|
HC BRUKER AER ID
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900913001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$8.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$58.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$71.63
|
| Rate for Payer: Blue Distinction Transplant |
$12.00
|
| Rate for Payer: Blue Shield of California Commercial |
$12.36
|
| Rate for Payer: Blue Shield of California EPN |
$9.72
|
| Rate for Payer: Caremore Medicare Advantage |
$8.08
|
| Rate for Payer: Cash Price |
$9.00
|
| 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: Cigna of CA HMO |
$12.80
|
| Rate for Payer: Cigna of CA PPO |
$14.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: Dignity Health Media |
$8.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.08
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$15.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.08
|
| Rate for Payer: InnovAge PACE Commercial |
$12.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.83
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Prime Health Services Medicare |
$8.56
|
| Rate for Payer: Riverside University Health System MISP |
$8.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.54
|
| Rate for Payer: United Healthcare All Other HMO |
$6.54
|
| Rate for Payer: United Healthcare HMO Rider |
$6.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
HC BRUKER ANA ID
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 87076
|
| Hospital Charge Code |
900913002
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$8.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$91.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$111.77
|
| Rate for Payer: Blue Distinction Transplant |
$12.00
|
| Rate for Payer: Blue Shield of California Commercial |
$12.36
|
| Rate for Payer: Blue Shield of California EPN |
$9.72
|
| Rate for Payer: Caremore Medicare Advantage |
$8.08
|
| Rate for Payer: Cash Price |
$9.00
|
| 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: Cigna of CA HMO |
$12.80
|
| Rate for Payer: Cigna of CA PPO |
$14.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: Dignity Health Media |
$8.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.08
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$15.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.08
|
| Rate for Payer: InnovAge PACE Commercial |
$12.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.83
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Prime Health Services Medicare |
$8.56
|
| Rate for Payer: Riverside University Health System MISP |
$8.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.54
|
| Rate for Payer: United Healthcare All Other HMO |
$6.54
|
| Rate for Payer: United Healthcare HMO Rider |
$6.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
HC BRUKER ANA ID
|
Facility
|
IP
|
$29.00
|
|
|
Service Code
|
CPT 87076
|
| Hospital Charge Code |
900913002
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.80 |
| Max. Negotiated Rate |
$26.10 |
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Central Health Plan Commercial |
$23.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.60
|
| Rate for Payer: Galaxy Health WC |
$24.65
|
| Rate for Payer: Global Benefits Group Commercial |
$17.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.80
|
| Rate for Payer: Multiplan Commercial |
$21.75
|
| Rate for Payer: Networks By Design Commercial |
$18.85
|
| Rate for Payer: Prime Health Services Commercial |
$24.65
|
|
|
HC BTTN MINI 1 12FRX0.8CM BLLN LP
|
Facility
|
OP
|
$891.11
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901696291
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.79 |
| Max. Negotiated Rate |
$802.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$101.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$757.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$490.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$490.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$431.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$526.47
|
| Rate for Payer: Blue Distinction Transplant |
$534.67
|
| Rate for Payer: Blue Shield of California Commercial |
$560.51
|
| Rate for Payer: Blue Shield of California EPN |
$435.75
|
| Rate for Payer: Cash Price |
$401.00
|
| Rate for Payer: Cash Price |
$401.00
|
| Rate for Payer: Central Health Plan Commercial |
$712.89
|
| Rate for Payer: Cigna of CA HMO |
$570.31
|
| Rate for Payer: Cigna of CA PPO |
$659.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$757.44
|
| Rate for Payer: Dignity Health Media |
$757.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$757.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$356.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$356.44
|
| Rate for Payer: Galaxy Health WC |
$757.44
|
| Rate for Payer: Global Benefits Group Commercial |
$534.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$802.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$668.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$311.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$594.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$339.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.22
|
| Rate for Payer: Multiplan Commercial |
$668.33
|
| Rate for Payer: Networks By Design Commercial |
$579.22
|
| Rate for Payer: Prime Health Services Commercial |
$757.44
|
| Rate for Payer: Riverside University Health System MISP |
$356.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$534.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$534.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$445.56
|
| Rate for Payer: United Healthcare All Other HMO |
$445.56
|
| Rate for Payer: United Healthcare HMO Rider |
$445.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$445.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$757.44
|
| Rate for Payer: Vantage Medical Group Senior |
$757.44
|
|
|
HC BTTN MINI 1 12FRX0.8CM BLLN LP
|
Facility
|
IP
|
$891.11
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901696291
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$178.22 |
| Max. Negotiated Rate |
$802.00 |
| Rate for Payer: Cash Price |
$401.00
|
| Rate for Payer: Central Health Plan Commercial |
$712.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$356.44
|
| Rate for Payer: Galaxy Health WC |
$757.44
|
| Rate for Payer: Global Benefits Group Commercial |
$534.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$802.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$594.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$339.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.22
|
| Rate for Payer: Multiplan Commercial |
$668.33
|
| Rate for Payer: Networks By Design Commercial |
$579.22
|
| Rate for Payer: Prime Health Services Commercial |
$757.44
|
|
|
HC BTTN MINI 1 12FRX1.0CM BLLN LP
|
Facility
|
OP
|
$891.11
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901696292
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.79 |
| Max. Negotiated Rate |
$802.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$101.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$757.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$490.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$490.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$431.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$526.47
|
| Rate for Payer: Blue Distinction Transplant |
$534.67
|
| Rate for Payer: Blue Shield of California Commercial |
$560.51
|
| Rate for Payer: Blue Shield of California EPN |
$435.75
|
| Rate for Payer: Cash Price |
$401.00
|
| Rate for Payer: Cash Price |
$401.00
|
| Rate for Payer: Central Health Plan Commercial |
$712.89
|
| Rate for Payer: Cigna of CA HMO |
$570.31
|
| Rate for Payer: Cigna of CA PPO |
$659.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$757.44
|
| Rate for Payer: Dignity Health Media |
$757.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$757.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$356.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$356.44
|
| Rate for Payer: Galaxy Health WC |
$757.44
|
| Rate for Payer: Global Benefits Group Commercial |
$534.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$802.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$668.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$311.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$594.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$339.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.22
|
| Rate for Payer: Multiplan Commercial |
$668.33
|
| Rate for Payer: Networks By Design Commercial |
$579.22
|
| Rate for Payer: Prime Health Services Commercial |
$757.44
|
| Rate for Payer: Riverside University Health System MISP |
$356.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$534.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$534.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$445.56
|
| Rate for Payer: United Healthcare All Other HMO |
$445.56
|
| Rate for Payer: United Healthcare HMO Rider |
$445.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$445.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$757.44
|
| Rate for Payer: Vantage Medical Group Senior |
$757.44
|
|
|
HC BTTN MINI 1 12FRX1.0CM BLLN LP
|
Facility
|
IP
|
$891.11
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901696292
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$178.22 |
| Max. Negotiated Rate |
$802.00 |
| Rate for Payer: Cash Price |
$401.00
|
| Rate for Payer: Central Health Plan Commercial |
$712.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$356.44
|
| Rate for Payer: Galaxy Health WC |
$757.44
|
| Rate for Payer: Global Benefits Group Commercial |
$534.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$802.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$594.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$339.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.22
|
| Rate for Payer: Multiplan Commercial |
$668.33
|
| Rate for Payer: Networks By Design Commercial |
$579.22
|
| Rate for Payer: Prime Health Services Commercial |
$757.44
|
|
|
HC BTTN MINI 1 14FRX1.0CM BLLN LP
|
Facility
|
IP
|
$246.96
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901696293
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.39 |
| Max. Negotiated Rate |
$222.26 |
| Rate for Payer: Cash Price |
$111.13
|
| Rate for Payer: Central Health Plan Commercial |
$197.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.78
|
| Rate for Payer: Galaxy Health WC |
$209.92
|
| Rate for Payer: Global Benefits Group Commercial |
$148.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$222.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$164.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.39
|
| Rate for Payer: Multiplan Commercial |
$185.22
|
| Rate for Payer: Networks By Design Commercial |
$160.52
|
| Rate for Payer: Prime Health Services Commercial |
$209.92
|
|
|
HC BTTN MINI 1 14FRX1.0CM BLLN LP
|
Facility
|
OP
|
$246.96
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901696293
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.39 |
| Max. Negotiated Rate |
$222.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$101.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$209.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$135.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$119.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$145.90
|
| Rate for Payer: Blue Distinction Transplant |
$148.18
|
| Rate for Payer: Blue Shield of California Commercial |
$155.34
|
| Rate for Payer: Blue Shield of California EPN |
$120.76
|
| Rate for Payer: Cash Price |
$111.13
|
| Rate for Payer: Cash Price |
$111.13
|
| Rate for Payer: Central Health Plan Commercial |
$197.57
|
| Rate for Payer: Cigna of CA HMO |
$158.05
|
| Rate for Payer: Cigna of CA PPO |
$182.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$209.92
|
| Rate for Payer: Dignity Health Media |
$209.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$209.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$98.78
|
| Rate for Payer: Galaxy Health WC |
$209.92
|
| Rate for Payer: Global Benefits Group Commercial |
$148.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$222.26
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$185.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$86.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$164.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.39
|
| Rate for Payer: Multiplan Commercial |
$185.22
|
| Rate for Payer: Networks By Design Commercial |
$160.52
|
| Rate for Payer: Prime Health Services Commercial |
$209.92
|
| Rate for Payer: Riverside University Health System MISP |
$98.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$148.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$148.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.48
|
| Rate for Payer: United Healthcare All Other HMO |
$123.48
|
| Rate for Payer: United Healthcare HMO Rider |
$123.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$209.92
|
| Rate for Payer: Vantage Medical Group Senior |
$209.92
|
|
|
HC BTTN MINI 1 14FRX1.2CM BLLN LP
|
Facility
|
IP
|
$568.40
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901696294
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$113.68 |
| Max. Negotiated Rate |
$511.56 |
| Rate for Payer: Cash Price |
$255.78
|
| Rate for Payer: Central Health Plan Commercial |
$454.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$227.36
|
| Rate for Payer: Galaxy Health WC |
$483.14
|
| Rate for Payer: Global Benefits Group Commercial |
$341.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$511.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$379.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$216.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.68
|
| Rate for Payer: Multiplan Commercial |
$426.30
|
| Rate for Payer: Networks By Design Commercial |
$369.46
|
| Rate for Payer: Prime Health Services Commercial |
$483.14
|
|
|
HC BTTN MINI 1 14FRX1.2CM BLLN LP
|
Facility
|
OP
|
$568.40
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901696294
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.79 |
| Max. Negotiated Rate |
$511.56 |
| Rate for Payer: Aetna of CA HMO/PPO |
$101.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$483.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$312.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$312.62
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$275.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$335.81
|
| Rate for Payer: Blue Distinction Transplant |
$341.04
|
| Rate for Payer: Blue Shield of California Commercial |
$357.52
|
| Rate for Payer: Blue Shield of California EPN |
$277.95
|
| Rate for Payer: Cash Price |
$255.78
|
| Rate for Payer: Cash Price |
$255.78
|
| Rate for Payer: Central Health Plan Commercial |
$454.72
|
| Rate for Payer: Cigna of CA HMO |
$363.78
|
| Rate for Payer: Cigna of CA PPO |
$420.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$483.14
|
| Rate for Payer: Dignity Health Media |
$483.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$483.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$227.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$227.36
|
| Rate for Payer: Galaxy Health WC |
$483.14
|
| Rate for Payer: Global Benefits Group Commercial |
$341.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$511.56
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$426.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$198.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$379.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$216.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.68
|
| Rate for Payer: Multiplan Commercial |
$426.30
|
| Rate for Payer: Networks By Design Commercial |
$369.46
|
| Rate for Payer: Prime Health Services Commercial |
$483.14
|
| Rate for Payer: Riverside University Health System MISP |
$227.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$341.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$341.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$284.20
|
| Rate for Payer: United Healthcare All Other HMO |
$284.20
|
| Rate for Payer: United Healthcare HMO Rider |
$284.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$284.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$483.14
|
| Rate for Payer: Vantage Medical Group Senior |
$483.14
|
|
|
HC BTTN MINI 1 14FRX1.7CM BLLN LP
|
Facility
|
IP
|
$568.40
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901696296
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$113.68 |
| Max. Negotiated Rate |
$511.56 |
| Rate for Payer: Cash Price |
$255.78
|
| Rate for Payer: Central Health Plan Commercial |
$454.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$227.36
|
| Rate for Payer: Galaxy Health WC |
$483.14
|
| Rate for Payer: Global Benefits Group Commercial |
$341.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$511.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$379.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$216.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.68
|
| Rate for Payer: Multiplan Commercial |
$426.30
|
| Rate for Payer: Networks By Design Commercial |
$369.46
|
| Rate for Payer: Prime Health Services Commercial |
$483.14
|
|
|
HC BTTN MINI 1 14FRX1.7CM BLLN LP
|
Facility
|
OP
|
$568.40
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901696296
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.79 |
| Max. Negotiated Rate |
$511.56 |
| Rate for Payer: Aetna of CA HMO/PPO |
$101.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$483.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$312.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$312.62
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$275.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$335.81
|
| Rate for Payer: Blue Distinction Transplant |
$341.04
|
| Rate for Payer: Blue Shield of California Commercial |
$357.52
|
| Rate for Payer: Blue Shield of California EPN |
$277.95
|
| Rate for Payer: Cash Price |
$255.78
|
| Rate for Payer: Cash Price |
$255.78
|
| Rate for Payer: Central Health Plan Commercial |
$454.72
|
| Rate for Payer: Cigna of CA HMO |
$363.78
|
| Rate for Payer: Cigna of CA PPO |
$420.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$483.14
|
| Rate for Payer: Dignity Health Media |
$483.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$483.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$227.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$227.36
|
| Rate for Payer: Galaxy Health WC |
$483.14
|
| Rate for Payer: Global Benefits Group Commercial |
$341.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$511.56
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$426.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$198.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$379.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$216.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.68
|
| Rate for Payer: Multiplan Commercial |
$426.30
|
| Rate for Payer: Networks By Design Commercial |
$369.46
|
| Rate for Payer: Prime Health Services Commercial |
$483.14
|
| Rate for Payer: Riverside University Health System MISP |
$227.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$341.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$341.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$284.20
|
| Rate for Payer: United Healthcare All Other HMO |
$284.20
|
| Rate for Payer: United Healthcare HMO Rider |
$284.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$284.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$483.14
|
| Rate for Payer: Vantage Medical Group Senior |
$483.14
|
|
|
HC BTTN MINI 1 14FRX2.0CM BLLN LP
|
Facility
|
IP
|
$643.45
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901696297
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$128.69 |
| Max. Negotiated Rate |
$579.10 |
| Rate for Payer: Cash Price |
$289.55
|
| Rate for Payer: Central Health Plan Commercial |
$514.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$257.38
|
| Rate for Payer: Galaxy Health WC |
$546.93
|
| Rate for Payer: Global Benefits Group Commercial |
$386.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$579.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$429.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$245.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.69
|
| Rate for Payer: Multiplan Commercial |
$482.59
|
| Rate for Payer: Networks By Design Commercial |
$418.24
|
| Rate for Payer: Prime Health Services Commercial |
$546.93
|
|
|
HC BTTN MINI 1 14FRX2.0CM BLLN LP
|
Facility
|
OP
|
$643.45
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901696297
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.79 |
| Max. Negotiated Rate |
$579.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$101.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$546.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$353.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$353.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$311.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$380.15
|
| Rate for Payer: Blue Distinction Transplant |
$386.07
|
| Rate for Payer: Blue Shield of California Commercial |
$404.73
|
| Rate for Payer: Blue Shield of California EPN |
$314.65
|
| Rate for Payer: Cash Price |
$289.55
|
| Rate for Payer: Cash Price |
$289.55
|
| Rate for Payer: Central Health Plan Commercial |
$514.76
|
| Rate for Payer: Cigna of CA HMO |
$411.81
|
| Rate for Payer: Cigna of CA PPO |
$476.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$546.93
|
| Rate for Payer: Dignity Health Media |
$546.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$546.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$257.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$257.38
|
| Rate for Payer: Galaxy Health WC |
$546.93
|
| Rate for Payer: Global Benefits Group Commercial |
$386.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$579.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$482.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$225.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$429.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$245.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.69
|
| Rate for Payer: Multiplan Commercial |
$482.59
|
| Rate for Payer: Networks By Design Commercial |
$418.24
|
| Rate for Payer: Prime Health Services Commercial |
$546.93
|
| Rate for Payer: Riverside University Health System MISP |
$257.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$386.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$386.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$321.72
|
| Rate for Payer: United Healthcare All Other HMO |
$321.72
|
| Rate for Payer: United Healthcare HMO Rider |
$321.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$321.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$546.93
|
| Rate for Payer: Vantage Medical Group Senior |
$546.93
|
|
|
HC BTTN MINI 14FRX1.5CM
|
Facility
|
IP
|
$512.60
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901696295
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$102.52 |
| Max. Negotiated Rate |
$461.34 |
| Rate for Payer: Cash Price |
$230.67
|
| Rate for Payer: Central Health Plan Commercial |
$410.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$205.04
|
| Rate for Payer: Galaxy Health WC |
$435.71
|
| Rate for Payer: Global Benefits Group Commercial |
$307.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$461.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$341.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$195.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.52
|
| Rate for Payer: Multiplan Commercial |
$384.45
|
| Rate for Payer: Networks By Design Commercial |
$333.19
|
| Rate for Payer: Prime Health Services Commercial |
$435.71
|
|
|
HC BTTN MINI 14FRX1.5CM
|
Facility
|
OP
|
$512.60
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901696295
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.79 |
| Max. Negotiated Rate |
$461.34 |
| Rate for Payer: Aetna of CA HMO/PPO |
$101.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$435.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$281.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$281.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$248.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$302.84
|
| Rate for Payer: Blue Distinction Transplant |
$307.56
|
| Rate for Payer: Blue Shield of California Commercial |
$322.43
|
| Rate for Payer: Blue Shield of California EPN |
$250.66
|
| Rate for Payer: Cash Price |
$230.67
|
| Rate for Payer: Cash Price |
$230.67
|
| Rate for Payer: Central Health Plan Commercial |
$410.08
|
| Rate for Payer: Cigna of CA HMO |
$328.06
|
| Rate for Payer: Cigna of CA PPO |
$379.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$435.71
|
| Rate for Payer: Dignity Health Media |
$435.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$435.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$205.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$205.04
|
| Rate for Payer: Galaxy Health WC |
$435.71
|
| Rate for Payer: Global Benefits Group Commercial |
$307.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$461.34
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$384.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$179.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$341.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$195.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.52
|
| Rate for Payer: Multiplan Commercial |
$384.45
|
| Rate for Payer: Networks By Design Commercial |
$333.19
|
| Rate for Payer: Prime Health Services Commercial |
$435.71
|
| Rate for Payer: Riverside University Health System MISP |
$205.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$307.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$307.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$256.30
|
| Rate for Payer: United Healthcare All Other HMO |
$256.30
|
| Rate for Payer: United Healthcare HMO Rider |
$256.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$256.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$435.71
|
| Rate for Payer: Vantage Medical Group Senior |
$435.71
|
|
|
HC BUFFY COAT EXAM
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 85009
|
| Hospital Charge Code |
900910196
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$32.98 |
| Rate for Payer: Adventist Health Medi-Cal |
$5.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$27.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.98
|
| Rate for Payer: Blue Distinction Transplant |
$9.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9.27
|
| Rate for Payer: Blue Shield of California EPN |
$7.29
|
| Rate for Payer: Caremore Medicare Advantage |
$5.07
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Central Health Plan Commercial |
$12.00
|
| Rate for Payer: Cigna of CA HMO |
$9.60
|
| Rate for Payer: Cigna of CA PPO |
$11.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.60
|
| Rate for Payer: Dignity Health Media |
$5.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.84
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.07
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.07
|
| Rate for Payer: InnovAge PACE Commercial |
$7.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.79
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
| Rate for Payer: Prime Health Services Medicare |
$5.37
|
| Rate for Payer: Riverside University Health System MISP |
$5.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.10
|
| Rate for Payer: United Healthcare All Other HMO |
$4.10
|
| Rate for Payer: United Healthcare HMO Rider |
$4.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.58
|
| Rate for Payer: Vantage Medical Group Senior |
$5.07
|
|
|
HC BUFFY COAT EXAM
|
Facility
|
IP
|
$279.00
|
|
|
Service Code
|
CPT 85009
|
| Hospital Charge Code |
900910196
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$55.80 |
| Max. Negotiated Rate |
$251.10 |
| Rate for Payer: Cash Price |
$125.55
|
| Rate for Payer: Central Health Plan Commercial |
$223.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$111.60
|
| Rate for Payer: Galaxy Health WC |
$237.15
|
| Rate for Payer: Global Benefits Group Commercial |
$167.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$251.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$186.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.80
|
| Rate for Payer: Multiplan Commercial |
$209.25
|
| Rate for Payer: Networks By Design Commercial |
$181.35
|
| Rate for Payer: Prime Health Services Commercial |
$237.15
|
|
|
HC BULB RESERVOIR JACKSON PRATT
|
Facility
|
OP
|
$54.04
|
|
| Hospital Charge Code |
901604267
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.81 |
| Max. Negotiated Rate |
$48.64 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$45.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$26.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.93
|
| Rate for Payer: Blue Distinction Transplant |
$32.42
|
| Rate for Payer: Blue Shield of California Commercial |
$33.99
|
| Rate for Payer: Blue Shield of California EPN |
$26.43
|
| Rate for Payer: Cash Price |
$24.32
|
| Rate for Payer: Central Health Plan Commercial |
$43.23
|
| Rate for Payer: Cigna of CA HMO |
$34.59
|
| Rate for Payer: Cigna of CA PPO |
$39.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.93
|
| Rate for Payer: Dignity Health Media |
$45.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$21.62
|
| Rate for Payer: Galaxy Health WC |
$45.93
|
| Rate for Payer: Global Benefits Group Commercial |
$32.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.64
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$40.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.81
|
| Rate for Payer: Multiplan Commercial |
$40.53
|
| Rate for Payer: Networks By Design Commercial |
$35.13
|
| Rate for Payer: Prime Health Services Commercial |
$45.93
|
| Rate for Payer: Riverside University Health System MISP |
$21.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.02
|
| Rate for Payer: United Healthcare All Other HMO |
$27.02
|
| Rate for Payer: United Healthcare HMO Rider |
$27.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.93
|
| Rate for Payer: Vantage Medical Group Senior |
$45.93
|
|
|
HC BULB RESERVOIR JACKSON PRATT
|
Facility
|
IP
|
$54.04
|
|
| Hospital Charge Code |
901604267
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.81 |
| Max. Negotiated Rate |
$48.64 |
| Rate for Payer: Cash Price |
$24.32
|
| Rate for Payer: Central Health Plan Commercial |
$43.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.62
|
| Rate for Payer: Galaxy Health WC |
$45.93
|
| Rate for Payer: Global Benefits Group Commercial |
$32.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.81
|
| Rate for Payer: Multiplan Commercial |
$40.53
|
| Rate for Payer: Networks By Design Commercial |
$35.13
|
| Rate for Payer: Prime Health Services Commercial |
$45.93
|
|
|
HC BUN
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
900910253
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.80 |
| Max. Negotiated Rate |
$80.10 |
| Rate for Payer: Cash Price |
$40.05
|
| Rate for Payer: Central Health Plan Commercial |
$71.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.60
|
| Rate for Payer: Galaxy Health WC |
$75.65
|
| Rate for Payer: Global Benefits Group Commercial |
$53.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$80.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$59.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.80
|
| Rate for Payer: Multiplan Commercial |
$66.75
|
| Rate for Payer: Networks By Design Commercial |
$57.85
|
| Rate for Payer: Prime Health Services Commercial |
$75.65
|
|
|
HC BUN
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
900910253
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$35.01 |
| Rate for Payer: Adventist Health Medi-Cal |
$3.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$29.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$28.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.01
|
| Rate for Payer: Blue Distinction Transplant |
$9.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9.27
|
| Rate for Payer: Blue Shield of California EPN |
$7.29
|
| Rate for Payer: Caremore Medicare Advantage |
$3.95
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Central Health Plan Commercial |
$12.00
|
| Rate for Payer: Cigna of CA HMO |
$9.60
|
| Rate for Payer: Cigna of CA PPO |
$11.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.92
|
| Rate for Payer: Dignity Health Media |
$3.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.33
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3.95
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.95
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.95
|
| Rate for Payer: InnovAge PACE Commercial |
$5.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.29
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
| Rate for Payer: Prime Health Services Medicare |
$4.19
|
| Rate for Payer: Riverside University Health System MISP |
$4.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.20
|
| Rate for Payer: United Healthcare All Other HMO |
$3.20
|
| Rate for Payer: United Healthcare HMO Rider |
$3.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.34
|
| Rate for Payer: Vantage Medical Group Senior |
$3.95
|
|
|
HC BUN BODY FLUID
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
900912241
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
|
|
HC BUN BODY FLUID
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
900912241
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$35.01 |
| Rate for Payer: Adventist Health Medi-Cal |
$3.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$29.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$28.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.01
|
| Rate for Payer: Blue Distinction Transplant |
$10.20
|
| Rate for Payer: Blue Shield of California Commercial |
$10.51
|
| Rate for Payer: Blue Shield of California EPN |
$8.26
|
| Rate for Payer: Caremore Medicare Advantage |
$3.95
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Central Health Plan Commercial |
$13.60
|
| Rate for Payer: Cigna of CA HMO |
$10.88
|
| Rate for Payer: Cigna of CA PPO |
$12.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.92
|
| Rate for Payer: Dignity Health Media |
$3.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.33
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3.95
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.95
|
| Rate for Payer: Galaxy Health WC |
$14.45
|
| Rate for Payer: Global Benefits Group Commercial |
$10.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.95
|
| Rate for Payer: InnovAge PACE Commercial |
$5.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.29
|
| Rate for Payer: Multiplan Commercial |
$12.75
|
| Rate for Payer: Networks By Design Commercial |
$11.05
|
| Rate for Payer: Prime Health Services Commercial |
$14.45
|
| Rate for Payer: Prime Health Services Medicare |
$4.19
|
| Rate for Payer: Riverside University Health System MISP |
$4.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.20
|
| Rate for Payer: United Healthcare All Other HMO |
$3.20
|
| Rate for Payer: United Healthcare HMO Rider |
$3.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.34
|
| Rate for Payer: Vantage Medical Group Senior |
$3.95
|
|
