|
HC ANTIMICROB SUSCEPTIBILITY TEST
|
Facility
|
IP
|
$215.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
900911660
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$43.00 |
| Max. Negotiated Rate |
$193.50 |
| Rate for Payer: Cash Price |
$96.75
|
| Rate for Payer: Central Health Plan Commercial |
$172.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.00
|
| Rate for Payer: Galaxy Health WC |
$182.75
|
| Rate for Payer: Global Benefits Group Commercial |
$129.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$193.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$143.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.00
|
| Rate for Payer: Multiplan Commercial |
$161.25
|
| Rate for Payer: Networks By Design Commercial |
$139.75
|
| Rate for Payer: Prime Health Services Commercial |
$182.75
|
|
|
HC ANTINUCLEAR ANTIBODIES (ANA)
|
Facility
|
IP
|
$169.00
|
|
|
Service Code
|
CPT 86038
|
| Hospital Charge Code |
900910969
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$33.80 |
| Max. Negotiated Rate |
$152.10 |
| Rate for Payer: Cash Price |
$76.05
|
| Rate for Payer: Central Health Plan Commercial |
$135.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.60
|
| Rate for Payer: Galaxy Health WC |
$143.65
|
| Rate for Payer: Global Benefits Group Commercial |
$101.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$152.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$112.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.80
|
| Rate for Payer: Multiplan Commercial |
$126.75
|
| Rate for Payer: Networks By Design Commercial |
$109.85
|
| Rate for Payer: Prime Health Services Commercial |
$143.65
|
|
|
HC ANTINUCLEAR ANTIBODIES (ANA)
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT 86038
|
| Hospital Charge Code |
900910969
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$107.23 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$88.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$87.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$107.23
|
| Rate for Payer: Blue Distinction Transplant |
$21.60
|
| Rate for Payer: Blue Shield of California Commercial |
$22.25
|
| Rate for Payer: Blue Shield of California EPN |
$17.50
|
| Rate for Payer: Caremore Medicare Advantage |
$12.09
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Central Health Plan Commercial |
$28.80
|
| Rate for Payer: Cigna of CA HMO |
$23.04
|
| Rate for Payer: Cigna of CA PPO |
$26.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.14
|
| Rate for Payer: Dignity Health Media |
$12.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.09
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$27.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.09
|
| Rate for Payer: InnovAge PACE Commercial |
$18.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.20
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
| Rate for Payer: Networks By Design Commercial |
$23.40
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
| Rate for Payer: Prime Health Services Medicare |
$12.82
|
| Rate for Payer: Riverside University Health System MISP |
$13.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.79
|
| Rate for Payer: United Healthcare All Other HMO |
$9.79
|
| Rate for Payer: United Healthcare HMO Rider |
$9.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.30
|
| Rate for Payer: Vantage Medical Group Senior |
$12.09
|
|
|
HC ANTI-REFLUX FILTER W/NG TUBES
|
Facility
|
OP
|
$34.69
|
|
| Hospital Charge Code |
901698758
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.94 |
| Max. Negotiated Rate |
$31.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$21.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$16.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.49
|
| Rate for Payer: Blue Distinction Transplant |
$20.81
|
| Rate for Payer: Blue Shield of California Commercial |
$21.82
|
| Rate for Payer: Blue Shield of California EPN |
$16.96
|
| Rate for Payer: Cash Price |
$15.61
|
| Rate for Payer: Central Health Plan Commercial |
$27.75
|
| Rate for Payer: Cigna of CA HMO |
$22.20
|
| Rate for Payer: Cigna of CA PPO |
$25.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.49
|
| Rate for Payer: Dignity Health Media |
$29.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.88
|
| Rate for Payer: Galaxy Health WC |
$29.49
|
| Rate for Payer: Global Benefits Group Commercial |
$20.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$31.22
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$26.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.94
|
| Rate for Payer: Multiplan Commercial |
$26.02
|
| Rate for Payer: Networks By Design Commercial |
$22.55
|
| Rate for Payer: Prime Health Services Commercial |
$29.49
|
| Rate for Payer: Riverside University Health System MISP |
$13.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.34
|
| Rate for Payer: United Healthcare All Other HMO |
$17.34
|
| Rate for Payer: United Healthcare HMO Rider |
$17.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.49
|
| Rate for Payer: Vantage Medical Group Senior |
$29.49
|
|
|
HC ANTI-REFLUX FILTER W/NG TUBES
|
Facility
|
IP
|
$34.69
|
|
| Hospital Charge Code |
901698758
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.94 |
| Max. Negotiated Rate |
$31.22 |
| Rate for Payer: Cash Price |
$15.61
|
| Rate for Payer: Central Health Plan Commercial |
$27.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.88
|
| Rate for Payer: Galaxy Health WC |
$29.49
|
| Rate for Payer: Global Benefits Group Commercial |
$20.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$31.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.94
|
| Rate for Payer: Multiplan Commercial |
$26.02
|
| Rate for Payer: Networks By Design Commercial |
$22.55
|
| Rate for Payer: Prime Health Services Commercial |
$29.49
|
|
|
HC ANTISTREPTOLYSIN O
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
900910881
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$151.20 |
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Central Health Plan Commercial |
$134.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.20
|
| Rate for Payer: Galaxy Health WC |
$142.80
|
| Rate for Payer: Global Benefits Group Commercial |
$100.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$151.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$112.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.60
|
| Rate for Payer: Multiplan Commercial |
$126.00
|
| Rate for Payer: Networks By Design Commercial |
$109.20
|
| Rate for Payer: Prime Health Services Commercial |
$142.80
|
|
|
HC ANTISTREPTOLYSIN O
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
900910881
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$120.79 |
| Rate for Payer: Adventist Health Medi-Cal |
$13.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$99.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$99.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$120.79
|
| Rate for Payer: Blue Distinction Transplant |
$27.00
|
| Rate for Payer: Blue Shield of California Commercial |
$27.81
|
| Rate for Payer: Blue Shield of California EPN |
$21.87
|
| Rate for Payer: Caremore Medicare Advantage |
$13.60
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Central Health Plan Commercial |
$36.00
|
| Rate for Payer: Cigna of CA HMO |
$28.80
|
| Rate for Payer: Cigna of CA PPO |
$33.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Media |
$13.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.60
|
| Rate for Payer: Galaxy Health WC |
$38.25
|
| Rate for Payer: Global Benefits Group Commercial |
$27.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$33.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.60
|
| Rate for Payer: InnovAge PACE Commercial |
$20.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.22
|
| Rate for Payer: Multiplan Commercial |
$33.75
|
| Rate for Payer: Networks By Design Commercial |
$29.25
|
| Rate for Payer: Prime Health Services Commercial |
$38.25
|
| Rate for Payer: Prime Health Services Medicare |
$14.42
|
| Rate for Payer: Riverside University Health System MISP |
$14.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.02
|
| Rate for Payer: United Healthcare All Other HMO |
$11.02
|
| Rate for Payer: United Healthcare HMO Rider |
$11.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.96
|
| Rate for Payer: Vantage Medical Group Senior |
$13.60
|
|
|
HC ANTITHROMBIN III ACTIVITY
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT 85300
|
| Hospital Charge Code |
900912010
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$105.14 |
| Rate for Payer: Adventist Health Medi-Cal |
$11.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$87.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$86.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$105.14
|
| Rate for Payer: Blue Distinction Transplant |
$27.00
|
| Rate for Payer: Blue Shield of California Commercial |
$27.81
|
| Rate for Payer: Blue Shield of California EPN |
$21.87
|
| Rate for Payer: Caremore Medicare Advantage |
$11.85
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Central Health Plan Commercial |
$36.00
|
| Rate for Payer: Cigna of CA HMO |
$28.80
|
| Rate for Payer: Cigna of CA PPO |
$33.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.78
|
| Rate for Payer: Dignity Health Media |
$11.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$11.85
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.85
|
| Rate for Payer: Galaxy Health WC |
$38.25
|
| Rate for Payer: Global Benefits Group Commercial |
$27.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$33.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.85
|
| Rate for Payer: InnovAge PACE Commercial |
$17.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.88
|
| Rate for Payer: Multiplan Commercial |
$33.75
|
| Rate for Payer: Networks By Design Commercial |
$29.25
|
| Rate for Payer: Prime Health Services Commercial |
$38.25
|
| Rate for Payer: Prime Health Services Medicare |
$12.56
|
| Rate for Payer: Riverside University Health System MISP |
$13.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.60
|
| Rate for Payer: United Healthcare All Other HMO |
$9.60
|
| Rate for Payer: United Healthcare HMO Rider |
$9.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.04
|
| Rate for Payer: Vantage Medical Group Senior |
$11.85
|
|
|
HC ANTITHROMBIN III ACTIVITY
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
CPT 85300
|
| Hospital Charge Code |
900912010
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$66.00 |
| Max. Negotiated Rate |
$297.00 |
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Central Health Plan Commercial |
$264.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$132.00
|
| Rate for Payer: Galaxy Health WC |
$280.50
|
| Rate for Payer: Global Benefits Group Commercial |
$198.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$297.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$220.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.00
|
| Rate for Payer: Multiplan Commercial |
$247.50
|
| Rate for Payer: Networks By Design Commercial |
$214.50
|
| Rate for Payer: Prime Health Services Commercial |
$280.50
|
|
|
HC ANTITHROMBIN III ANTIGEN
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
CPT 85301
|
| Hospital Charge Code |
900912011
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$95.94 |
| Rate for Payer: Adventist Health Medi-Cal |
$10.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$79.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$78.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$95.94
|
| Rate for Payer: Blue Distinction Transplant |
$24.60
|
| Rate for Payer: Blue Shield of California Commercial |
$25.34
|
| Rate for Payer: Blue Shield of California EPN |
$19.93
|
| Rate for Payer: Caremore Medicare Advantage |
$10.81
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Central Health Plan Commercial |
$32.80
|
| Rate for Payer: Cigna of CA HMO |
$26.24
|
| Rate for Payer: Cigna of CA PPO |
$30.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.22
|
| Rate for Payer: Dignity Health Media |
$10.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.59
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$10.81
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.81
|
| Rate for Payer: Galaxy Health WC |
$34.85
|
| Rate for Payer: Global Benefits Group Commercial |
$24.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$30.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$17.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.81
|
| Rate for Payer: InnovAge PACE Commercial |
$16.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.49
|
| Rate for Payer: Multiplan Commercial |
$30.75
|
| Rate for Payer: Networks By Design Commercial |
$26.65
|
| Rate for Payer: Prime Health Services Commercial |
$34.85
|
| Rate for Payer: Prime Health Services Medicare |
$11.46
|
| Rate for Payer: Riverside University Health System MISP |
$11.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.76
|
| Rate for Payer: United Healthcare All Other HMO |
$8.76
|
| Rate for Payer: United Healthcare HMO Rider |
$8.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.89
|
| Rate for Payer: Vantage Medical Group Senior |
$10.81
|
|
|
HC ANTITHROMBIN III ANTIGEN
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
CPT 85301
|
| Hospital Charge Code |
900912011
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$66.00 |
| Max. Negotiated Rate |
$297.00 |
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Central Health Plan Commercial |
$264.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$132.00
|
| Rate for Payer: Galaxy Health WC |
$280.50
|
| Rate for Payer: Global Benefits Group Commercial |
$198.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$297.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$220.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.00
|
| Rate for Payer: Multiplan Commercial |
$247.50
|
| Rate for Payer: Networks By Design Commercial |
$214.50
|
| Rate for Payer: Prime Health Services Commercial |
$280.50
|
|
|
HC ANTI-XA APIXABAN
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 85520
|
| Hospital Charge Code |
900912042
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$98.69 |
| Rate for Payer: Adventist Health Medi-Cal |
$13.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$96.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$80.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$98.69
|
| Rate for Payer: Blue Distinction Transplant |
$15.00
|
| Rate for Payer: Blue Shield of California Commercial |
$15.45
|
| Rate for Payer: Blue Shield of California EPN |
$12.15
|
| Rate for Payer: Caremore Medicare Advantage |
$13.09
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: Cigna of CA HMO |
$16.00
|
| Rate for Payer: Cigna of CA PPO |
$18.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.64
|
| Rate for Payer: Dignity Health Media |
$13.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.67
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.09
|
| 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: Health Plan of Nevada (Sierra) Other |
$18.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.09
|
| Rate for Payer: InnovAge PACE Commercial |
$19.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.54
|
| 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
|
| Rate for Payer: Prime Health Services Medicare |
$13.88
|
| Rate for Payer: Riverside University Health System MISP |
$14.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.60
|
| Rate for Payer: United Healthcare All Other HMO |
$10.60
|
| Rate for Payer: United Healthcare HMO Rider |
$10.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.40
|
| Rate for Payer: Vantage Medical Group Senior |
$13.09
|
|
|
HC ANTI-XA APIXABAN
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
CPT 85520
|
| Hospital Charge Code |
900912042
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Central Health Plan Commercial |
$27.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.60
|
| Rate for Payer: Galaxy Health WC |
$28.90
|
| Rate for Payer: Global Benefits Group Commercial |
$20.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.95
|
| Rate for Payer: 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
|
|
|
HC ANTI-XA UNFRACTIONATED HEPARIN
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
CPT 85520
|
| Hospital Charge Code |
900912030
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.60 |
| Max. Negotiated Rate |
$98.69 |
| Rate for Payer: Adventist Health Medi-Cal |
$13.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$96.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$80.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$98.69
|
| Rate for Payer: Blue Distinction Transplant |
$43.80
|
| Rate for Payer: Blue Shield of California Commercial |
$45.11
|
| Rate for Payer: Blue Shield of California EPN |
$35.48
|
| Rate for Payer: Caremore Medicare Advantage |
$13.09
|
| Rate for Payer: Cash Price |
$32.85
|
| Rate for Payer: Cash Price |
$32.85
|
| Rate for Payer: Central Health Plan Commercial |
$58.40
|
| Rate for Payer: Cigna of CA HMO |
$46.72
|
| Rate for Payer: Cigna of CA PPO |
$54.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.64
|
| Rate for Payer: Dignity Health Media |
$13.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.67
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.09
|
| Rate for Payer: Galaxy Health WC |
$62.05
|
| Rate for Payer: Global Benefits Group Commercial |
$43.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$65.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$54.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.09
|
| Rate for Payer: InnovAge PACE Commercial |
$19.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.54
|
| Rate for Payer: Multiplan Commercial |
$54.75
|
| Rate for Payer: Networks By Design Commercial |
$47.45
|
| Rate for Payer: Prime Health Services Commercial |
$62.05
|
| Rate for Payer: Prime Health Services Medicare |
$13.88
|
| Rate for Payer: Riverside University Health System MISP |
$14.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$43.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.60
|
| Rate for Payer: United Healthcare All Other HMO |
$10.60
|
| Rate for Payer: United Healthcare HMO Rider |
$10.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.40
|
| Rate for Payer: Vantage Medical Group Senior |
$13.09
|
|
|
HC ANTI-XA UNFRACTIONATED HEPARIN
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
CPT 85520
|
| Hospital Charge Code |
900912030
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$25.80 |
| Max. Negotiated Rate |
$116.10 |
| Rate for Payer: Cash Price |
$58.05
|
| Rate for Payer: Central Health Plan Commercial |
$103.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.60
|
| Rate for Payer: Galaxy Health WC |
$109.65
|
| Rate for Payer: Global Benefits Group Commercial |
$77.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$116.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$86.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.80
|
| Rate for Payer: Multiplan Commercial |
$96.75
|
| Rate for Payer: Networks By Design Commercial |
$83.85
|
| Rate for Payer: Prime Health Services Commercial |
$109.65
|
|
|
HC AORTA CATHETER (FEMORAL/AX
|
Facility
|
IP
|
$1,416.00
|
|
|
Service Code
|
CPT 36200
|
| Hospital Charge Code |
906820175
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$283.20 |
| Max. Negotiated Rate |
$1,274.40 |
| Rate for Payer: Cash Price |
$637.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,132.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$566.40
|
| Rate for Payer: Galaxy Health WC |
$1,203.60
|
| Rate for Payer: Global Benefits Group Commercial |
$849.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,274.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$944.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$539.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$283.20
|
| Rate for Payer: Multiplan Commercial |
$1,062.00
|
| Rate for Payer: Networks By Design Commercial |
$920.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,203.60
|
|
|
HC AORTA CATHETER (FEMORAL/AX
|
Facility
|
OP
|
$1,416.00
|
|
|
Service Code
|
CPT 36200
|
| Hospital Charge Code |
909081318
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$282.95 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,203.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$778.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$778.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Distinction Transplant |
$849.60
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$637.20
|
| Rate for Payer: Cash Price |
$637.20
|
| Rate for Payer: Cash Price |
$637.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,132.80
|
| Rate for Payer: Cigna of CA PPO |
$1,047.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,203.60
|
| Rate for Payer: Dignity Health Media |
$1,203.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,203.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$566.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$566.40
|
| Rate for Payer: Galaxy Health WC |
$1,203.60
|
| Rate for Payer: Global Benefits Group Commercial |
$849.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,274.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,062.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$495.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$944.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$282.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$283.20
|
| Rate for Payer: Multiplan Commercial |
$1,062.00
|
| Rate for Payer: Networks By Design Commercial |
$920.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,203.60
|
| Rate for Payer: Riverside University Health System MISP |
$566.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$849.60
|
| 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 |
$1,203.60
|
| Rate for Payer: Vantage Medical Group Senior |
$1,203.60
|
|
|
HC AORTA CATHETER (FEMORAL/AX
|
Facility
|
IP
|
$1,416.00
|
|
|
Service Code
|
CPT 36200
|
| Hospital Charge Code |
909081318
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$283.20 |
| Max. Negotiated Rate |
$1,274.40 |
| Rate for Payer: Cash Price |
$637.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,132.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$566.40
|
| Rate for Payer: Galaxy Health WC |
$1,203.60
|
| Rate for Payer: Global Benefits Group Commercial |
$849.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,274.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$944.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$539.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$283.20
|
| Rate for Payer: Multiplan Commercial |
$1,062.00
|
| Rate for Payer: Networks By Design Commercial |
$920.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,203.60
|
|
|
HC AORTA CATHETER (FEMORAL/AX
|
Facility
|
OP
|
$1,416.00
|
|
|
Service Code
|
CPT 36200
|
| Hospital Charge Code |
906820175
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$282.95 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,203.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$778.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$778.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Distinction Transplant |
$849.60
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$637.20
|
| Rate for Payer: Cash Price |
$637.20
|
| Rate for Payer: Cash Price |
$637.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,132.80
|
| Rate for Payer: Cigna of CA PPO |
$1,047.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,203.60
|
| Rate for Payer: Dignity Health Media |
$1,203.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,203.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$566.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$566.40
|
| Rate for Payer: Galaxy Health WC |
$1,203.60
|
| Rate for Payer: Global Benefits Group Commercial |
$849.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,274.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,062.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$495.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$944.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$282.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$283.20
|
| Rate for Payer: Multiplan Commercial |
$1,062.00
|
| Rate for Payer: Networks By Design Commercial |
$920.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,203.60
|
| Rate for Payer: Riverside University Health System MISP |
$566.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$849.60
|
| 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 |
$1,203.60
|
| Rate for Payer: Vantage Medical Group Senior |
$1,203.60
|
|
|
HC AORTOGRAM/SUPRAVALVULAR
|
Facility
|
OP
|
$2,530.00
|
|
|
Service Code
|
CPT 93567
|
| Hospital Charge Code |
906820073
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$177.08 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,613.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,150.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,391.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,391.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,518.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$1,138.50
|
| Rate for Payer: Cash Price |
$1,138.50
|
| Rate for Payer: Cash Price |
$1,138.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,024.00
|
| Rate for Payer: Cigna of CA PPO |
$1,872.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,150.50
|
| Rate for Payer: Dignity Health Media |
$2,150.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,150.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,012.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,012.00
|
| Rate for Payer: Galaxy Health WC |
$2,150.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,518.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,277.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,897.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$885.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,687.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$177.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$506.00
|
| Rate for Payer: Multiplan Commercial |
$1,897.50
|
| Rate for Payer: Networks By Design Commercial |
$1,644.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,150.50
|
| Rate for Payer: Riverside University Health System MISP |
$1,012.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,518.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,518.00
|
| 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 |
$2,150.50
|
| Rate for Payer: Vantage Medical Group Senior |
$2,150.50
|
|
|
HC AORTOGRAM/SUPRAVALVULAR
|
Facility
|
IP
|
$2,530.00
|
|
|
Service Code
|
CPT 93567
|
| Hospital Charge Code |
906820073
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$506.00 |
| Max. Negotiated Rate |
$2,277.00 |
| Rate for Payer: Cash Price |
$1,138.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,024.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,012.00
|
| Rate for Payer: Galaxy Health WC |
$2,150.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,518.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,277.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,687.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$963.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$506.00
|
| Rate for Payer: Multiplan Commercial |
$1,897.50
|
| Rate for Payer: Networks By Design Commercial |
$1,644.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,150.50
|
|
|
HC AORTOGRAM/SUPRAVALVULAR
|
Facility
|
IP
|
$2,530.00
|
|
|
Service Code
|
CPT 93567
|
| Hospital Charge Code |
906811416
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$506.00 |
| Max. Negotiated Rate |
$2,277.00 |
| Rate for Payer: Cash Price |
$1,138.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,024.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,012.00
|
| Rate for Payer: Galaxy Health WC |
$2,150.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,518.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,277.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,687.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$963.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$506.00
|
| Rate for Payer: Multiplan Commercial |
$1,897.50
|
| Rate for Payer: Networks By Design Commercial |
$1,644.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,150.50
|
|
|
HC AORTOGRAM/SUPRAVALVULAR
|
Facility
|
OP
|
$2,530.00
|
|
|
Service Code
|
CPT 93567
|
| Hospital Charge Code |
906811416
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$177.08 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,613.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,150.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,391.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,391.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,518.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$1,138.50
|
| Rate for Payer: Cash Price |
$1,138.50
|
| Rate for Payer: Cash Price |
$1,138.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,024.00
|
| Rate for Payer: Cigna of CA PPO |
$1,872.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,150.50
|
| Rate for Payer: Dignity Health Media |
$2,150.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,150.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,012.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,012.00
|
| Rate for Payer: Galaxy Health WC |
$2,150.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,518.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,277.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,897.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$885.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,687.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$177.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$506.00
|
| Rate for Payer: Multiplan Commercial |
$1,897.50
|
| Rate for Payer: Networks By Design Commercial |
$1,644.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,150.50
|
| Rate for Payer: Riverside University Health System MISP |
$1,012.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,518.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,518.00
|
| 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 |
$2,150.50
|
| Rate for Payer: Vantage Medical Group Senior |
$2,150.50
|
|
|
HC AORTOGRAPH ABDOMINAL
|
Facility
|
OP
|
$12,988.00
|
|
|
Service Code
|
CPT 75625
|
| Hospital Charge Code |
906820189
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$218.46 |
| Max. Negotiated Rate |
$11,689.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,982.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$887.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,608.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,181.45
|
| Rate for Payer: Blue Distinction Transplant |
$7,792.80
|
| Rate for Payer: Blue Shield of California Commercial |
$8,026.58
|
| Rate for Payer: Blue Shield of California EPN |
$6,312.17
|
| Rate for Payer: Caremore Medicare Advantage |
$3,982.55
|
| Rate for Payer: Cash Price |
$5,844.60
|
| Rate for Payer: Cash Price |
$5,844.60
|
| Rate for Payer: Central Health Plan Commercial |
$10,390.40
|
| Rate for Payer: Cigna of CA HMO |
$8,312.32
|
| Rate for Payer: Cigna of CA PPO |
$9,611.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Media |
$3,982.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,376.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,982.55
|
| Rate for Payer: Galaxy Health WC |
$11,039.80
|
| Rate for Payer: Global Benefits Group Commercial |
$7,792.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,689.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9,741.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,531.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,571.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: InnovAge PACE Commercial |
$5,973.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,663.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$218.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,597.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,336.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,336.62
|
| Rate for Payer: Multiplan Commercial |
$9,741.00
|
| Rate for Payer: Networks By Design Commercial |
$8,442.20
|
| Rate for Payer: Prime Health Services Commercial |
$11,039.80
|
| Rate for Payer: Prime Health Services Medicare |
$4,221.50
|
| Rate for Payer: Riverside University Health System MISP |
$4,380.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,792.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,792.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,341.78
|
| Rate for Payer: United Healthcare All Other HMO |
$5,341.78
|
| Rate for Payer: United Healthcare HMO Rider |
$5,341.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,341.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC AORTOGRAPH ABDOMINAL
|
Facility
|
IP
|
$12,988.00
|
|
|
Service Code
|
CPT 75625
|
| Hospital Charge Code |
909081602
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,597.60 |
| Max. Negotiated Rate |
$11,689.20 |
| Rate for Payer: Cash Price |
$5,844.60
|
| Rate for Payer: Central Health Plan Commercial |
$10,390.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,195.20
|
| Rate for Payer: Galaxy Health WC |
$11,039.80
|
| Rate for Payer: Global Benefits Group Commercial |
$7,792.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,689.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,663.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,948.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,597.60
|
| Rate for Payer: Multiplan Commercial |
$9,741.00
|
| Rate for Payer: Networks By Design Commercial |
$8,442.20
|
| Rate for Payer: Prime Health Services Commercial |
$11,039.80
|
|
