|
HC CALCIUM URINE RANDOM
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 82340
|
| Hospital Charge Code |
900912197
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$53.53 |
| Rate for Payer: Adventist Health Medi-Cal |
$6.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$44.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$43.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.53
|
| 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 |
$6.03
|
| 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 |
$9.04
|
| Rate for Payer: Dignity Health Media |
$6.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.14
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.03
|
| 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 |
$9.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.03
|
| Rate for Payer: InnovAge PACE Commercial |
$9.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.08
|
| 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 |
$6.39
|
| Rate for Payer: Riverside University Health System MISP |
$6.63
|
| 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 |
$4.89
|
| Rate for Payer: United Healthcare All Other HMO |
$4.89
|
| Rate for Payer: United Healthcare HMO Rider |
$4.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.63
|
| Rate for Payer: Vantage Medical Group Senior |
$6.03
|
|
|
HC CALCIUM URINE RANDOM
|
Facility
|
IP
|
$53.00
|
|
|
Service Code
|
CPT 82340
|
| Hospital Charge Code |
900912197
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.60 |
| Max. Negotiated Rate |
$47.70 |
| Rate for Payer: Cash Price |
$23.85
|
| Rate for Payer: Central Health Plan Commercial |
$42.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.20
|
| Rate for Payer: Galaxy Health WC |
$45.05
|
| Rate for Payer: Global Benefits Group Commercial |
$31.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$47.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.60
|
| Rate for Payer: Multiplan Commercial |
$39.75
|
| Rate for Payer: Networks By Design Commercial |
$34.45
|
| Rate for Payer: Prime Health Services Commercial |
$45.05
|
|
|
HC CANALITH REPOSITIONING PROC
|
Facility
|
IP
|
$179.00
|
|
|
Service Code
|
CPT 95992
|
| Hospital Charge Code |
905103410
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$35.80 |
| Max. Negotiated Rate |
$161.10 |
| Rate for Payer: Cash Price |
$80.55
|
| Rate for Payer: Central Health Plan Commercial |
$143.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.60
|
| Rate for Payer: Galaxy Health WC |
$152.15
|
| Rate for Payer: Global Benefits Group Commercial |
$107.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$161.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$119.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.80
|
| Rate for Payer: Multiplan Commercial |
$134.25
|
| Rate for Payer: Networks By Design Commercial |
$116.35
|
| Rate for Payer: Prime Health Services Commercial |
$152.15
|
|
|
HC CANALITH REPOSITIONING PROC
|
Facility
|
OP
|
$179.00
|
|
|
Service Code
|
CPT 95992
|
| Hospital Charge Code |
905103410
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$62.65 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$217.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$152.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$98.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$98.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$107.40
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$80.55
|
| Rate for Payer: Cash Price |
$80.55
|
| Rate for Payer: Cash Price |
$80.55
|
| Rate for Payer: Cash Price |
$80.55
|
| Rate for Payer: Central Health Plan Commercial |
$143.20
|
| Rate for Payer: Cigna of CA HMO |
$114.56
|
| Rate for Payer: Cigna of CA PPO |
$132.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$152.15
|
| Rate for Payer: Dignity Health Media |
$152.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$152.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$71.60
|
| Rate for Payer: Galaxy Health WC |
$152.15
|
| Rate for Payer: Global Benefits Group Commercial |
$107.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$161.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$134.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$62.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$119.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.39
|
| Rate for Payer: Multiplan Commercial |
$134.25
|
| Rate for Payer: Networks By Design Commercial |
$116.35
|
| Rate for Payer: Prime Health Services Commercial |
$152.15
|
| Rate for Payer: Riverside University Health System MISP |
$71.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$107.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$107.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$152.15
|
| Rate for Payer: Vantage Medical Group Senior |
$152.15
|
|
|
HC CANNABINOIDS SEMI-QUANTITATIVE
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900910380
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$109.80 |
| Rate for Payer: Cash Price |
$54.90
|
| Rate for Payer: Central Health Plan Commercial |
$97.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.80
|
| Rate for Payer: Galaxy Health WC |
$103.70
|
| Rate for Payer: Global Benefits Group Commercial |
$73.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$109.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$81.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.40
|
| Rate for Payer: Multiplan Commercial |
$91.50
|
| Rate for Payer: Networks By Design Commercial |
$79.30
|
| Rate for Payer: Prime Health Services Commercial |
$103.70
|
|
|
HC CANNABINOIDS SEMI-QUANTITATIVE
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900910380
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.10 |
| Max. Negotiated Rate |
$129.22 |
| Rate for Payer: Adventist Health Medi-Cal |
$18.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$97.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$105.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$129.22
|
| Rate for Payer: Blue Distinction Transplant |
$60.60
|
| Rate for Payer: Blue Shield of California Commercial |
$62.42
|
| Rate for Payer: Blue Shield of California EPN |
$49.09
|
| Rate for Payer: Caremore Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$45.45
|
| Rate for Payer: Cash Price |
$45.45
|
| Rate for Payer: Central Health Plan Commercial |
$80.80
|
| Rate for Payer: Cigna of CA HMO |
$64.64
|
| Rate for Payer: Cigna of CA PPO |
$74.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Media |
$18.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.16
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$18.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.64
|
| Rate for Payer: Galaxy Health WC |
$85.85
|
| Rate for Payer: Global Benefits Group Commercial |
$60.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$75.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$30.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: InnovAge PACE Commercial |
$27.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$67.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.98
|
| Rate for Payer: Multiplan Commercial |
$75.75
|
| Rate for Payer: Networks By Design Commercial |
$65.65
|
| Rate for Payer: Prime Health Services Commercial |
$85.85
|
| Rate for Payer: Prime Health Services Medicare |
$19.76
|
| Rate for Payer: Riverside University Health System MISP |
$20.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.10
|
| Rate for Payer: United Healthcare All Other HMO |
$15.10
|
| Rate for Payer: United Healthcare HMO Rider |
$15.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Vantage Medical Group Senior |
$18.64
|
|
|
HC CANN INNER #6 EXT LENGTH
|
Facility
|
IP
|
$54.12
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
901604685
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$48.71 |
| Rate for Payer: Cash Price |
$24.35
|
| Rate for Payer: Central Health Plan Commercial |
$43.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.65
|
| Rate for Payer: Galaxy Health WC |
$46.00
|
| Rate for Payer: Global Benefits Group Commercial |
$32.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.82
|
| Rate for Payer: Multiplan Commercial |
$40.59
|
| Rate for Payer: Networks By Design Commercial |
$35.18
|
| Rate for Payer: Prime Health Services Commercial |
$46.00
|
|
|
HC CANN INNER #6 EXT LENGTH
|
Facility
|
OP
|
$54.12
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
901604685
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$48.71 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$26.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.97
|
| Rate for Payer: Blue Distinction Transplant |
$32.47
|
| Rate for Payer: Blue Shield of California Commercial |
$34.04
|
| Rate for Payer: Blue Shield of California EPN |
$26.46
|
| Rate for Payer: Cash Price |
$24.35
|
| Rate for Payer: Cash Price |
$24.35
|
| Rate for Payer: Central Health Plan Commercial |
$43.30
|
| Rate for Payer: Cigna of CA HMO |
$34.64
|
| Rate for Payer: Cigna of CA PPO |
$40.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.00
|
| Rate for Payer: Dignity Health Media |
$46.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$46.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.65
|
| Rate for Payer: EPIC Health Plan Transplant |
$21.65
|
| Rate for Payer: Galaxy Health WC |
$46.00
|
| Rate for Payer: Global Benefits Group Commercial |
$32.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.71
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$40.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.82
|
| Rate for Payer: Multiplan Commercial |
$40.59
|
| Rate for Payer: Networks By Design Commercial |
$35.18
|
| Rate for Payer: Prime Health Services Commercial |
$46.00
|
| Rate for Payer: Riverside University Health System MISP |
$21.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.06
|
| Rate for Payer: United Healthcare All Other HMO |
$27.06
|
| Rate for Payer: United Healthcare HMO Rider |
$27.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$46.00
|
| Rate for Payer: Vantage Medical Group Senior |
$46.00
|
|
|
HC CANN INNER #7 EXT LENGTH
|
Facility
|
OP
|
$54.12
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
901604683
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$48.71 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$26.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.97
|
| Rate for Payer: Blue Distinction Transplant |
$32.47
|
| Rate for Payer: Blue Shield of California Commercial |
$34.04
|
| Rate for Payer: Blue Shield of California EPN |
$26.46
|
| Rate for Payer: Cash Price |
$24.35
|
| Rate for Payer: Cash Price |
$24.35
|
| Rate for Payer: Central Health Plan Commercial |
$43.30
|
| Rate for Payer: Cigna of CA HMO |
$34.64
|
| Rate for Payer: Cigna of CA PPO |
$40.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.00
|
| Rate for Payer: Dignity Health Media |
$46.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$46.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.65
|
| Rate for Payer: EPIC Health Plan Transplant |
$21.65
|
| Rate for Payer: Galaxy Health WC |
$46.00
|
| Rate for Payer: Global Benefits Group Commercial |
$32.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.71
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$40.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.82
|
| Rate for Payer: Multiplan Commercial |
$40.59
|
| Rate for Payer: Networks By Design Commercial |
$35.18
|
| Rate for Payer: Prime Health Services Commercial |
$46.00
|
| Rate for Payer: Riverside University Health System MISP |
$21.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.06
|
| Rate for Payer: United Healthcare All Other HMO |
$27.06
|
| Rate for Payer: United Healthcare HMO Rider |
$27.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$46.00
|
| Rate for Payer: Vantage Medical Group Senior |
$46.00
|
|
|
HC CANN INNER #7 EXT LENGTH
|
Facility
|
IP
|
$54.12
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
901604683
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$48.71 |
| Rate for Payer: Cash Price |
$24.35
|
| Rate for Payer: Central Health Plan Commercial |
$43.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.65
|
| Rate for Payer: Galaxy Health WC |
$46.00
|
| Rate for Payer: Global Benefits Group Commercial |
$32.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.82
|
| Rate for Payer: Multiplan Commercial |
$40.59
|
| Rate for Payer: Networks By Design Commercial |
$35.18
|
| Rate for Payer: Prime Health Services Commercial |
$46.00
|
|
|
HC CANN INNER #8 EXT LENGTH
|
Facility
|
OP
|
$54.12
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
901604682
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$48.71 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$26.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.97
|
| Rate for Payer: Blue Distinction Transplant |
$32.47
|
| Rate for Payer: Blue Shield of California Commercial |
$34.04
|
| Rate for Payer: Blue Shield of California EPN |
$26.46
|
| Rate for Payer: Cash Price |
$24.35
|
| Rate for Payer: Cash Price |
$24.35
|
| Rate for Payer: Central Health Plan Commercial |
$43.30
|
| Rate for Payer: Cigna of CA HMO |
$34.64
|
| Rate for Payer: Cigna of CA PPO |
$40.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.00
|
| Rate for Payer: Dignity Health Media |
$46.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$46.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.65
|
| Rate for Payer: EPIC Health Plan Transplant |
$21.65
|
| Rate for Payer: Galaxy Health WC |
$46.00
|
| Rate for Payer: Global Benefits Group Commercial |
$32.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.71
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$40.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.82
|
| Rate for Payer: Multiplan Commercial |
$40.59
|
| Rate for Payer: Networks By Design Commercial |
$35.18
|
| Rate for Payer: Prime Health Services Commercial |
$46.00
|
| Rate for Payer: Riverside University Health System MISP |
$21.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.06
|
| Rate for Payer: United Healthcare All Other HMO |
$27.06
|
| Rate for Payer: United Healthcare HMO Rider |
$27.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$46.00
|
| Rate for Payer: Vantage Medical Group Senior |
$46.00
|
|
|
HC CANN INNER #8 EXT LENGTH
|
Facility
|
IP
|
$54.12
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
901604682
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$48.71 |
| Rate for Payer: Cash Price |
$24.35
|
| Rate for Payer: Central Health Plan Commercial |
$43.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.65
|
| Rate for Payer: Galaxy Health WC |
$46.00
|
| Rate for Payer: Global Benefits Group Commercial |
$32.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.82
|
| Rate for Payer: Multiplan Commercial |
$40.59
|
| Rate for Payer: Networks By Design Commercial |
$35.18
|
| Rate for Payer: Prime Health Services Commercial |
$46.00
|
|
|
HC CANN TRACH SHILEY SIZE 4
|
Facility
|
OP
|
$24.93
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
901600953
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.99 |
| Max. Negotiated Rate |
$22.44 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.73
|
| Rate for Payer: Blue Distinction Transplant |
$14.96
|
| Rate for Payer: Blue Shield of California Commercial |
$15.68
|
| Rate for Payer: Blue Shield of California EPN |
$12.19
|
| Rate for Payer: Cash Price |
$11.22
|
| Rate for Payer: Cash Price |
$11.22
|
| Rate for Payer: Central Health Plan Commercial |
$19.94
|
| Rate for Payer: Cigna of CA HMO |
$15.96
|
| Rate for Payer: Cigna of CA PPO |
$18.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.19
|
| Rate for Payer: Dignity Health Media |
$21.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.97
|
| Rate for Payer: Galaxy Health WC |
$21.19
|
| Rate for Payer: Global Benefits Group Commercial |
$14.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.44
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$18.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.99
|
| Rate for Payer: Multiplan Commercial |
$18.70
|
| Rate for Payer: Networks By Design Commercial |
$16.20
|
| Rate for Payer: Prime Health Services Commercial |
$21.19
|
| Rate for Payer: Riverside University Health System MISP |
$9.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.46
|
| Rate for Payer: United Healthcare All Other HMO |
$12.46
|
| Rate for Payer: United Healthcare HMO Rider |
$12.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.19
|
| Rate for Payer: Vantage Medical Group Senior |
$21.19
|
|
|
HC CANN TRACH SHILEY SIZE 4
|
Facility
|
IP
|
$24.93
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
901600953
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.99 |
| Max. Negotiated Rate |
$22.44 |
| Rate for Payer: Cash Price |
$11.22
|
| Rate for Payer: Central Health Plan Commercial |
$19.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.97
|
| Rate for Payer: Galaxy Health WC |
$21.19
|
| Rate for Payer: Global Benefits Group Commercial |
$14.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.99
|
| Rate for Payer: Multiplan Commercial |
$18.70
|
| Rate for Payer: Networks By Design Commercial |
$16.20
|
| Rate for Payer: Prime Health Services Commercial |
$21.19
|
|
|
HC CANN TRACH SHILEY SIZE 6
|
Facility
|
OP
|
$24.93
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
901600966
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.99 |
| Max. Negotiated Rate |
$22.44 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.73
|
| Rate for Payer: Blue Distinction Transplant |
$14.96
|
| Rate for Payer: Blue Shield of California Commercial |
$15.68
|
| Rate for Payer: Blue Shield of California EPN |
$12.19
|
| Rate for Payer: Cash Price |
$11.22
|
| Rate for Payer: Cash Price |
$11.22
|
| Rate for Payer: Central Health Plan Commercial |
$19.94
|
| Rate for Payer: Cigna of CA HMO |
$15.96
|
| Rate for Payer: Cigna of CA PPO |
$18.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.19
|
| Rate for Payer: Dignity Health Media |
$21.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.97
|
| Rate for Payer: Galaxy Health WC |
$21.19
|
| Rate for Payer: Global Benefits Group Commercial |
$14.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.44
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$18.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.99
|
| Rate for Payer: Multiplan Commercial |
$18.70
|
| Rate for Payer: Networks By Design Commercial |
$16.20
|
| Rate for Payer: Prime Health Services Commercial |
$21.19
|
| Rate for Payer: Riverside University Health System MISP |
$9.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.46
|
| Rate for Payer: United Healthcare All Other HMO |
$12.46
|
| Rate for Payer: United Healthcare HMO Rider |
$12.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.19
|
| Rate for Payer: Vantage Medical Group Senior |
$21.19
|
|
|
HC CANN TRACH SHILEY SIZE 6
|
Facility
|
IP
|
$24.93
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
901600966
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.99 |
| Max. Negotiated Rate |
$22.44 |
| Rate for Payer: Cash Price |
$11.22
|
| Rate for Payer: Central Health Plan Commercial |
$19.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.97
|
| Rate for Payer: Galaxy Health WC |
$21.19
|
| Rate for Payer: Global Benefits Group Commercial |
$14.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.99
|
| Rate for Payer: Multiplan Commercial |
$18.70
|
| Rate for Payer: Networks By Design Commercial |
$16.20
|
| Rate for Payer: Prime Health Services Commercial |
$21.19
|
|
|
HC CANN TRACH SHILEY SIZE 8
|
Facility
|
OP
|
$32.96
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
901600967
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$29.66 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.47
|
| Rate for Payer: Blue Distinction Transplant |
$19.78
|
| Rate for Payer: Blue Shield of California Commercial |
$20.73
|
| Rate for Payer: Blue Shield of California EPN |
$16.12
|
| Rate for Payer: Cash Price |
$14.83
|
| Rate for Payer: Cash Price |
$14.83
|
| Rate for Payer: Central Health Plan Commercial |
$26.37
|
| Rate for Payer: Cigna of CA HMO |
$21.09
|
| Rate for Payer: Cigna of CA PPO |
$24.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.02
|
| Rate for Payer: Dignity Health Media |
$28.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.18
|
| Rate for Payer: Galaxy Health WC |
$28.02
|
| Rate for Payer: Global Benefits Group Commercial |
$19.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$29.66
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$24.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.59
|
| Rate for Payer: Multiplan Commercial |
$24.72
|
| Rate for Payer: Networks By Design Commercial |
$21.42
|
| Rate for Payer: Prime Health Services Commercial |
$28.02
|
| Rate for Payer: Riverside University Health System MISP |
$13.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.48
|
| Rate for Payer: United Healthcare All Other HMO |
$16.48
|
| Rate for Payer: United Healthcare HMO Rider |
$16.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.02
|
| Rate for Payer: Vantage Medical Group Senior |
$28.02
|
|
|
HC CANN TRACH SHILEY SIZE 8
|
Facility
|
IP
|
$32.96
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
901600967
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$29.66 |
| Rate for Payer: Cash Price |
$14.83
|
| Rate for Payer: Central Health Plan Commercial |
$26.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.18
|
| Rate for Payer: Galaxy Health WC |
$28.02
|
| Rate for Payer: Global Benefits Group Commercial |
$19.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$29.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.59
|
| Rate for Payer: Multiplan Commercial |
$24.72
|
| Rate for Payer: Networks By Design Commercial |
$21.42
|
| Rate for Payer: Prime Health Services Commercial |
$28.02
|
|
|
HC CANNULATION, THORACIC DUCT
|
Facility
|
IP
|
$659.00
|
|
|
Service Code
|
CPT 38794
|
| Hospital Charge Code |
909008794
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$131.80 |
| Max. Negotiated Rate |
$593.10 |
| Rate for Payer: Cash Price |
$296.55
|
| Rate for Payer: Central Health Plan Commercial |
$527.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$263.60
|
| Rate for Payer: Galaxy Health WC |
$560.15
|
| Rate for Payer: Global Benefits Group Commercial |
$395.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$593.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$439.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$251.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.80
|
| Rate for Payer: Multiplan Commercial |
$494.25
|
| Rate for Payer: Networks By Design Commercial |
$428.35
|
| Rate for Payer: Prime Health Services Commercial |
$560.15
|
|
|
HC CANNULATION, THORACIC DUCT
|
Facility
|
OP
|
$659.00
|
|
|
Service Code
|
CPT 38794
|
| Hospital Charge Code |
909008794
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$131.80 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,631.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$560.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$362.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$362.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$395.40
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$296.55
|
| Rate for Payer: Cash Price |
$296.55
|
| Rate for Payer: Cash Price |
$296.55
|
| Rate for Payer: Central Health Plan Commercial |
$527.20
|
| Rate for Payer: Cigna of CA PPO |
$487.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$560.15
|
| Rate for Payer: Dignity Health Media |
$560.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$560.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$263.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$263.60
|
| Rate for Payer: Galaxy Health WC |
$560.15
|
| Rate for Payer: Global Benefits Group Commercial |
$395.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$593.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$494.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$230.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$439.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$320.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.80
|
| Rate for Payer: Multiplan Commercial |
$494.25
|
| Rate for Payer: Networks By Design Commercial |
$428.35
|
| Rate for Payer: Prime Health Services Commercial |
$560.15
|
| Rate for Payer: Riverside University Health System MISP |
$263.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$395.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$560.15
|
| Rate for Payer: Vantage Medical Group Senior |
$560.15
|
|
|
HC CANTHOTOMY
|
Facility
|
IP
|
$6,148.00
|
|
|
Service Code
|
CPT 67715
|
| Hospital Charge Code |
900501183
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,229.60 |
| Max. Negotiated Rate |
$5,533.20 |
| Rate for Payer: Cash Price |
$2,766.60
|
| Rate for Payer: Central Health Plan Commercial |
$4,918.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,459.20
|
| Rate for Payer: Galaxy Health WC |
$5,225.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,688.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,533.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,100.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,342.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,229.60
|
| Rate for Payer: Multiplan Commercial |
$4,611.00
|
| Rate for Payer: Networks By Design Commercial |
$3,996.20
|
| Rate for Payer: Prime Health Services Commercial |
$5,225.80
|
|
|
HC CANTHOTOMY
|
Facility
|
OP
|
$6,148.00
|
|
|
Service Code
|
CPT 67715
|
| Hospital Charge Code |
900501183
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$60.14 |
| Max. Negotiated Rate |
$5,533.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,919.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,688.80
|
| Rate for Payer: Caremore Medicare Advantage |
$2,919.67
|
| Rate for Payer: Cash Price |
$2,766.60
|
| Rate for Payer: Cash Price |
$2,766.60
|
| Rate for Payer: Cash Price |
$2,766.60
|
| Rate for Payer: Cash Price |
$2,766.60
|
| Rate for Payer: Central Health Plan Commercial |
$4,918.40
|
| Rate for Payer: Cigna of CA PPO |
$4,549.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Dignity Health Media |
$2,919.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,211.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,941.55
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,919.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,919.67
|
| Rate for Payer: Galaxy Health WC |
$5,225.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,688.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,533.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,611.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,788.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,919.67
|
| Rate for Payer: InnovAge PACE Commercial |
$4,379.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,100.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,919.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,229.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,912.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,912.36
|
| Rate for Payer: Multiplan Commercial |
$4,611.00
|
| Rate for Payer: Networks By Design Commercial |
$3,996.20
|
| Rate for Payer: Prime Health Services Commercial |
$5,225.80
|
| Rate for Payer: Prime Health Services Medicare |
$3,094.85
|
| Rate for Payer: Riverside University Health System MISP |
$3,211.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,688.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,074.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,074.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,074.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,074.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,919.67
|
|
|
HC CANVAS VEST SO
|
Facility
|
IP
|
$323.00
|
|
|
Service Code
|
CPT L3675
|
| Hospital Charge Code |
905353675
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$64.60 |
| Max. Negotiated Rate |
$290.70 |
| Rate for Payer: Blue Shield of California EPN |
$172.48
|
| Rate for Payer: Cash Price |
$145.35
|
| Rate for Payer: Central Health Plan Commercial |
$258.40
|
| Rate for Payer: Cigna of CA HMO |
$226.10
|
| Rate for Payer: Cigna of CA PPO |
$226.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$129.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$129.20
|
| Rate for Payer: Galaxy Health WC |
$274.55
|
| Rate for Payer: Global Benefits Group Commercial |
$193.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$290.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$215.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.60
|
| Rate for Payer: Multiplan Commercial |
$242.25
|
| Rate for Payer: Networks By Design Commercial |
$161.50
|
| Rate for Payer: Prime Health Services Commercial |
$274.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$121.96
|
| Rate for Payer: United Healthcare All Other HMO |
$119.12
|
| Rate for Payer: United Healthcare HMO Rider |
$116.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$106.59
|
|
|
HC CANVAS VEST SO
|
Facility
|
OP
|
$323.00
|
|
|
Service Code
|
CPT L3675
|
| Hospital Charge Code |
905353675
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$113.05 |
| Max. Negotiated Rate |
$290.70 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$274.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$177.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$177.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$156.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$190.83
|
| Rate for Payer: Blue Distinction Transplant |
$193.80
|
| Rate for Payer: Blue Shield of California Commercial |
$242.25
|
| Rate for Payer: Blue Shield of California EPN |
$175.71
|
| Rate for Payer: Cash Price |
$145.35
|
| Rate for Payer: Cash Price |
$145.35
|
| Rate for Payer: Central Health Plan Commercial |
$258.40
|
| Rate for Payer: Cigna of CA HMO |
$226.10
|
| Rate for Payer: Cigna of CA PPO |
$226.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$274.55
|
| Rate for Payer: Dignity Health Media |
$274.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$274.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$129.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$129.20
|
| Rate for Payer: Galaxy Health WC |
$274.55
|
| Rate for Payer: Global Benefits Group Commercial |
$193.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$290.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$242.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$113.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$215.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$166.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.43
|
| Rate for Payer: Multiplan Commercial |
$242.25
|
| Rate for Payer: Networks By Design Commercial |
$161.50
|
| Rate for Payer: Prime Health Services Commercial |
$274.55
|
| Rate for Payer: Riverside University Health System MISP |
$129.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$193.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$193.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$161.50
|
| Rate for Payer: United Healthcare All Other HMO |
$161.50
|
| Rate for Payer: United Healthcare HMO Rider |
$161.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$161.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$274.55
|
| Rate for Payer: Vantage Medical Group Senior |
$274.55
|
|
|
HC CAPD DAILY TREATMENT
|
Facility
|
IP
|
$1,288.00
|
|
|
Service Code
|
CPT 90945
|
| Hospital Charge Code |
944000101
|
|
Hospital Revenue Code
|
803
|
| Min. Negotiated Rate |
$257.60 |
| Max. Negotiated Rate |
$1,159.20 |
| Rate for Payer: Cash Price |
$579.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,030.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$515.20
|
| Rate for Payer: Galaxy Health WC |
$1,094.80
|
| Rate for Payer: Global Benefits Group Commercial |
$772.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,159.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$859.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$490.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$257.60
|
| Rate for Payer: Multiplan Commercial |
$966.00
|
| Rate for Payer: Networks By Design Commercial |
$837.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,094.80
|
|
