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,984.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,102.74
|
| Rate for Payer: United Healthcare All Other HMO |
$3,030.43
|
| Rate for Payer: United Healthcare HMO Rider |
$2,964.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,711.61
|
|
|
HC AK STUBBIES W/ ARTICULTD ANKLE
|
Facility
|
OP
|
$8,217.00
|
|
|
Service Code
|
CPT L5220
|
| Hospital Charge Code |
905355220
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,875.95 |
| Max. Negotiated Rate |
$7,395.30 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,984.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,519.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,519.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,978.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,854.60
|
| Rate for Payer: Blue Distinction Transplant |
$4,930.20
|
| Rate for Payer: Blue Shield of California Commercial |
$6,162.75
|
| Rate for Payer: Blue Shield of California EPN |
$4,470.05
|
| Rate for Payer: Cash Price |
$3,697.65
|
| Rate for Payer: Cash Price |
$3,697.65
|
| Rate for Payer: Central Health Plan Commercial |
$6,573.60
|
| Rate for Payer: Cigna of CA HMO |
$5,751.90
|
| Rate for Payer: Cigna of CA PPO |
$5,751.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,984.45
|
| Rate for Payer: Dignity Health Media |
$6,984.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,984.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,286.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,286.80
|
| Rate for Payer: Galaxy Health WC |
$6,984.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,930.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,395.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,162.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,875.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,480.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,618.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,368.97
|
| Rate for Payer: Multiplan Commercial |
$6,162.75
|
| Rate for Payer: Networks By Design Commercial |
$4,108.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,984.45
|
| Rate for Payer: Riverside University Health System MISP |
$3,286.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,930.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,930.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,108.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,108.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,108.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,108.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,984.45
|
| Rate for Payer: Vantage Medical Group Senior |
$6,984.45
|
|
|
HC ALAIR BRONCH THERMOPLASTY CATH
|
Facility
|
IP
|
$7,813.00
|
|
|
Service Code
|
CPT C1886
|
| Hospital Charge Code |
900801886
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,562.60 |
| Max. Negotiated Rate |
$7,031.70 |
| Rate for Payer: Blue Shield of California EPN |
$4,172.14
|
| Rate for Payer: Cash Price |
$3,515.85
|
| Rate for Payer: Central Health Plan Commercial |
$6,250.40
|
| Rate for Payer: Cigna of CA HMO |
$5,469.10
|
| Rate for Payer: Cigna of CA PPO |
$5,469.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,125.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,125.20
|
| Rate for Payer: Galaxy Health WC |
$6,641.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,687.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,031.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,211.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,976.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,562.60
|
| Rate for Payer: Multiplan Commercial |
$5,859.75
|
| Rate for Payer: Prime Health Services Commercial |
$6,641.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,950.19
|
| Rate for Payer: United Healthcare All Other HMO |
$2,881.43
|
| Rate for Payer: United Healthcare HMO Rider |
$2,818.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,578.29
|
|
|
HC ALAIR BRONCH THERMOPLASTY CATH
|
Facility
|
OP
|
$7,813.00
|
|
|
Service Code
|
CPT C1886
|
| Hospital Charge Code |
900801886
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,562.60 |
| Max. Negotiated Rate |
$7,031.70 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,641.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,297.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,297.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,567.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,351.84
|
| Rate for Payer: Blue Distinction Transplant |
$4,687.80
|
| Rate for Payer: Blue Shield of California Commercial |
$5,859.75
|
| Rate for Payer: Blue Shield of California EPN |
$4,250.27
|
| Rate for Payer: Cash Price |
$3,515.85
|
| Rate for Payer: Central Health Plan Commercial |
$6,250.40
|
| Rate for Payer: Cigna of CA HMO |
$5,469.10
|
| Rate for Payer: Cigna of CA PPO |
$5,469.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,641.05
|
| Rate for Payer: Dignity Health Media |
$6,641.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,641.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,125.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,125.20
|
| Rate for Payer: Galaxy Health WC |
$6,641.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,687.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,031.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,859.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,734.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,211.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,562.60
|
| Rate for Payer: Multiplan Commercial |
$5,859.75
|
| Rate for Payer: Networks By Design Commercial |
$3,906.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,641.05
|
| Rate for Payer: Riverside University Health System MISP |
$3,125.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,687.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,687.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,906.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,906.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,906.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,906.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,641.05
|
| Rate for Payer: Vantage Medical Group Senior |
$6,641.05
|
|
|
HC ALBUMIN
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
900910220
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$43.97 |
| Rate for Payer: Adventist Health Medi-Cal |
$4.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$36.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$36.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.97
|
| Rate for Payer: Blue Distinction Transplant |
$9.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9.27
|
| Rate for Payer: Blue Shield of California EPN |
$7.29
|
| Rate for Payer: Caremore Medicare Advantage |
$4.95
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Central Health Plan Commercial |
$12.00
|
| Rate for Payer: Cigna of CA HMO |
$9.60
|
| Rate for Payer: Cigna of CA PPO |
$11.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.42
|
| Rate for Payer: Dignity Health Media |
$4.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4.95
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.95
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.95
|
| Rate for Payer: InnovAge PACE Commercial |
$7.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.63
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
| Rate for Payer: Prime Health Services Medicare |
$5.25
|
| Rate for Payer: Riverside University Health System MISP |
$5.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.01
|
| Rate for Payer: United Healthcare All Other HMO |
$4.01
|
| Rate for Payer: United Healthcare HMO Rider |
$4.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.44
|
| Rate for Payer: Vantage Medical Group Senior |
$4.95
|
|
|
HC ALBUMIN
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
900910220
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.80 |
| Max. Negotiated Rate |
$80.10 |
| Rate for Payer: Cash Price |
$40.05
|
| Rate for Payer: Central Health Plan Commercial |
$71.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.60
|
| Rate for Payer: Galaxy Health WC |
$75.65
|
| Rate for Payer: Global Benefits Group Commercial |
$53.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$80.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$59.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.80
|
| Rate for Payer: Multiplan Commercial |
$66.75
|
| Rate for Payer: Networks By Design Commercial |
$57.85
|
| Rate for Payer: Prime Health Services Commercial |
$75.65
|
|
|
HC ALBUMIN BODY FLUID
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
900910715
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$45.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$7.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$37.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.88
|
| Rate for Payer: Blue Distinction Transplant |
$10.20
|
| Rate for Payer: Blue Shield of California Commercial |
$10.51
|
| Rate for Payer: Blue Shield of California EPN |
$8.26
|
| Rate for Payer: Caremore Medicare Advantage |
$7.78
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Central Health Plan Commercial |
$13.60
|
| Rate for Payer: Cigna of CA HMO |
$10.88
|
| Rate for Payer: Cigna of CA PPO |
$12.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.67
|
| Rate for Payer: Dignity Health Media |
$7.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.50
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.78
|
| Rate for Payer: Galaxy Health WC |
$14.45
|
| Rate for Payer: Global Benefits Group Commercial |
$10.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.78
|
| Rate for Payer: InnovAge PACE Commercial |
$11.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.43
|
| Rate for Payer: Multiplan Commercial |
$12.75
|
| Rate for Payer: Networks By Design Commercial |
$11.05
|
| Rate for Payer: Prime Health Services Commercial |
$14.45
|
| Rate for Payer: Prime Health Services Medicare |
$8.25
|
| Rate for Payer: Riverside University Health System MISP |
$8.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.30
|
| Rate for Payer: United Healthcare All Other HMO |
$6.30
|
| Rate for Payer: United Healthcare HMO Rider |
$6.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.56
|
| Rate for Payer: Vantage Medical Group Senior |
$7.78
|
|
|
HC ALBUMIN BODY FLUID
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
900910715
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
|
|
HC ALCOHOL ETHANOL (SERUM/URINE)
|
Facility
|
IP
|
$380.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
900910322
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$76.00 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: Cash Price |
$171.00
|
| Rate for Payer: Central Health Plan Commercial |
$304.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$152.00
|
| Rate for Payer: Galaxy Health WC |
$323.00
|
| Rate for Payer: Global Benefits Group Commercial |
$228.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$342.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$253.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.00
|
| Rate for Payer: Multiplan Commercial |
$285.00
|
| Rate for Payer: Networks By Design Commercial |
$247.00
|
| Rate for Payer: Prime Health Services Commercial |
$323.00
|
|
|
HC ALCOHOL ETHANOL (SERUM/URINE)
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
900910322
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$92.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$75.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$92.00
|
| Rate for Payer: Blue Distinction Transplant |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$24.10
|
| Rate for Payer: Blue Shield of California EPN |
$18.95
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Central Health Plan Commercial |
$31.20
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.15
|
| Rate for Payer: Dignity Health Media |
$33.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.60
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.80
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Riverside University Health System MISP |
$15.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.50
|
| Rate for Payer: United Healthcare All Other HMO |
$19.50
|
| Rate for Payer: United Healthcare HMO Rider |
$19.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.15
|
| Rate for Payer: Vantage Medical Group Senior |
$33.15
|
|
|
HC ALCOHOL INJECTION INTO ORBIT
|
Facility
|
OP
|
$1,222.00
|
|
|
Service Code
|
CPT 67505
|
| Hospital Charge Code |
900567505
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$229.20 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$363.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$545.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$400.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$363.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$733.20
|
| Rate for Payer: Blue Shield of California Commercial |
$768.64
|
| Rate for Payer: Blue Shield of California EPN |
$597.56
|
| Rate for Payer: Caremore Medicare Advantage |
$363.98
|
| Rate for Payer: Cash Price |
$549.90
|
| Rate for Payer: Cash Price |
$549.90
|
| Rate for Payer: Cash Price |
$549.90
|
| Rate for Payer: Central Health Plan Commercial |
$977.60
|
| Rate for Payer: Cigna of CA HMO |
$782.08
|
| Rate for Payer: Cigna of CA PPO |
$904.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$545.97
|
| Rate for Payer: Dignity Health Media |
$363.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$400.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$491.37
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$363.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$363.98
|
| Rate for Payer: Galaxy Health WC |
$1,038.70
|
| Rate for Payer: Global Benefits Group Commercial |
$733.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,099.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$916.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$596.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$600.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$363.98
|
| Rate for Payer: InnovAge PACE Commercial |
$545.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$815.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$229.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$363.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$244.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$487.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$487.73
|
| Rate for Payer: Multiplan Commercial |
$916.50
|
| Rate for Payer: Networks By Design Commercial |
$794.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,038.70
|
| Rate for Payer: Prime Health Services Medicare |
$385.82
|
| Rate for Payer: Riverside University Health System MISP |
$400.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$733.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$733.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$611.00
|
| Rate for Payer: United Healthcare All Other HMO |
$611.00
|
| Rate for Payer: United Healthcare HMO Rider |
$611.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$611.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$545.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$400.38
|
| Rate for Payer: Vantage Medical Group Senior |
$363.98
|
|
|
HC ALCOHOL INJECTION INTO ORBIT
|
Facility
|
OP
|
$1,222.00
|
|
|
Service Code
|
CPT 67505
|
| Hospital Charge Code |
900567505
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$229.20 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$545.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$400.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$363.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$733.20
|
| Rate for Payer: Caremore Medicare Advantage |
$363.98
|
| Rate for Payer: Cash Price |
$549.90
|
| Rate for Payer: Cash Price |
$549.90
|
| Rate for Payer: Cash Price |
$549.90
|
| Rate for Payer: Cash Price |
$549.90
|
| Rate for Payer: Central Health Plan Commercial |
$977.60
|
| Rate for Payer: Cigna of CA PPO |
$904.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$545.97
|
| Rate for Payer: Dignity Health Media |
$363.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$400.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$491.37
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$363.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$363.98
|
| Rate for Payer: Galaxy Health WC |
$1,038.70
|
| Rate for Payer: Global Benefits Group Commercial |
$733.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,099.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$916.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$596.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$363.98
|
| Rate for Payer: InnovAge PACE Commercial |
$545.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$815.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$229.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$363.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$244.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$487.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$487.73
|
| Rate for Payer: Multiplan Commercial |
$916.50
|
| Rate for Payer: Networks By Design Commercial |
$794.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,038.70
|
| Rate for Payer: Prime Health Services Medicare |
$385.82
|
| Rate for Payer: Riverside University Health System MISP |
$400.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$733.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$611.00
|
| Rate for Payer: United Healthcare All Other HMO |
$611.00
|
| Rate for Payer: United Healthcare HMO Rider |
$611.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$611.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$545.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$400.38
|
| Rate for Payer: Vantage Medical Group Senior |
$363.98
|
|
|
HC ALCOHOL INJECTION INTO ORBIT
|
Facility
|
IP
|
$1,222.00
|
|
|
Service Code
|
CPT 67505
|
| Hospital Charge Code |
900567505
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$244.40 |
| Max. Negotiated Rate |
$1,099.80 |
| Rate for Payer: Cash Price |
$549.90
|
| Rate for Payer: Central Health Plan Commercial |
$977.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$488.80
|
| Rate for Payer: Galaxy Health WC |
$1,038.70
|
| Rate for Payer: Global Benefits Group Commercial |
$733.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,099.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$815.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$465.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$244.40
|
| Rate for Payer: Multiplan Commercial |
$916.50
|
| Rate for Payer: Networks By Design Commercial |
$794.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,038.70
|
|
|
HC ALCOHOL INJECTION INTO ORBIT
|
Facility
|
IP
|
$1,222.00
|
|
|
Service Code
|
CPT 67505
|
| Hospital Charge Code |
900567505
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$244.40 |
| Max. Negotiated Rate |
$1,099.80 |
| Rate for Payer: Cash Price |
$549.90
|
| Rate for Payer: Central Health Plan Commercial |
$977.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$488.80
|
| Rate for Payer: Galaxy Health WC |
$1,038.70
|
| Rate for Payer: Global Benefits Group Commercial |
$733.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,099.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$815.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$465.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$244.40
|
| Rate for Payer: Multiplan Commercial |
$916.50
|
| Rate for Payer: Networks By Design Commercial |
$794.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,038.70
|
|
|
HC ALCOHOL INJECTION INTO ORBIT
|
Facility
|
OP
|
$1,222.00
|
|
|
Service Code
|
CPT 67505
|
| Hospital Charge Code |
900567505
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$229.20 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$363.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$545.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$400.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$363.98
|
| 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 |
$733.20
|
| 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 |
$363.98
|
| Rate for Payer: Cash Price |
$549.90
|
| Rate for Payer: Cash Price |
$549.90
|
| Rate for Payer: Central Health Plan Commercial |
$977.60
|
| Rate for Payer: Cigna of CA PPO |
$904.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$545.97
|
| Rate for Payer: Dignity Health Media |
$363.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$400.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$491.37
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$363.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$363.98
|
| Rate for Payer: Galaxy Health WC |
$1,038.70
|
| Rate for Payer: Global Benefits Group Commercial |
$733.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,099.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$916.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$596.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$600.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$363.98
|
| Rate for Payer: InnovAge PACE Commercial |
$545.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$815.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$229.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$363.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$244.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$487.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$487.73
|
| Rate for Payer: Multiplan Commercial |
$916.50
|
| Rate for Payer: Networks By Design Commercial |
$794.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,038.70
|
| Rate for Payer: Prime Health Services Medicare |
$385.82
|
| Rate for Payer: Riverside University Health System MISP |
$400.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$733.20
|
| 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 |
$545.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$400.38
|
| Rate for Payer: Vantage Medical Group Senior |
$363.98
|
|
|
HC ALCOHOL INJECTION INTO ORBIT
|
Facility
|
IP
|
$1,222.00
|
|
|
Service Code
|
CPT 67505
|
| Hospital Charge Code |
900567505
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$244.40 |
| Max. Negotiated Rate |
$1,099.80 |
| Rate for Payer: Cash Price |
$549.90
|
| Rate for Payer: Central Health Plan Commercial |
$977.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$488.80
|
| Rate for Payer: Galaxy Health WC |
$1,038.70
|
| Rate for Payer: Global Benefits Group Commercial |
$733.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,099.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$815.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$465.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$244.40
|
| Rate for Payer: Multiplan Commercial |
$916.50
|
| Rate for Payer: Networks By Design Commercial |
$794.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,038.70
|
|
|
HC ALCOHOL URINE
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
900912192
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$92.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$75.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$92.00
|
| Rate for Payer: Blue Distinction Transplant |
$20.40
|
| Rate for Payer: Blue Shield of California Commercial |
$21.01
|
| Rate for Payer: Blue Shield of California EPN |
$16.52
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Central Health Plan Commercial |
$27.20
|
| Rate for Payer: Cigna of CA HMO |
$21.76
|
| Rate for Payer: Cigna of CA PPO |
$25.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.90
|
| Rate for Payer: Dignity Health Media |
$28.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.60
|
| Rate for Payer: Galaxy Health WC |
$28.90
|
| Rate for Payer: Global Benefits Group Commercial |
$20.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$25.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.80
|
| Rate for Payer: Multiplan Commercial |
$25.50
|
| Rate for Payer: Networks By Design Commercial |
$22.10
|
| Rate for Payer: Prime Health Services Commercial |
$28.90
|
| Rate for Payer: Riverside University Health System MISP |
$13.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.00
|
| Rate for Payer: United Healthcare All Other HMO |
$17.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.90
|
| Rate for Payer: Vantage Medical Group Senior |
$28.90
|
|
|
HC ALCOHOL URINE
|
Facility
|
IP
|
$322.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
900912192
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$64.40 |
| Max. Negotiated Rate |
$289.80 |
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: Central Health Plan Commercial |
$257.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$128.80
|
| Rate for Payer: Galaxy Health WC |
$273.70
|
| Rate for Payer: Global Benefits Group Commercial |
$193.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$289.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$214.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$122.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.40
|
| Rate for Payer: Multiplan Commercial |
$241.50
|
| Rate for Payer: Networks By Design Commercial |
$209.30
|
| Rate for Payer: Prime Health Services Commercial |
$273.70
|
|
|
HC ALELRGEN CUCUMBER IGE
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913581
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Central Health Plan Commercial |
$51.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.60
|
| Rate for Payer: Galaxy Health WC |
$54.40
|
| Rate for Payer: Global Benefits Group Commercial |
$38.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$57.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.80
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: Networks By Design Commercial |
$41.60
|
| Rate for Payer: Prime Health Services Commercial |
$54.40
|
|
|
HC ALELRGEN CUCUMBER IGE
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913581
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$140.27 |
| Rate for Payer: Adventist Health Medi-Cal |
$5.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$38.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$115.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$140.27
|
| Rate for Payer: Blue Distinction Transplant |
$9.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9.27
|
| Rate for Payer: Blue Shield of California EPN |
$7.29
|
| Rate for Payer: Caremore Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Central Health Plan Commercial |
$12.00
|
| Rate for Payer: Cigna of CA HMO |
$9.60
|
| Rate for Payer: Cigna of CA PPO |
$11.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: Dignity Health Media |
$5.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.05
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.22
|
| Rate for Payer: InnovAge PACE Commercial |
$7.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.99
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
| Rate for Payer: Prime Health Services Medicare |
$5.53
|
| Rate for Payer: Riverside University Health System MISP |
$5.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Other HMO |
$4.23
|
| Rate for Payer: United Healthcare HMO Rider |
$4.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
