|
HC FETAL FLUID DRAIN INCLUD US GU
|
Facility
|
IP
|
$1,111.00
|
|
|
Service Code
|
CPT 59074
|
| Hospital Charge Code |
910400098
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$222.20 |
| Max. Negotiated Rate |
$999.90 |
| Rate for Payer: Adventist Health Commercial |
$222.20
|
| Rate for Payer: Cash Price |
$499.95
|
| Rate for Payer: Central Health Plan Commercial |
$888.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$777.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$444.40
|
| Rate for Payer: EPIC Health Plan Senior |
$444.40
|
| Rate for Payer: Galaxy Health WC |
$944.35
|
| Rate for Payer: Global Benefits Group Commercial |
$666.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$999.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$705.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$655.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$222.20
|
| Rate for Payer: Multiplan Commercial |
$833.25
|
| Rate for Payer: Networks By Design Commercial |
$722.15
|
| Rate for Payer: Prime Health Services Commercial |
$944.35
|
|
|
HC FETAL LUNG MATURITY (FLM)
|
Facility
|
IP
|
$538.00
|
|
|
Service Code
|
CPT 83663
|
| Hospital Charge Code |
900910962
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$107.60 |
| Max. Negotiated Rate |
$484.20 |
| Rate for Payer: Adventist Health Commercial |
$107.60
|
| Rate for Payer: Cash Price |
$242.10
|
| Rate for Payer: Central Health Plan Commercial |
$430.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$376.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.20
|
| Rate for Payer: EPIC Health Plan Senior |
$215.20
|
| Rate for Payer: Galaxy Health WC |
$457.30
|
| Rate for Payer: Global Benefits Group Commercial |
$322.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$484.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$341.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$317.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.60
|
| Rate for Payer: Multiplan Commercial |
$403.50
|
| Rate for Payer: Networks By Design Commercial |
$349.70
|
| Rate for Payer: Prime Health Services Commercial |
$457.30
|
|
|
HC FETAL LUNG MATURITY (FLM)
|
Facility
|
OP
|
$538.00
|
|
|
Service Code
|
CPT 83663
|
| Hospital Charge Code |
900910962
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.32 |
| Max. Negotiated Rate |
$484.20 |
| Rate for Payer: Adventist Health Commercial |
$107.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$18.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$138.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$68.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$95.60
|
| Rate for Payer: Blue Shield of California Commercial |
$338.94
|
| Rate for Payer: Blue Shield of California EPN |
$213.59
|
| Rate for Payer: Cash Price |
$242.10
|
| Rate for Payer: Cash Price |
$242.10
|
| Rate for Payer: Central Health Plan Commercial |
$430.40
|
| Rate for Payer: Cigna of CA HMO |
$344.32
|
| Rate for Payer: Cigna of CA PPO |
$398.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.91
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$376.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.20
|
| Rate for Payer: EPIC Health Plan Senior |
$20.80
|
| Rate for Payer: Galaxy Health WC |
$457.30
|
| Rate for Payer: Global Benefits Group Commercial |
$322.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$484.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$31.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$341.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25.34
|
| Rate for Payer: Multiplan Commercial |
$403.50
|
| Rate for Payer: Networks By Design Commercial |
$349.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18.91
|
| Rate for Payer: Prime Health Services Commercial |
$457.30
|
| Rate for Payer: Prime Health Services Medicare |
$20.04
|
| Rate for Payer: Riverside University Health System MISP |
$20.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$322.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$322.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.32
|
| Rate for Payer: United Healthcare All Other HMO |
$15.32
|
| Rate for Payer: United Healthcare HMO Rider |
$15.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.32
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.80
|
| Rate for Payer: Vantage Medical Group Senior |
$18.91
|
|
|
HC FETAL MONITOR CONT HRLY
|
Facility
|
IP
|
$43.00
|
|
| Hospital Charge Code |
902400355
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$8.60 |
| Max. Negotiated Rate |
$38.70 |
| Rate for Payer: Adventist Health Commercial |
$8.60
|
| Rate for Payer: Cash Price |
$19.35
|
| Rate for Payer: Central Health Plan Commercial |
$34.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.20
|
| Rate for Payer: EPIC Health Plan Senior |
$17.20
|
| Rate for Payer: Galaxy Health WC |
$36.55
|
| Rate for Payer: Global Benefits Group Commercial |
$25.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.60
|
| Rate for Payer: Multiplan Commercial |
$32.25
|
| Rate for Payer: Networks By Design Commercial |
$27.95
|
| Rate for Payer: Prime Health Services Commercial |
$36.55
|
|
|
HC FETAL MONITOR CONT HRLY
|
Facility
|
OP
|
$43.00
|
|
| Hospital Charge Code |
902400355
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$8.60 |
| Max. Negotiated Rate |
$1,091.00 |
| Rate for Payer: Adventist Health Commercial |
$8.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$32.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$20.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.01
|
| Rate for Payer: Blue Shield of California Commercial |
$27.26
|
| Rate for Payer: Blue Shield of California EPN |
$17.16
|
| Rate for Payer: Cash Price |
$19.35
|
| Rate for Payer: Cash Price |
$19.35
|
| Rate for Payer: Central Health Plan Commercial |
$34.40
|
| Rate for Payer: Cigna of CA HMO |
$27.52
|
| Rate for Payer: Cigna of CA PPO |
$31.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$36.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.20
|
| Rate for Payer: EPIC Health Plan Senior |
$17.20
|
| Rate for Payer: Galaxy Health WC |
$36.55
|
| Rate for Payer: Global Benefits Group Commercial |
$25.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$30.10
|
| Rate for Payer: Multiplan Commercial |
$32.25
|
| Rate for Payer: Networks By Design Commercial |
$27.95
|
| Rate for Payer: Prime Health Services Commercial |
$36.55
|
| Rate for Payer: Riverside University Health System MISP |
$17.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,091.00
|
| Rate for Payer: United Healthcare All Other HMO |
$839.00
|
| Rate for Payer: United Healthcare HMO Rider |
$635.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$581.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.55
|
| Rate for Payer: Vantage Medical Group Senior |
$36.55
|
|
|
HC FETAL MONITORING W/REPORT
|
Facility
|
OP
|
$1,170.00
|
|
|
Service Code
|
CPT 59050
|
| Hospital Charge Code |
902890264
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$154.03 |
| Max. Negotiated Rate |
$1,833.00 |
| Rate for Payer: Adventist Health Commercial |
$479.70
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$305.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$994.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$643.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$877.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$680.59
|
| Rate for Payer: Cash Price |
$526.50
|
| Rate for Payer: Cash Price |
$526.50
|
| Rate for Payer: Cash Price |
$526.50
|
| Rate for Payer: Cash Price |
$526.50
|
| Rate for Payer: Central Health Plan Commercial |
$936.00
|
| Rate for Payer: Cigna of CA HMO |
$748.80
|
| Rate for Payer: Cigna of CA PPO |
$865.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$994.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$994.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$994.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$819.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$468.00
|
| Rate for Payer: EPIC Health Plan Senior |
$468.00
|
| Rate for Payer: Galaxy Health WC |
$994.50
|
| Rate for Payer: Global Benefits Group Commercial |
$702.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,053.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$742.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$154.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$690.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$819.00
|
| Rate for Payer: Multiplan Commercial |
$877.50
|
| Rate for Payer: Networks By Design Commercial |
$760.50
|
| Rate for Payer: Prime Health Services Commercial |
$994.50
|
| Rate for Payer: Riverside University Health System MISP |
$468.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$702.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$702.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$994.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$994.50
|
| Rate for Payer: Vantage Medical Group Senior |
$994.50
|
|
|
HC FETAL MONITORING W/REPORT
|
Facility
|
IP
|
$1,170.00
|
|
|
Service Code
|
CPT 59050
|
| Hospital Charge Code |
902890264
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$234.00 |
| Max. Negotiated Rate |
$1,053.00 |
| Rate for Payer: Adventist Health Commercial |
$234.00
|
| Rate for Payer: Cash Price |
$526.50
|
| Rate for Payer: Central Health Plan Commercial |
$936.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$819.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$468.00
|
| Rate for Payer: EPIC Health Plan Senior |
$468.00
|
| Rate for Payer: Galaxy Health WC |
$994.50
|
| Rate for Payer: Global Benefits Group Commercial |
$702.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,053.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$742.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$690.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.00
|
| Rate for Payer: Multiplan Commercial |
$877.50
|
| Rate for Payer: Networks By Design Commercial |
$760.50
|
| Rate for Payer: Prime Health Services Commercial |
$994.50
|
|
|
HC FETAL NON-STRESS TEST
|
Facility
|
IP
|
$1,322.00
|
|
|
Service Code
|
CPT 59025
|
| Hospital Charge Code |
902400362
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$264.40 |
| Max. Negotiated Rate |
$1,189.80 |
| Rate for Payer: Adventist Health Commercial |
$264.40
|
| Rate for Payer: Cash Price |
$594.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,057.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$925.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$528.80
|
| Rate for Payer: EPIC Health Plan Senior |
$528.80
|
| Rate for Payer: Galaxy Health WC |
$1,123.70
|
| Rate for Payer: Global Benefits Group Commercial |
$793.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,189.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$839.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$779.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.40
|
| Rate for Payer: Multiplan Commercial |
$991.50
|
| Rate for Payer: Networks By Design Commercial |
$859.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,123.70
|
|
|
HC FETAL NON-STRESS TEST
|
Facility
|
OP
|
$1,322.00
|
|
|
Service Code
|
CPT 59025
|
| Hospital Charge Code |
902400362
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$39.22 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$264.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$260.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$119.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$390.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$286.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$260.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$838.15
|
| Rate for Payer: Blue Shield of California EPN |
$527.48
|
| Rate for Payer: Cash Price |
$594.90
|
| Rate for Payer: Cash Price |
$594.90
|
| Rate for Payer: Cash Price |
$594.90
|
| Rate for Payer: Cash Price |
$594.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,057.60
|
| Rate for Payer: Cigna of CA HMO |
$846.08
|
| Rate for Payer: Cigna of CA PPO |
$978.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$390.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$286.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$260.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$925.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$429.05
|
| Rate for Payer: EPIC Health Plan Senior |
$286.03
|
| Rate for Payer: Galaxy Health WC |
$1,123.70
|
| Rate for Payer: Global Benefits Group Commercial |
$793.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,189.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$426.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$39.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$260.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$839.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$43.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$364.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$348.44
|
| Rate for Payer: Multiplan Commercial |
$991.50
|
| Rate for Payer: Networks By Design Commercial |
$859.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$260.03
|
| Rate for Payer: Prime Health Services Commercial |
$1,123.70
|
| Rate for Payer: Prime Health Services Medicare |
$275.63
|
| Rate for Payer: Riverside University Health System MISP |
$286.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$793.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$793.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,091.00
|
| Rate for Payer: United Healthcare All Other HMO |
$839.00
|
| Rate for Payer: United Healthcare HMO Rider |
$635.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$581.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$260.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$390.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$286.03
|
| Rate for Payer: Vantage Medical Group Senior |
$260.03
|
|
|
HC FETAL SHUNT PLACEMENT
|
Facility
|
OP
|
$1,011.00
|
|
|
Service Code
|
CPT 59076
|
| Hospital Charge Code |
910400092
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$202.20 |
| Max. Negotiated Rate |
$6,587.00 |
| Rate for Payer: Adventist Health Commercial |
$202.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$391.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,126.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$587.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$391.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Blue Shield of California Commercial |
$640.97
|
| Rate for Payer: Blue Shield of California EPN |
$403.39
|
| Rate for Payer: Cash Price |
$454.95
|
| Rate for Payer: Cash Price |
$454.95
|
| Rate for Payer: Cash Price |
$454.95
|
| Rate for Payer: Cash Price |
$454.95
|
| Rate for Payer: Central Health Plan Commercial |
$808.80
|
| Rate for Payer: Cigna of CA HMO |
$647.04
|
| Rate for Payer: Cigna of CA PPO |
$748.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$587.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$391.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$707.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$646.68
|
| Rate for Payer: EPIC Health Plan Senior |
$431.12
|
| Rate for Payer: Galaxy Health WC |
$859.35
|
| Rate for Payer: Global Benefits Group Commercial |
$606.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$909.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$642.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$759.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$391.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$641.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$839.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$548.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$525.19
|
| Rate for Payer: Multiplan Commercial |
$758.25
|
| Rate for Payer: Networks By Design Commercial |
$657.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$391.93
|
| Rate for Payer: Prime Health Services Commercial |
$859.35
|
| Rate for Payer: Prime Health Services Medicare |
$415.45
|
| Rate for Payer: Riverside University Health System MISP |
$431.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$606.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$606.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,091.00
|
| Rate for Payer: United Healthcare All Other HMO |
$839.00
|
| Rate for Payer: United Healthcare HMO Rider |
$635.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$581.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$391.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$587.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.12
|
| Rate for Payer: Vantage Medical Group Senior |
$391.93
|
|
|
HC FETAL SHUNT PLACEMENT
|
Facility
|
IP
|
$1,011.00
|
|
|
Service Code
|
CPT 59076
|
| Hospital Charge Code |
910400092
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$202.20 |
| Max. Negotiated Rate |
$909.90 |
| Rate for Payer: Adventist Health Commercial |
$202.20
|
| Rate for Payer: Cash Price |
$454.95
|
| Rate for Payer: Central Health Plan Commercial |
$808.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$707.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$404.40
|
| Rate for Payer: EPIC Health Plan Senior |
$404.40
|
| Rate for Payer: Galaxy Health WC |
$859.35
|
| Rate for Payer: Global Benefits Group Commercial |
$606.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$909.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$641.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$596.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.20
|
| Rate for Payer: Multiplan Commercial |
$758.25
|
| Rate for Payer: Networks By Design Commercial |
$657.15
|
| Rate for Payer: Prime Health Services Commercial |
$859.35
|
|
|
HC FIBRIN DEGRAD SPLIT PRODUCTS
|
Facility
|
OP
|
$262.00
|
|
|
Service Code
|
CPT 85362
|
| Hospital Charge Code |
900910069
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.58 |
| Max. Negotiated Rate |
$235.80 |
| Rate for Payer: Adventist Health Commercial |
$52.40
|
| Rate for Payer: Adventist Health Commercial |
$7.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$6.89
|
| Rate for Payer: Adventist Health Medi-Cal |
$6.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$48.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$48.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.89
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$50.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$50.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69.59
|
| Rate for Payer: Blue Shield of California Commercial |
$23.31
|
| Rate for Payer: Blue Shield of California Commercial |
$165.06
|
| Rate for Payer: Blue Shield of California EPN |
$14.69
|
| Rate for Payer: Blue Shield of California EPN |
$104.01
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cash Price |
$117.90
|
| Rate for Payer: Cash Price |
$117.90
|
| Rate for Payer: Central Health Plan Commercial |
$209.60
|
| Rate for Payer: Central Health Plan Commercial |
$29.60
|
| Rate for Payer: Cigna of CA HMO |
$23.68
|
| Rate for Payer: Cigna of CA HMO |
$167.68
|
| Rate for Payer: Cigna of CA PPO |
$27.38
|
| Rate for Payer: Cigna of CA PPO |
$193.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.89
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$183.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.37
|
| Rate for Payer: EPIC Health Plan Senior |
$7.58
|
| Rate for Payer: EPIC Health Plan Senior |
$7.58
|
| Rate for Payer: Galaxy Health WC |
$31.45
|
| Rate for Payer: Galaxy Health WC |
$222.70
|
| Rate for Payer: Global Benefits Group Commercial |
$22.20
|
| Rate for Payer: Global Benefits Group Commercial |
$157.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$235.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$166.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.23
|
| Rate for Payer: Multiplan Commercial |
$27.75
|
| Rate for Payer: Multiplan Commercial |
$196.50
|
| Rate for Payer: Networks By Design Commercial |
$170.30
|
| Rate for Payer: Networks By Design Commercial |
$24.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6.89
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6.89
|
| Rate for Payer: Prime Health Services Commercial |
$31.45
|
| Rate for Payer: Prime Health Services Commercial |
$222.70
|
| Rate for Payer: Prime Health Services Medicare |
$7.30
|
| Rate for Payer: Prime Health Services Medicare |
$7.30
|
| Rate for Payer: Riverside University Health System MISP |
$7.58
|
| Rate for Payer: Riverside University Health System MISP |
$7.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$157.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$157.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.58
|
| Rate for Payer: United Healthcare All Other HMO |
$5.58
|
| Rate for Payer: United Healthcare All Other HMO |
$5.58
|
| Rate for Payer: United Healthcare HMO Rider |
$5.58
|
| Rate for Payer: United Healthcare HMO Rider |
$5.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.58
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.89
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.58
|
| Rate for Payer: Vantage Medical Group Senior |
$6.89
|
| Rate for Payer: Vantage Medical Group Senior |
$6.89
|
|
|
HC FIBRIN DEGRAD SPLIT PRODUCTS
|
Facility
|
IP
|
$262.00
|
|
|
Service Code
|
CPT 85362
|
| Hospital Charge Code |
900910069
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$52.40 |
| Max. Negotiated Rate |
$235.80 |
| Rate for Payer: Adventist Health Commercial |
$52.40
|
| Rate for Payer: Cash Price |
$117.90
|
| Rate for Payer: Central Health Plan Commercial |
$209.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$183.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$104.80
|
| Rate for Payer: EPIC Health Plan Senior |
$104.80
|
| Rate for Payer: Galaxy Health WC |
$222.70
|
| Rate for Payer: Global Benefits Group Commercial |
$157.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$235.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$166.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.40
|
| Rate for Payer: Multiplan Commercial |
$196.50
|
| Rate for Payer: Networks By Design Commercial |
$170.30
|
| Rate for Payer: Prime Health Services Commercial |
$222.70
|
|
|
HC FIBRINOGEN ASSAY
|
Facility
|
IP
|
$299.00
|
|
|
Service Code
|
CPT 85384
|
| Hospital Charge Code |
900910013
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$59.80 |
| Max. Negotiated Rate |
$269.10 |
| Rate for Payer: Adventist Health Commercial |
$59.80
|
| Rate for Payer: Cash Price |
$134.55
|
| Rate for Payer: Central Health Plan Commercial |
$239.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$209.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$119.60
|
| Rate for Payer: EPIC Health Plan Senior |
$119.60
|
| Rate for Payer: Galaxy Health WC |
$254.15
|
| Rate for Payer: Global Benefits Group Commercial |
$179.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$269.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$189.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$176.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.80
|
| Rate for Payer: Multiplan Commercial |
$224.25
|
| Rate for Payer: Networks By Design Commercial |
$194.35
|
| Rate for Payer: Prime Health Services Commercial |
$254.15
|
|
|
HC FIBRINOGEN ASSAY
|
Facility
|
OP
|
$299.00
|
|
|
Service Code
|
CPT 85384
|
| Hospital Charge Code |
900910013
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.88 |
| Max. Negotiated Rate |
$269.10 |
| Rate for Payer: Adventist Health Commercial |
$59.80
|
| Rate for Payer: Adventist Health Commercial |
$16.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$9.72
|
| Rate for Payer: Adventist Health Medi-Cal |
$9.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$62.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$62.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$61.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$61.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.38
|
| Rate for Payer: Blue Shield of California Commercial |
$52.92
|
| Rate for Payer: Blue Shield of California Commercial |
$188.37
|
| Rate for Payer: Blue Shield of California EPN |
$33.35
|
| Rate for Payer: Blue Shield of California EPN |
$118.70
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cash Price |
$134.55
|
| Rate for Payer: Cash Price |
$134.55
|
| Rate for Payer: Central Health Plan Commercial |
$239.20
|
| Rate for Payer: Central Health Plan Commercial |
$67.20
|
| Rate for Payer: Cigna of CA HMO |
$53.76
|
| Rate for Payer: Cigna of CA HMO |
$191.36
|
| Rate for Payer: Cigna of CA PPO |
$62.16
|
| Rate for Payer: Cigna of CA PPO |
$221.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$209.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$58.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.04
|
| Rate for Payer: EPIC Health Plan Senior |
$10.69
|
| Rate for Payer: EPIC Health Plan Senior |
$10.69
|
| Rate for Payer: Galaxy Health WC |
$71.40
|
| Rate for Payer: Galaxy Health WC |
$254.15
|
| Rate for Payer: Global Benefits Group Commercial |
$50.40
|
| Rate for Payer: Global Benefits Group Commercial |
$179.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$75.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$269.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15.94
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$189.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$53.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13.02
|
| Rate for Payer: Multiplan Commercial |
$63.00
|
| Rate for Payer: Multiplan Commercial |
$224.25
|
| Rate for Payer: Networks By Design Commercial |
$194.35
|
| Rate for Payer: Networks By Design Commercial |
$54.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9.72
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9.72
|
| Rate for Payer: Prime Health Services Commercial |
$71.40
|
| Rate for Payer: Prime Health Services Commercial |
$254.15
|
| Rate for Payer: Prime Health Services Medicare |
$10.30
|
| Rate for Payer: Prime Health Services Medicare |
$10.30
|
| Rate for Payer: Riverside University Health System MISP |
$10.69
|
| Rate for Payer: Riverside University Health System MISP |
$10.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$179.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$50.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$50.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$179.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.88
|
| Rate for Payer: United Healthcare All Other HMO |
$7.88
|
| Rate for Payer: United Healthcare All Other HMO |
$7.88
|
| Rate for Payer: United Healthcare HMO Rider |
$7.88
|
| Rate for Payer: United Healthcare HMO Rider |
$7.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.88
|
| Rate for Payer: Upland Medical Group Pediatric |
$9.72
|
| Rate for Payer: Upland Medical Group Pediatric |
$9.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.69
|
| Rate for Payer: Vantage Medical Group Senior |
$9.72
|
| Rate for Payer: Vantage Medical Group Senior |
$9.72
|
|
|
HC FINE NDL ASP WO IMG EA ADD LSN
|
Facility
|
IP
|
$770.00
|
|
|
Service Code
|
CPT 10004
|
| Hospital Charge Code |
903810004
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$154.00 |
| Max. Negotiated Rate |
$693.00 |
| Rate for Payer: Adventist Health Commercial |
$154.00
|
| Rate for Payer: Cash Price |
$346.50
|
| Rate for Payer: Central Health Plan Commercial |
$616.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$539.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$308.00
|
| Rate for Payer: EPIC Health Plan Senior |
$308.00
|
| Rate for Payer: Galaxy Health WC |
$654.50
|
| Rate for Payer: Global Benefits Group Commercial |
$462.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$693.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$488.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$454.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.00
|
| Rate for Payer: Multiplan Commercial |
$577.50
|
| Rate for Payer: Networks By Design Commercial |
$500.50
|
| Rate for Payer: Prime Health Services Commercial |
$654.50
|
|
|
HC FINE NDL ASP WO IMG EA ADD LSN
|
Facility
|
OP
|
$770.00
|
|
|
Service Code
|
CPT 10004
|
| Hospital Charge Code |
903810004
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$77.49 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$154.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$654.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$423.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$577.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$346.50
|
| Rate for Payer: Cash Price |
$346.50
|
| Rate for Payer: Cash Price |
$346.50
|
| Rate for Payer: Central Health Plan Commercial |
$616.00
|
| Rate for Payer: Cigna of CA HMO |
$492.80
|
| Rate for Payer: Cigna of CA PPO |
$569.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$654.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$654.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$654.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$539.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$308.00
|
| Rate for Payer: EPIC Health Plan Senior |
$308.00
|
| Rate for Payer: Galaxy Health WC |
$654.50
|
| Rate for Payer: Global Benefits Group Commercial |
$462.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$693.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$77.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$488.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$85.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$454.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$539.00
|
| Rate for Payer: Multiplan Commercial |
$577.50
|
| Rate for Payer: Networks By Design Commercial |
$500.50
|
| Rate for Payer: Prime Health Services Commercial |
$654.50
|
| Rate for Payer: Riverside University Health System MISP |
$308.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$462.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$385.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$654.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$654.50
|
| Rate for Payer: Vantage Medical Group Senior |
$654.50
|
|
|
HC FINE NDLE ASPIR W/GUIDANCE
|
Facility
|
OP
|
$3,437.00
|
|
|
Service Code
|
CPT 62267
|
| Hospital Charge Code |
909000240
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$200.43 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$687.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$910.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$910.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,424.40
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,546.65
|
| Rate for Payer: Cash Price |
$1,546.65
|
| Rate for Payer: Cash Price |
$1,546.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,749.60
|
| Rate for Payer: Cigna of CA HMO |
$2,199.68
|
| Rate for Payer: Cigna of CA PPO |
$2,543.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,001.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$910.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,405.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,502.79
|
| Rate for Payer: EPIC Health Plan Senior |
$1,001.86
|
| Rate for Payer: Galaxy Health WC |
$2,921.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,062.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,093.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,493.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$200.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$910.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,182.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$221.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,275.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$687.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,220.45
|
| Rate for Payer: Multiplan Commercial |
$2,577.75
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$2,234.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$910.78
|
| Rate for Payer: Preferred Health Network WC |
$1,453.47
|
| Rate for Payer: Prime Health Services Commercial |
$2,921.45
|
| Rate for Payer: Prime Health Services Medicare |
$965.43
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Riverside University Health System MISP |
$1,001.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,062.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,718.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$910.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Vantage Medical Group Senior |
$910.78
|
|
|
HC FINE NDLE ASPIR W/GUIDANCE
|
Facility
|
IP
|
$3,437.00
|
|
|
Service Code
|
CPT 62267
|
| Hospital Charge Code |
909000240
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$687.40 |
| Max. Negotiated Rate |
$3,093.30 |
| Rate for Payer: Adventist Health Commercial |
$687.40
|
| Rate for Payer: Cash Price |
$1,546.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,749.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,405.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,374.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,374.80
|
| Rate for Payer: Galaxy Health WC |
$2,921.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,062.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,093.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,182.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,027.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$687.40
|
| Rate for Payer: Multiplan Commercial |
$2,577.75
|
| Rate for Payer: Networks By Design Commercial |
$2,234.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,921.45
|
|
|
HC FINE NEEDLE ASPIRATION
|
Facility
|
OP
|
$328.00
|
|
|
Service Code
|
CPT 88173
|
| Hospital Charge Code |
903800007
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$41.11 |
| Max. Negotiated Rate |
$440.11 |
| Rate for Payer: Adventist Health Commercial |
$65.60
|
| Rate for Payer: Adventist Health Commercial |
$151.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$67.02
|
| Rate for Payer: Adventist Health Medi-Cal |
$67.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$440.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$440.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$100.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$100.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$73.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$73.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$79.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$79.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.58
|
| Rate for Payer: Blue Shield of California Commercial |
$475.65
|
| Rate for Payer: Blue Shield of California Commercial |
$206.64
|
| Rate for Payer: Blue Shield of California EPN |
$299.74
|
| Rate for Payer: Blue Shield of California EPN |
$130.22
|
| Rate for Payer: Cash Price |
$339.75
|
| Rate for Payer: Cash Price |
$339.75
|
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Central Health Plan Commercial |
$262.40
|
| Rate for Payer: Central Health Plan Commercial |
$604.00
|
| Rate for Payer: Cigna of CA HMO |
$483.20
|
| Rate for Payer: Cigna of CA HMO |
$209.92
|
| Rate for Payer: Cigna of CA PPO |
$558.70
|
| Rate for Payer: Cigna of CA PPO |
$242.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$100.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$100.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$73.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$73.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$229.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$528.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$110.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$110.58
|
| Rate for Payer: EPIC Health Plan Senior |
$73.72
|
| Rate for Payer: EPIC Health Plan Senior |
$73.72
|
| Rate for Payer: Galaxy Health WC |
$641.75
|
| Rate for Payer: Galaxy Health WC |
$278.80
|
| Rate for Payer: Global Benefits Group Commercial |
$453.00
|
| Rate for Payer: Global Benefits Group Commercial |
$196.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$679.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$295.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$109.91
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$109.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$89.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$89.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$208.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$479.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$98.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$98.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$93.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$93.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$89.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$89.81
|
| Rate for Payer: Multiplan Commercial |
$566.25
|
| Rate for Payer: Multiplan Commercial |
$246.00
|
| Rate for Payer: Networks By Design Commercial |
$213.20
|
| Rate for Payer: Networks By Design Commercial |
$490.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$67.02
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$67.02
|
| Rate for Payer: Prime Health Services Commercial |
$641.75
|
| Rate for Payer: Prime Health Services Commercial |
$278.80
|
| Rate for Payer: Prime Health Services Medicare |
$71.04
|
| Rate for Payer: Prime Health Services Medicare |
$71.04
|
| Rate for Payer: Riverside University Health System MISP |
$73.72
|
| Rate for Payer: Riverside University Health System MISP |
$73.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$196.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$453.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$453.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$196.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.11
|
| Rate for Payer: United Healthcare All Other HMO |
$41.11
|
| Rate for Payer: United Healthcare All Other HMO |
$41.11
|
| Rate for Payer: United Healthcare HMO Rider |
$41.11
|
| Rate for Payer: United Healthcare HMO Rider |
$41.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.11
|
| Rate for Payer: Upland Medical Group Pediatric |
$67.02
|
| Rate for Payer: Upland Medical Group Pediatric |
$67.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$100.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$100.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.72
|
| Rate for Payer: Vantage Medical Group Senior |
$67.02
|
| Rate for Payer: Vantage Medical Group Senior |
$67.02
|
|
|
HC FINE NEEDLE ASPIRATION
|
Facility
|
IP
|
$755.00
|
|
|
Service Code
|
CPT 88173
|
| Hospital Charge Code |
903800007
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$151.00 |
| Max. Negotiated Rate |
$679.50 |
| Rate for Payer: Adventist Health Commercial |
$151.00
|
| Rate for Payer: Cash Price |
$339.75
|
| Rate for Payer: Central Health Plan Commercial |
$604.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$528.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$302.00
|
| Rate for Payer: EPIC Health Plan Senior |
$302.00
|
| Rate for Payer: Galaxy Health WC |
$641.75
|
| Rate for Payer: Global Benefits Group Commercial |
$453.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$679.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$479.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$445.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.00
|
| Rate for Payer: Multiplan Commercial |
$566.25
|
| Rate for Payer: Networks By Design Commercial |
$490.75
|
| Rate for Payer: Prime Health Services Commercial |
$641.75
|
|
|
HC FINE NEEDLE ASPIRATION PG
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
CPT 88173
|
| Hospital Charge Code |
903800290
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$440.11 |
| Rate for Payer: Adventist Health Commercial |
$24.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$67.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$440.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$100.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$73.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$79.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.58
|
| Rate for Payer: Blue Shield of California Commercial |
$76.86
|
| Rate for Payer: Blue Shield of California EPN |
$48.43
|
| Rate for Payer: Cash Price |
$54.90
|
| Rate for Payer: Cash Price |
$54.90
|
| Rate for Payer: Central Health Plan Commercial |
$97.60
|
| Rate for Payer: Cigna of CA HMO |
$78.08
|
| Rate for Payer: Cigna of CA PPO |
$90.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$100.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$73.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$85.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$110.58
|
| Rate for Payer: EPIC Health Plan Senior |
$73.72
|
| 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: Heritage Provider Network Commercial/Senior |
$109.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$89.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$77.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$98.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$93.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$89.81
|
| Rate for Payer: Multiplan Commercial |
$91.50
|
| Rate for Payer: Networks By Design Commercial |
$79.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$67.02
|
| Rate for Payer: Prime Health Services Commercial |
$103.70
|
| Rate for Payer: Prime Health Services Medicare |
$71.04
|
| Rate for Payer: Riverside University Health System MISP |
$73.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$73.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$73.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.11
|
| Rate for Payer: United Healthcare All Other HMO |
$41.11
|
| Rate for Payer: United Healthcare HMO Rider |
$41.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.11
|
| Rate for Payer: Upland Medical Group Pediatric |
$67.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$100.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.72
|
| Rate for Payer: Vantage Medical Group Senior |
$67.02
|
|
|
HC FINE NEEDLE ASPIRATION PG
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
CPT 88173
|
| Hospital Charge Code |
903800290
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$109.80 |
| Rate for Payer: Adventist Health Commercial |
$24.40
|
| Rate for Payer: Cash Price |
$54.90
|
| Rate for Payer: Central Health Plan Commercial |
$97.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$85.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.80
|
| Rate for Payer: EPIC Health Plan Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$77.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.98
|
| 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 FINE NEEDLE ASP W IMAGE
|
Facility
|
IP
|
$2,366.00
|
|
|
Service Code
|
CPT 10022
|
| Hospital Charge Code |
903800168
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$473.20 |
| Max. Negotiated Rate |
$2,129.40 |
| Rate for Payer: Adventist Health Commercial |
$473.20
|
| Rate for Payer: Cash Price |
$1,064.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,892.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,656.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$946.40
|
| Rate for Payer: EPIC Health Plan Senior |
$946.40
|
| Rate for Payer: Galaxy Health WC |
$2,011.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,419.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,129.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,502.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,395.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$473.20
|
| Rate for Payer: Multiplan Commercial |
$1,774.50
|
| Rate for Payer: Networks By Design Commercial |
$1,537.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,011.10
|
|
|
HC FINE NEEDLE ASP W IMAGE
|
Facility
|
IP
|
$2,366.00
|
|
|
Service Code
|
CPT 10022
|
| Hospital Charge Code |
903800168
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$473.20 |
| Max. Negotiated Rate |
$2,129.40 |
| Rate for Payer: Adventist Health Commercial |
$473.20
|
| Rate for Payer: Cash Price |
$1,064.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,892.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,656.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$946.40
|
| Rate for Payer: EPIC Health Plan Senior |
$946.40
|
| Rate for Payer: Galaxy Health WC |
$2,011.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,419.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,129.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,502.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,395.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$473.20
|
| Rate for Payer: Multiplan Commercial |
$1,774.50
|
| Rate for Payer: Networks By Design Commercial |
$1,537.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,011.10
|
|
