|
HC CORONARY STENT TWO OR MORE VESSELS
|
Facility
|
OP
|
$57,455.00
|
|
|
Service Code
|
CPT 92930
|
| Hospital Charge Code |
906811866
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,113.68 |
| Max. Negotiated Rate |
$51,709.50 |
| Rate for Payer: Adventist Health Commercial |
$11,491.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$23,577.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23,577.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$27,819.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33,421.57
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$25,854.75
|
| Rate for Payer: Cash Price |
$25,854.75
|
| Rate for Payer: Cash Price |
$25,854.75
|
| Rate for Payer: Central Health Plan Commercial |
$45,964.00
|
| Rate for Payer: Cigna of CA HMO |
$37,345.75
|
| Rate for Payer: Cigna of CA PPO |
$42,516.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,935.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,577.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$40,218.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$38,902.96
|
| Rate for Payer: EPIC Health Plan Senior |
$25,935.31
|
| Rate for Payer: Galaxy Health WC |
$48,836.75
|
| Rate for Payer: Global Benefits Group Commercial |
$34,473.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$51,709.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$38,667.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$36,483.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33,008.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,491.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$31,593.92
|
| Rate for Payer: Multiplan Commercial |
$43,091.25
|
| Rate for Payer: Networks By Design Commercial |
$37,345.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Prime Health Services Commercial |
$48,836.75
|
| Rate for Payer: Prime Health Services Medicare |
$24,992.20
|
| Rate for Payer: Riverside University Health System MISP |
$25,935.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34,473.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$34,473.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$28,727.50
|
| Rate for Payer: United Healthcare All Other HMO |
$28,727.50
|
| Rate for Payer: United Healthcare HMO Rider |
$28,727.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28,727.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$23,577.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Vantage Medical Group Senior |
$23,577.55
|
|
|
HC CORONARY STENT TWO OR MORE VESSELS
|
Facility
|
IP
|
$57,455.00
|
|
|
Service Code
|
CPT 92930
|
| Hospital Charge Code |
906811866
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$11,491.00 |
| Max. Negotiated Rate |
$51,709.50 |
| Rate for Payer: Adventist Health Commercial |
$11,491.00
|
| Rate for Payer: Cash Price |
$25,854.75
|
| Rate for Payer: Central Health Plan Commercial |
$45,964.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$40,218.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$22,982.00
|
| Rate for Payer: EPIC Health Plan Senior |
$22,982.00
|
| Rate for Payer: Galaxy Health WC |
$48,836.75
|
| Rate for Payer: Global Benefits Group Commercial |
$34,473.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$51,709.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$36,483.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33,898.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,491.00
|
| Rate for Payer: Multiplan Commercial |
$43,091.25
|
| Rate for Payer: Networks By Design Commercial |
$37,345.75
|
| Rate for Payer: Prime Health Services Commercial |
$48,836.75
|
|
|
HC CORONARY THROMBECTOMY
|
Facility
|
OP
|
$6,611.00
|
|
|
Service Code
|
CPT 92973
|
| Hospital Charge Code |
906812217
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$252.34 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,322.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,619.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,636.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,958.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,138.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$2,974.95
|
| Rate for Payer: Cash Price |
$2,974.95
|
| Rate for Payer: Cash Price |
$2,974.95
|
| Rate for Payer: Central Health Plan Commercial |
$5,288.80
|
| Rate for Payer: Cigna of CA HMO |
$4,297.15
|
| Rate for Payer: Cigna of CA PPO |
$4,892.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,619.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,619.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,619.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,627.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,644.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,644.40
|
| Rate for Payer: Galaxy Health WC |
$5,619.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,966.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,949.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$252.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,197.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$278.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,900.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,322.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,627.70
|
| Rate for Payer: Multiplan Commercial |
$4,958.25
|
| Rate for Payer: Networks By Design Commercial |
$4,297.15
|
| Rate for Payer: Prime Health Services Commercial |
$5,619.35
|
| Rate for Payer: Riverside University Health System MISP |
$2,644.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,966.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,966.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,305.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,619.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,619.35
|
| Rate for Payer: Vantage Medical Group Senior |
$5,619.35
|
|
|
HC CORONARY THROMBECTOMY
|
Facility
|
IP
|
$6,611.00
|
|
|
Service Code
|
CPT 92973
|
| Hospital Charge Code |
906812217
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,322.20 |
| Max. Negotiated Rate |
$5,949.90 |
| Rate for Payer: Adventist Health Commercial |
$1,322.20
|
| Rate for Payer: Cash Price |
$2,974.95
|
| Rate for Payer: Central Health Plan Commercial |
$5,288.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,627.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,644.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,644.40
|
| Rate for Payer: Galaxy Health WC |
$5,619.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,966.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,949.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,197.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,900.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,322.20
|
| Rate for Payer: Multiplan Commercial |
$4,958.25
|
| Rate for Payer: Networks By Design Commercial |
$4,297.15
|
| Rate for Payer: Prime Health Services Commercial |
$5,619.35
|
|
|
HC CORPORA CAVERNOSA-GLANS PENIS
|
Facility
|
OP
|
$14,422.00
|
|
|
Service Code
|
CPT 54435
|
| Hospital Charge Code |
900501751
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$164.10 |
| Max. Negotiated Rate |
$12,979.80 |
| Rate for Payer: Adventist Health Commercial |
$2,884.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,800.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,987.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,533.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,924.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,982.34
|
| Rate for Payer: Cash Price |
$6,489.90
|
| Rate for Payer: Cash Price |
$6,489.90
|
| Rate for Payer: Cash Price |
$6,489.90
|
| Rate for Payer: Cash Price |
$6,489.90
|
| Rate for Payer: Central Health Plan Commercial |
$11,537.60
|
| Rate for Payer: Cigna of CA HMO |
$9,230.08
|
| Rate for Payer: Cigna of CA PPO |
$10,672.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,800.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,987.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,533.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,095.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,480.62
|
| Rate for Payer: EPIC Health Plan Senior |
$4,987.08
|
| Rate for Payer: Galaxy Health WC |
$12,258.70
|
| Rate for Payer: Global Benefits Group Commercial |
$8,653.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,979.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,435.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,533.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,157.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$164.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,873.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,884.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,075.17
|
| Rate for Payer: Multiplan Commercial |
$10,816.50
|
| Rate for Payer: Multiplan WC |
$6,982.34
|
| Rate for Payer: Networks By Design Commercial |
$9,374.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,533.71
|
| Rate for Payer: Preferred Health Network WC |
$7,124.84
|
| Rate for Payer: Prime Health Services Commercial |
$12,258.70
|
| Rate for Payer: Prime Health Services Medicare |
$4,805.73
|
| Rate for Payer: Prime Health Services WC |
$6,911.09
|
| Rate for Payer: Riverside University Health System MISP |
$4,987.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,653.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,211.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,211.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,211.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,211.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,533.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,800.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,987.08
|
| Rate for Payer: Vantage Medical Group Senior |
$4,533.71
|
|
|
HC CORPORA CAVERNOSA-GLANS PENIS
|
Facility
|
IP
|
$14,422.00
|
|
|
Service Code
|
CPT 54435
|
| Hospital Charge Code |
900501751
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,884.40 |
| Max. Negotiated Rate |
$12,979.80 |
| Rate for Payer: Adventist Health Commercial |
$2,884.40
|
| Rate for Payer: Cash Price |
$6,489.90
|
| Rate for Payer: Central Health Plan Commercial |
$11,537.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,095.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,768.80
|
| Rate for Payer: EPIC Health Plan Senior |
$5,768.80
|
| Rate for Payer: Galaxy Health WC |
$12,258.70
|
| Rate for Payer: Global Benefits Group Commercial |
$8,653.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,979.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,157.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,508.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,884.40
|
| Rate for Payer: Multiplan Commercial |
$10,816.50
|
| Rate for Payer: Networks By Design Commercial |
$9,374.30
|
| Rate for Payer: Prime Health Services Commercial |
$12,258.70
|
|
|
HC CORPORA CAVERNOSOGRAPHY
|
Facility
|
IP
|
$690.00
|
|
|
Service Code
|
CPT 74445
|
| Hospital Charge Code |
909080040
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$138.00 |
| Max. Negotiated Rate |
$621.00 |
| Rate for Payer: Adventist Health Commercial |
$138.00
|
| Rate for Payer: Cash Price |
$310.50
|
| Rate for Payer: Central Health Plan Commercial |
$552.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$483.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$276.00
|
| Rate for Payer: EPIC Health Plan Senior |
$276.00
|
| Rate for Payer: Galaxy Health WC |
$586.50
|
| Rate for Payer: Global Benefits Group Commercial |
$414.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$621.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$438.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$407.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.00
|
| Rate for Payer: Multiplan Commercial |
$517.50
|
| Rate for Payer: Networks By Design Commercial |
$448.50
|
| Rate for Payer: Prime Health Services Commercial |
$586.50
|
|
|
HC CORPORA CAVERNOSOGRAPHY
|
Facility
|
OP
|
$690.00
|
|
|
Service Code
|
CPT 74445
|
| Hospital Charge Code |
909080040
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.29 |
| Max. Negotiated Rate |
$1,118.97 |
| Rate for Payer: Adventist Health Commercial |
$138.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$134.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,118.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$236.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$328.40
|
| Rate for Payer: Blue Shield of California Commercial |
$434.70
|
| Rate for Payer: Blue Shield of California EPN |
$273.93
|
| Rate for Payer: Cash Price |
$310.50
|
| Rate for Payer: Cash Price |
$310.50
|
| Rate for Payer: Central Health Plan Commercial |
$552.00
|
| Rate for Payer: Cigna of CA HMO |
$441.60
|
| Rate for Payer: Cigna of CA PPO |
$510.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$483.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$586.50
|
| Rate for Payer: Global Benefits Group Commercial |
$414.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$621.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$89.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$438.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$98.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$517.50
|
| Rate for Payer: Networks By Design Commercial |
$448.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$134.46
|
| Rate for Payer: Prime Health Services Commercial |
$586.50
|
| Rate for Payer: Prime Health Services Medicare |
$142.53
|
| Rate for Payer: Riverside University Health System MISP |
$147.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$414.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$414.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$470.69
|
| Rate for Payer: United Healthcare All Other HMO |
$470.69
|
| Rate for Payer: United Healthcare HMO Rider |
$470.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$470.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC CORTISOL
|
Facility
|
IP
|
$296.00
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
900912125
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$59.20 |
| Max. Negotiated Rate |
$266.40 |
| Rate for Payer: Adventist Health Commercial |
$59.20
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Central Health Plan Commercial |
$236.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$207.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.40
|
| Rate for Payer: EPIC Health Plan Senior |
$118.40
|
| Rate for Payer: Galaxy Health WC |
$251.60
|
| Rate for Payer: Global Benefits Group Commercial |
$177.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$266.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$187.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$174.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.20
|
| Rate for Payer: Multiplan Commercial |
$222.00
|
| Rate for Payer: Networks By Design Commercial |
$192.40
|
| Rate for Payer: Prime Health Services Commercial |
$251.60
|
|
|
HC CORTISOL
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
900912125
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$165.05 |
| Rate for Payer: Adventist Health Commercial |
$25.60
|
| Rate for Payer: Adventist Health Commercial |
$59.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$16.30
|
| Rate for Payer: Adventist Health Medi-Cal |
$16.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$119.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$119.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$118.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$118.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$165.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$165.05
|
| Rate for Payer: Blue Shield of California Commercial |
$186.48
|
| Rate for Payer: Blue Shield of California Commercial |
$80.64
|
| Rate for Payer: Blue Shield of California EPN |
$117.51
|
| Rate for Payer: Blue Shield of California EPN |
$50.82
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Central Health Plan Commercial |
$102.40
|
| Rate for Payer: Central Health Plan Commercial |
$236.80
|
| Rate for Payer: Cigna of CA HMO |
$189.44
|
| Rate for Payer: Cigna of CA HMO |
$81.92
|
| Rate for Payer: Cigna of CA PPO |
$219.04
|
| Rate for Payer: Cigna of CA PPO |
$94.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$89.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$207.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.89
|
| Rate for Payer: EPIC Health Plan Senior |
$17.93
|
| Rate for Payer: EPIC Health Plan Senior |
$17.93
|
| Rate for Payer: Galaxy Health WC |
$251.60
|
| Rate for Payer: Galaxy Health WC |
$108.80
|
| Rate for Payer: Global Benefits Group Commercial |
$177.60
|
| Rate for Payer: Global Benefits Group Commercial |
$76.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$266.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$115.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$26.73
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$26.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$81.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$187.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21.84
|
| Rate for Payer: Multiplan Commercial |
$222.00
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Networks By Design Commercial |
$83.20
|
| Rate for Payer: Networks By Design Commercial |
$192.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16.30
|
| Rate for Payer: Prime Health Services Commercial |
$251.60
|
| Rate for Payer: Prime Health Services Commercial |
$108.80
|
| Rate for Payer: Prime Health Services Medicare |
$17.28
|
| Rate for Payer: Prime Health Services Medicare |
$17.28
|
| Rate for Payer: Riverside University Health System MISP |
$17.93
|
| Rate for Payer: Riverside University Health System MISP |
$17.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$76.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$177.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$177.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$76.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.20
|
| Rate for Payer: United Healthcare All Other HMO |
$13.20
|
| Rate for Payer: United Healthcare All Other HMO |
$13.20
|
| Rate for Payer: United Healthcare HMO Rider |
$13.20
|
| Rate for Payer: United Healthcare HMO Rider |
$13.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.20
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.30
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.93
|
| Rate for Payer: Vantage Medical Group Senior |
$16.30
|
| Rate for Payer: Vantage Medical Group Senior |
$16.30
|
|
|
HC COUGH ASSIST
|
Facility
|
IP
|
$499.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900801124
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$99.80 |
| Max. Negotiated Rate |
$449.10 |
| Rate for Payer: Adventist Health Commercial |
$99.80
|
| Rate for Payer: Cash Price |
$224.55
|
| Rate for Payer: Central Health Plan Commercial |
$399.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$349.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$199.60
|
| Rate for Payer: EPIC Health Plan Senior |
$199.60
|
| Rate for Payer: Galaxy Health WC |
$424.15
|
| Rate for Payer: Global Benefits Group Commercial |
$299.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$449.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$316.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$294.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.80
|
| Rate for Payer: Multiplan Commercial |
$374.25
|
| Rate for Payer: Networks By Design Commercial |
$324.35
|
| Rate for Payer: Prime Health Services Commercial |
$424.15
|
|
|
HC COUGH ASSIST
|
Facility
|
OP
|
$499.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900801124
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$99.80 |
| Max. Negotiated Rate |
$764.00 |
| Rate for Payer: Adventist Health Commercial |
$99.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$165.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$303.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$241.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$290.27
|
| Rate for Payer: Blue Shield of California Commercial |
$314.37
|
| Rate for Payer: Blue Shield of California EPN |
$198.10
|
| Rate for Payer: Cash Price |
$224.55
|
| Rate for Payer: Cash Price |
$224.55
|
| Rate for Payer: Cash Price |
$224.55
|
| Rate for Payer: Central Health Plan Commercial |
$399.20
|
| Rate for Payer: Cigna of CA HMO |
$319.36
|
| Rate for Payer: Cigna of CA PPO |
$369.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$248.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$182.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$165.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$349.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.06
|
| Rate for Payer: EPIC Health Plan Senior |
$182.04
|
| Rate for Payer: Galaxy Health WC |
$424.15
|
| Rate for Payer: Global Benefits Group Commercial |
$299.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$449.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$271.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$165.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$316.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$231.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$221.76
|
| Rate for Payer: Multiplan Commercial |
$374.25
|
| Rate for Payer: Networks By Design Commercial |
$324.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$165.49
|
| Rate for Payer: Prime Health Services Commercial |
$424.15
|
| Rate for Payer: Prime Health Services Medicare |
$175.42
|
| Rate for Payer: Riverside University Health System MISP |
$182.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$299.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$299.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$764.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$731.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$669.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$165.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Vantage Medical Group Senior |
$165.49
|
|
|
HC COVID 19 IGM IGG
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
CPT 86318
|
| Hospital Charge Code |
900912259
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$25.80 |
| Max. Negotiated Rate |
$116.10 |
| Rate for Payer: Adventist Health Commercial |
$25.80
|
| Rate for Payer: Cash Price |
$58.05
|
| Rate for Payer: Central Health Plan Commercial |
$103.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$90.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.60
|
| Rate for Payer: EPIC Health Plan Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$81.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$76.11
|
| 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 COVID 19 IGM IGG
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
CPT 86318
|
| Hospital Charge Code |
900912259
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$14.65 |
| Max. Negotiated Rate |
$130.94 |
| Rate for Payer: Adventist Health Commercial |
$25.80
|
| Rate for Payer: Adventist Health Commercial |
$17.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$18.09
|
| Rate for Payer: Adventist Health Medi-Cal |
$18.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$95.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$95.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$94.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$94.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.94
|
| Rate for Payer: Blue Shield of California Commercial |
$56.07
|
| Rate for Payer: Blue Shield of California Commercial |
$81.27
|
| Rate for Payer: Blue Shield of California EPN |
$35.33
|
| Rate for Payer: Blue Shield of California EPN |
$51.21
|
| Rate for Payer: Cash Price |
$40.05
|
| Rate for Payer: Cash Price |
$40.05
|
| Rate for Payer: Cash Price |
$58.05
|
| Rate for Payer: Cash Price |
$58.05
|
| Rate for Payer: Central Health Plan Commercial |
$103.20
|
| Rate for Payer: Central Health Plan Commercial |
$71.20
|
| Rate for Payer: Cigna of CA HMO |
$56.96
|
| Rate for Payer: Cigna of CA HMO |
$82.56
|
| Rate for Payer: Cigna of CA PPO |
$65.86
|
| Rate for Payer: Cigna of CA PPO |
$95.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$90.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$62.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.85
|
| Rate for Payer: EPIC Health Plan Senior |
$19.90
|
| Rate for Payer: EPIC Health Plan Senior |
$19.90
|
| Rate for Payer: Galaxy Health WC |
$75.65
|
| Rate for Payer: Galaxy Health WC |
$109.65
|
| Rate for Payer: Global Benefits Group Commercial |
$53.40
|
| Rate for Payer: Global Benefits Group Commercial |
$77.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$80.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$116.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.67
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$81.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$56.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.24
|
| Rate for Payer: Multiplan Commercial |
$66.75
|
| Rate for Payer: Multiplan Commercial |
$96.75
|
| Rate for Payer: Networks By Design Commercial |
$83.85
|
| Rate for Payer: Networks By Design Commercial |
$57.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18.09
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18.09
|
| Rate for Payer: Prime Health Services Commercial |
$75.65
|
| Rate for Payer: Prime Health Services Commercial |
$109.65
|
| Rate for Payer: Prime Health Services Medicare |
$19.18
|
| Rate for Payer: Prime Health Services Medicare |
$19.18
|
| Rate for Payer: Riverside University Health System MISP |
$19.90
|
| Rate for Payer: Riverside University Health System MISP |
$19.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$77.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$53.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$53.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$77.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.65
|
| Rate for Payer: United Healthcare All Other HMO |
$14.65
|
| Rate for Payer: United Healthcare All Other HMO |
$14.65
|
| Rate for Payer: United Healthcare HMO Rider |
$14.65
|
| Rate for Payer: United Healthcare HMO Rider |
$14.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.65
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.09
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.90
|
| Rate for Payer: Vantage Medical Group Senior |
$18.09
|
| Rate for Payer: Vantage Medical Group Senior |
$18.09
|
|
|
HC COVID19 RNA STAT
|
Facility
|
OP
|
$264.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
900913689
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$41.56 |
| Max. Negotiated Rate |
$364.89 |
| Rate for Payer: Adventist Health Commercial |
$52.80
|
| Rate for Payer: Adventist Health Commercial |
$74.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$51.31
|
| Rate for Payer: Adventist Health Medi-Cal |
$51.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$55.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$55.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.31
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$262.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$262.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$364.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$364.89
|
| Rate for Payer: Blue Shield of California Commercial |
$233.10
|
| Rate for Payer: Blue Shield of California Commercial |
$166.32
|
| Rate for Payer: Blue Shield of California EPN |
$146.89
|
| Rate for Payer: Blue Shield of California EPN |
$104.81
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Central Health Plan Commercial |
$211.20
|
| Rate for Payer: Central Health Plan Commercial |
$296.00
|
| Rate for Payer: Cigna of CA HMO |
$236.80
|
| Rate for Payer: Cigna of CA HMO |
$168.96
|
| Rate for Payer: Cigna of CA PPO |
$273.80
|
| Rate for Payer: Cigna of CA PPO |
$195.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$184.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$259.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.66
|
| Rate for Payer: EPIC Health Plan Senior |
$56.44
|
| Rate for Payer: EPIC Health Plan Senior |
$56.44
|
| Rate for Payer: Galaxy Health WC |
$314.50
|
| Rate for Payer: Galaxy Health WC |
$224.40
|
| Rate for Payer: Global Benefits Group Commercial |
$222.00
|
| Rate for Payer: Global Benefits Group Commercial |
$158.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$333.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$237.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$84.15
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$84.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$88.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$88.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$167.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$234.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$97.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$97.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$68.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$68.76
|
| Rate for Payer: Multiplan Commercial |
$277.50
|
| Rate for Payer: Multiplan Commercial |
$198.00
|
| Rate for Payer: Networks By Design Commercial |
$171.60
|
| Rate for Payer: Networks By Design Commercial |
$240.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$51.31
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$51.31
|
| Rate for Payer: Prime Health Services Commercial |
$314.50
|
| Rate for Payer: Prime Health Services Commercial |
$224.40
|
| Rate for Payer: Prime Health Services Medicare |
$54.39
|
| Rate for Payer: Prime Health Services Medicare |
$54.39
|
| Rate for Payer: Riverside University Health System MISP |
$56.44
|
| Rate for Payer: Riverside University Health System MISP |
$56.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$158.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$222.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$222.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$158.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.56
|
| Rate for Payer: United Healthcare All Other HMO |
$41.56
|
| Rate for Payer: United Healthcare All Other HMO |
$41.56
|
| Rate for Payer: United Healthcare HMO Rider |
$41.56
|
| Rate for Payer: United Healthcare HMO Rider |
$41.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$51.31
|
| Rate for Payer: Upland Medical Group Pediatric |
$51.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.44
|
| Rate for Payer: Vantage Medical Group Senior |
$51.31
|
| Rate for Payer: Vantage Medical Group Senior |
$51.31
|
|
|
HC COVID19 RNA STAT
|
Facility
|
IP
|
$370.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
900913689
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$74.00 |
| Max. Negotiated Rate |
$333.00 |
| Rate for Payer: Adventist Health Commercial |
$74.00
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Central Health Plan Commercial |
$296.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$259.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$148.00
|
| Rate for Payer: EPIC Health Plan Senior |
$148.00
|
| Rate for Payer: Galaxy Health WC |
$314.50
|
| Rate for Payer: Global Benefits Group Commercial |
$222.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$333.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$234.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$218.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.00
|
| Rate for Payer: Multiplan Commercial |
$277.50
|
| Rate for Payer: Networks By Design Commercial |
$240.50
|
| Rate for Payer: Prime Health Services Commercial |
$314.50
|
|
|
HC COVID19 SCREEN POOL
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
900912262
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$364.89 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Adventist Health Commercial |
$77.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$51.31
|
| Rate for Payer: Adventist Health Medi-Cal |
$51.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$55.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$55.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.31
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$262.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$262.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$364.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$364.89
|
| Rate for Payer: Blue Shield of California Commercial |
$243.18
|
| Rate for Payer: Blue Shield of California Commercial |
$12.60
|
| Rate for Payer: Blue Shield of California EPN |
$153.24
|
| Rate for Payer: Blue Shield of California EPN |
$7.94
|
| Rate for Payer: Cash Price |
$173.70
|
| Rate for Payer: Cash Price |
$173.70
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Central Health Plan Commercial |
$16.00
|
| Rate for Payer: Central Health Plan Commercial |
$308.80
|
| Rate for Payer: Cigna of CA HMO |
$247.04
|
| Rate for Payer: Cigna of CA HMO |
$12.80
|
| Rate for Payer: Cigna of CA PPO |
$285.64
|
| Rate for Payer: Cigna of CA PPO |
$14.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$270.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.66
|
| Rate for Payer: EPIC Health Plan Senior |
$56.44
|
| Rate for Payer: EPIC Health Plan Senior |
$56.44
|
| Rate for Payer: Galaxy Health WC |
$328.10
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$231.60
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$347.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$84.15
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$84.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$88.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$88.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$245.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$97.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$97.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$68.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$68.76
|
| Rate for Payer: Multiplan Commercial |
$289.50
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Networks By Design Commercial |
$250.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$51.31
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$51.31
|
| Rate for Payer: Prime Health Services Commercial |
$328.10
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Prime Health Services Medicare |
$54.39
|
| Rate for Payer: Prime Health Services Medicare |
$54.39
|
| Rate for Payer: Riverside University Health System MISP |
$56.44
|
| Rate for Payer: Riverside University Health System MISP |
$56.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$231.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$231.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.56
|
| Rate for Payer: United Healthcare All Other HMO |
$41.56
|
| Rate for Payer: United Healthcare All Other HMO |
$41.56
|
| Rate for Payer: United Healthcare HMO Rider |
$41.56
|
| Rate for Payer: United Healthcare HMO Rider |
$41.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$51.31
|
| Rate for Payer: Upland Medical Group Pediatric |
$51.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.44
|
| Rate for Payer: Vantage Medical Group Senior |
$51.31
|
| Rate for Payer: Vantage Medical Group Senior |
$51.31
|
|
|
HC COVID19 SCREEN POOL
|
Facility
|
IP
|
$386.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
900912262
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$77.20 |
| Max. Negotiated Rate |
$347.40 |
| Rate for Payer: Adventist Health Commercial |
$77.20
|
| Rate for Payer: Cash Price |
$173.70
|
| Rate for Payer: Central Health Plan Commercial |
$308.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$270.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$154.40
|
| Rate for Payer: EPIC Health Plan Senior |
$154.40
|
| Rate for Payer: Galaxy Health WC |
$328.10
|
| Rate for Payer: Global Benefits Group Commercial |
$231.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$347.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$245.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$227.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.20
|
| Rate for Payer: Multiplan Commercial |
$289.50
|
| Rate for Payer: Networks By Design Commercial |
$250.90
|
| Rate for Payer: Prime Health Services Commercial |
$328.10
|
|
|
HC CPAP/BIPAP/NIPPV - DAILY
|
Facility
|
IP
|
$5,495.00
|
|
|
Service Code
|
CPT 94660
|
| Hospital Charge Code |
900800110
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$1,099.00 |
| Max. Negotiated Rate |
$4,945.50 |
| Rate for Payer: Adventist Health Commercial |
$1,099.00
|
| Rate for Payer: Cash Price |
$2,472.75
|
| Rate for Payer: Central Health Plan Commercial |
$4,396.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,846.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,198.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,198.00
|
| Rate for Payer: Galaxy Health WC |
$4,670.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,297.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,945.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,489.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,242.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,099.00
|
| Rate for Payer: Multiplan Commercial |
$4,121.25
|
| Rate for Payer: Networks By Design Commercial |
$3,571.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,670.75
|
|
|
HC CPAP/BIPAP/NIPPV - DAILY
|
Facility
|
OP
|
$5,495.00
|
|
|
Service Code
|
CPT 94660
|
| Hospital Charge Code |
900800110
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$70.18 |
| Max. Negotiated Rate |
$4,945.50 |
| Rate for Payer: Adventist Health Commercial |
$1,099.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$281.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$209.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$422.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$309.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$281.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$378.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$2,472.75
|
| Rate for Payer: Cash Price |
$2,472.75
|
| Rate for Payer: Cash Price |
$2,472.75
|
| Rate for Payer: Central Health Plan Commercial |
$4,396.00
|
| Rate for Payer: Cigna of CA HMO |
$3,516.80
|
| Rate for Payer: Cigna of CA PPO |
$4,066.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$422.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$309.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$281.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,846.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$464.71
|
| Rate for Payer: EPIC Health Plan Senior |
$309.80
|
| Rate for Payer: Galaxy Health WC |
$4,670.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,297.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,945.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$461.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$70.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$281.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,489.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$77.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$394.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,099.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$377.40
|
| Rate for Payer: Multiplan Commercial |
$4,121.25
|
| Rate for Payer: Networks By Design Commercial |
$3,571.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$281.64
|
| Rate for Payer: Prime Health Services Commercial |
$4,670.75
|
| Rate for Payer: Prime Health Services Medicare |
$298.54
|
| Rate for Payer: Riverside University Health System MISP |
$309.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,297.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,297.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$281.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$422.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$309.80
|
| Rate for Payer: Vantage Medical Group Senior |
$281.64
|
|
|
HC C PARAPSILOSIS NAT
|
Facility
|
IP
|
$106.00
|
|
|
Service Code
|
CPT 87481 59
|
| Hospital Charge Code |
900912493
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$21.20 |
| Max. Negotiated Rate |
$95.40 |
| Rate for Payer: Adventist Health Commercial |
$21.20
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Central Health Plan Commercial |
$84.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$74.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.40
|
| Rate for Payer: EPIC Health Plan Senior |
$42.40
|
| Rate for Payer: Galaxy Health WC |
$90.10
|
| Rate for Payer: Global Benefits Group Commercial |
$63.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$95.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$67.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$62.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.20
|
| Rate for Payer: Multiplan Commercial |
$79.50
|
| Rate for Payer: Networks By Design Commercial |
$68.90
|
| Rate for Payer: Prime Health Services Commercial |
$90.10
|
|
|
HC C PARAPSILOSIS NAT
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
CPT 87481 59
|
| Hospital Charge Code |
900912493
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$15.20 |
| Max. Negotiated Rate |
$343.45 |
| Rate for Payer: Adventist Health Commercial |
$15.20
|
| Rate for Payer: Adventist Health Commercial |
$21.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$257.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$257.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$90.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$58.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$79.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$57.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$247.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$247.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$343.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$343.45
|
| Rate for Payer: Blue Shield of California Commercial |
$66.78
|
| Rate for Payer: Blue Shield of California Commercial |
$47.88
|
| Rate for Payer: Blue Shield of California EPN |
$42.08
|
| Rate for Payer: Blue Shield of California EPN |
$30.17
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Central Health Plan Commercial |
$60.80
|
| Rate for Payer: Central Health Plan Commercial |
$84.80
|
| Rate for Payer: Cigna of CA HMO |
$67.84
|
| Rate for Payer: Cigna of CA HMO |
$48.64
|
| Rate for Payer: Cigna of CA PPO |
$78.44
|
| Rate for Payer: Cigna of CA PPO |
$56.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$90.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$64.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$90.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$90.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$64.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$74.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$53.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.40
|
| Rate for Payer: EPIC Health Plan Senior |
$30.40
|
| Rate for Payer: EPIC Health Plan Senior |
$42.40
|
| Rate for Payer: Galaxy Health WC |
$90.10
|
| Rate for Payer: Galaxy Health WC |
$64.60
|
| Rate for Payer: Global Benefits Group Commercial |
$45.60
|
| Rate for Payer: Global Benefits Group Commercial |
$63.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$95.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$68.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$53.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$53.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$67.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$48.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$59.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$59.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$62.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$44.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$53.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$74.20
|
| Rate for Payer: Multiplan Commercial |
$57.00
|
| Rate for Payer: Multiplan Commercial |
$79.50
|
| Rate for Payer: Networks By Design Commercial |
$49.40
|
| Rate for Payer: Networks By Design Commercial |
$68.90
|
| Rate for Payer: Prime Health Services Commercial |
$90.10
|
| Rate for Payer: Prime Health Services Commercial |
$64.60
|
| Rate for Payer: Riverside University Health System MISP |
$30.40
|
| Rate for Payer: Riverside University Health System MISP |
$42.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$63.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$63.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$90.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$90.10
|
| Rate for Payer: Vantage Medical Group Senior |
$90.10
|
| Rate for Payer: Vantage Medical Group Senior |
$64.60
|
|
|
HC CPM DORSAL SPLINT
|
Facility
|
OP
|
$230.00
|
|
| Hospital Charge Code |
901301036
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$83.49 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$94.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$139.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$195.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$126.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$172.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Central Health Plan Commercial |
$184.00
|
| Rate for Payer: Cigna of CA HMO |
$147.20
|
| Rate for Payer: Cigna of CA PPO |
$170.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$195.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$195.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$195.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$161.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.00
|
| Rate for Payer: EPIC Health Plan Senior |
$92.00
|
| Rate for Payer: Galaxy Health WC |
$195.50
|
| Rate for Payer: Global Benefits Group Commercial |
$138.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$207.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$146.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$83.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$135.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$161.00
|
| Rate for Payer: Multiplan Commercial |
$172.50
|
| Rate for Payer: Networks By Design Commercial |
$149.50
|
| Rate for Payer: Prime Health Services Commercial |
$195.50
|
| Rate for Payer: Riverside University Health System MISP |
$92.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$138.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$138.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$195.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$195.50
|
| Rate for Payer: Vantage Medical Group Senior |
$195.50
|
|
|
HC CPM DORSAL SPLINT
|
Facility
|
IP
|
$230.00
|
|
| Hospital Charge Code |
901301036
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$46.00 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: Adventist Health Commercial |
$46.00
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Central Health Plan Commercial |
$184.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$161.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.00
|
| Rate for Payer: EPIC Health Plan Senior |
$92.00
|
| Rate for Payer: Galaxy Health WC |
$195.50
|
| Rate for Payer: Global Benefits Group Commercial |
$138.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$207.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$146.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$135.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.00
|
| Rate for Payer: Multiplan Commercial |
$172.50
|
| Rate for Payer: Networks By Design Commercial |
$149.50
|
| Rate for Payer: Prime Health Services Commercial |
$195.50
|
|
|
HC CR51 SOD CHROMATE TO 250 UCI
|
Facility
|
IP
|
$2,771.00
|
|
|
Service Code
|
CPT A9553
|
| Hospital Charge Code |
909301525
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$554.20 |
| Max. Negotiated Rate |
$2,493.90 |
| Rate for Payer: Adventist Health Commercial |
$554.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,222.34
|
| Rate for Payer: Blue Shield of California EPN |
$1,396.58
|
| Rate for Payer: Cash Price |
$1,246.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,216.80
|
| Rate for Payer: Cigna of CA HMO |
$1,939.70
|
| Rate for Payer: Cigna of CA PPO |
$1,939.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,939.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,108.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,108.40
|
| Rate for Payer: Galaxy Health WC |
$2,355.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,662.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,493.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,759.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,634.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$554.20
|
| Rate for Payer: Multiplan Commercial |
$2,078.25
|
| Rate for Payer: Networks By Design Commercial |
$1,385.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,355.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,039.96
|
| Rate for Payer: United Healthcare All Other HMO |
$1,012.25
|
| Rate for Payer: United Healthcare HMO Rider |
$990.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$907.50
|
|
