|
HC GLUCOSE TEST STRIP
|
Facility
|
OP
|
$190.00
|
|
|
Service Code
|
CPT 82948
|
| Hospital Charge Code |
908600850
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.09 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Adventist Health Commercial |
$38.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$22.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.93
|
| Rate for Payer: Blue Shield of California Commercial |
$119.70
|
| Rate for Payer: Blue Shield of California EPN |
$75.43
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Central Health Plan Commercial |
$152.00
|
| Rate for Payer: Cigna of CA HMO |
$121.60
|
| Rate for Payer: Cigna of CA PPO |
$140.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$133.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.32
|
| Rate for Payer: EPIC Health Plan Senior |
$5.54
|
| Rate for Payer: Galaxy Health WC |
$161.50
|
| Rate for Payer: Global Benefits Group Commercial |
$114.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$171.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$120.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.75
|
| Rate for Payer: Multiplan Commercial |
$142.50
|
| Rate for Payer: Networks By Design Commercial |
$123.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.04
|
| Rate for Payer: Prime Health Services Commercial |
$161.50
|
| Rate for Payer: Prime Health Services Medicare |
$5.34
|
| Rate for Payer: Riverside University Health System MISP |
$5.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$114.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$114.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.09
|
| Rate for Payer: United Healthcare All Other HMO |
$4.09
|
| Rate for Payer: United Healthcare HMO Rider |
$4.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.09
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.54
|
| Rate for Payer: Vantage Medical Group Senior |
$5.04
|
|
|
HC GLUCOSE TOLERANCE TEST 2 HR
|
Facility
|
OP
|
$118.00
|
|
|
Service Code
|
CPT 82951
|
| Hospital Charge Code |
900910208
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.42 |
| Max. Negotiated Rate |
$130.19 |
| Rate for Payer: Adventist Health Commercial |
$23.60
|
| Rate for Payer: Adventist Health Commercial |
$45.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.87
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$93.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$93.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.19
|
| Rate for Payer: Blue Shield of California Commercial |
$142.38
|
| Rate for Payer: Blue Shield of California Commercial |
$74.34
|
| Rate for Payer: Blue Shield of California EPN |
$89.72
|
| Rate for Payer: Blue Shield of California EPN |
$46.85
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Central Health Plan Commercial |
$94.40
|
| Rate for Payer: Central Health Plan Commercial |
$180.80
|
| Rate for Payer: Cigna of CA HMO |
$144.64
|
| Rate for Payer: Cigna of CA HMO |
$75.52
|
| Rate for Payer: Cigna of CA PPO |
$167.24
|
| Rate for Payer: Cigna of CA PPO |
$87.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$82.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$158.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.24
|
| Rate for Payer: EPIC Health Plan Senior |
$14.16
|
| Rate for Payer: EPIC Health Plan Senior |
$14.16
|
| Rate for Payer: Galaxy Health WC |
$192.10
|
| Rate for Payer: Galaxy Health WC |
$100.30
|
| Rate for Payer: Global Benefits Group Commercial |
$135.60
|
| Rate for Payer: Global Benefits Group Commercial |
$70.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$203.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$106.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.11
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$74.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$143.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.25
|
| Rate for Payer: Multiplan Commercial |
$169.50
|
| Rate for Payer: Multiplan Commercial |
$88.50
|
| Rate for Payer: Networks By Design Commercial |
$76.70
|
| Rate for Payer: Networks By Design Commercial |
$146.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.87
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.87
|
| Rate for Payer: Prime Health Services Commercial |
$192.10
|
| Rate for Payer: Prime Health Services Commercial |
$100.30
|
| Rate for Payer: Prime Health Services Medicare |
$13.64
|
| Rate for Payer: Prime Health Services Medicare |
$13.64
|
| Rate for Payer: Riverside University Health System MISP |
$14.16
|
| Rate for Payer: Riverside University Health System MISP |
$14.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$70.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$135.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$135.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$70.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.42
|
| Rate for Payer: United Healthcare All Other HMO |
$10.42
|
| Rate for Payer: United Healthcare All Other HMO |
$10.42
|
| Rate for Payer: United Healthcare HMO Rider |
$10.42
|
| Rate for Payer: United Healthcare HMO Rider |
$10.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.87
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Vantage Medical Group Senior |
$12.87
|
| Rate for Payer: Vantage Medical Group Senior |
$12.87
|
|
|
HC GLUCOSE TOLERANCE TEST 2 HR
|
Facility
|
IP
|
$226.00
|
|
|
Service Code
|
CPT 82951
|
| Hospital Charge Code |
900910208
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.20 |
| Max. Negotiated Rate |
$203.40 |
| Rate for Payer: Adventist Health Commercial |
$45.20
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Central Health Plan Commercial |
$180.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$158.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.40
|
| Rate for Payer: EPIC Health Plan Senior |
$90.40
|
| Rate for Payer: Galaxy Health WC |
$192.10
|
| Rate for Payer: Global Benefits Group Commercial |
$135.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$203.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$143.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$133.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.20
|
| Rate for Payer: Multiplan Commercial |
$169.50
|
| Rate for Payer: Networks By Design Commercial |
$146.90
|
| Rate for Payer: Prime Health Services Commercial |
$192.10
|
|
|
HC GLUCOSE TOLERANCE TEST 3 HR
|
Facility
|
OP
|
$118.00
|
|
|
Service Code
|
CPT 82951
|
| Hospital Charge Code |
900910308
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.42 |
| Max. Negotiated Rate |
$130.19 |
| Rate for Payer: Adventist Health Commercial |
$23.60
|
| Rate for Payer: Adventist Health Commercial |
$45.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.87
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$93.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$93.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.19
|
| Rate for Payer: Blue Shield of California Commercial |
$142.38
|
| Rate for Payer: Blue Shield of California Commercial |
$74.34
|
| Rate for Payer: Blue Shield of California EPN |
$89.72
|
| Rate for Payer: Blue Shield of California EPN |
$46.85
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Central Health Plan Commercial |
$94.40
|
| Rate for Payer: Central Health Plan Commercial |
$180.80
|
| Rate for Payer: Cigna of CA HMO |
$144.64
|
| Rate for Payer: Cigna of CA HMO |
$75.52
|
| Rate for Payer: Cigna of CA PPO |
$167.24
|
| Rate for Payer: Cigna of CA PPO |
$87.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$82.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$158.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.24
|
| Rate for Payer: EPIC Health Plan Senior |
$14.16
|
| Rate for Payer: EPIC Health Plan Senior |
$14.16
|
| Rate for Payer: Galaxy Health WC |
$192.10
|
| Rate for Payer: Galaxy Health WC |
$100.30
|
| Rate for Payer: Global Benefits Group Commercial |
$135.60
|
| Rate for Payer: Global Benefits Group Commercial |
$70.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$203.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$106.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.11
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$74.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$143.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.25
|
| Rate for Payer: Multiplan Commercial |
$169.50
|
| Rate for Payer: Multiplan Commercial |
$88.50
|
| Rate for Payer: Networks By Design Commercial |
$76.70
|
| Rate for Payer: Networks By Design Commercial |
$146.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.87
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.87
|
| Rate for Payer: Prime Health Services Commercial |
$192.10
|
| Rate for Payer: Prime Health Services Commercial |
$100.30
|
| Rate for Payer: Prime Health Services Medicare |
$13.64
|
| Rate for Payer: Prime Health Services Medicare |
$13.64
|
| Rate for Payer: Riverside University Health System MISP |
$14.16
|
| Rate for Payer: Riverside University Health System MISP |
$14.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$70.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$135.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$135.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$70.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.42
|
| Rate for Payer: United Healthcare All Other HMO |
$10.42
|
| Rate for Payer: United Healthcare All Other HMO |
$10.42
|
| Rate for Payer: United Healthcare HMO Rider |
$10.42
|
| Rate for Payer: United Healthcare HMO Rider |
$10.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.87
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Vantage Medical Group Senior |
$12.87
|
| Rate for Payer: Vantage Medical Group Senior |
$12.87
|
|
|
HC GLUCOSE TOLERANCE TEST 3 HR
|
Facility
|
IP
|
$226.00
|
|
|
Service Code
|
CPT 82951
|
| Hospital Charge Code |
900910308
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.20 |
| Max. Negotiated Rate |
$203.40 |
| Rate for Payer: Adventist Health Commercial |
$45.20
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Central Health Plan Commercial |
$180.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$158.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.40
|
| Rate for Payer: EPIC Health Plan Senior |
$90.40
|
| Rate for Payer: Galaxy Health WC |
$192.10
|
| Rate for Payer: Global Benefits Group Commercial |
$135.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$203.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$143.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$133.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.20
|
| Rate for Payer: Multiplan Commercial |
$169.50
|
| Rate for Payer: Networks By Design Commercial |
$146.90
|
| Rate for Payer: Prime Health Services Commercial |
$192.10
|
|
|
HC GLUCOSE URINE
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 82945
|
| Hospital Charge Code |
900910311
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.19 |
| Max. Negotiated Rate |
$39.63 |
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$3.93
|
| Rate for Payer: Adventist Health Medi-Cal |
$3.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$28.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$28.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.63
|
| Rate for Payer: Blue Shield of California Commercial |
$34.02
|
| Rate for Payer: Blue Shield of California Commercial |
$26.46
|
| Rate for Payer: Blue Shield of California EPN |
$21.44
|
| Rate for Payer: Blue Shield of California EPN |
$16.67
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Central Health Plan Commercial |
$33.60
|
| Rate for Payer: Central Health Plan Commercial |
$43.20
|
| Rate for Payer: Cigna of CA HMO |
$34.56
|
| Rate for Payer: Cigna of CA HMO |
$26.88
|
| Rate for Payer: Cigna of CA PPO |
$39.96
|
| Rate for Payer: Cigna of CA PPO |
$31.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.48
|
| Rate for Payer: EPIC Health Plan Senior |
$4.32
|
| Rate for Payer: EPIC Health Plan Senior |
$4.32
|
| Rate for Payer: Galaxy Health WC |
$45.90
|
| Rate for Payer: Galaxy Health WC |
$35.70
|
| Rate for Payer: Global Benefits Group Commercial |
$32.40
|
| Rate for Payer: Global Benefits Group Commercial |
$25.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$37.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6.45
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.27
|
| Rate for Payer: Multiplan Commercial |
$40.50
|
| Rate for Payer: Multiplan Commercial |
$31.50
|
| Rate for Payer: Networks By Design Commercial |
$27.30
|
| Rate for Payer: Networks By Design Commercial |
$35.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3.93
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3.93
|
| Rate for Payer: Prime Health Services Commercial |
$45.90
|
| Rate for Payer: Prime Health Services Commercial |
$35.70
|
| Rate for Payer: Prime Health Services Medicare |
$4.17
|
| Rate for Payer: Prime Health Services Medicare |
$4.17
|
| Rate for Payer: Riverside University Health System MISP |
$4.32
|
| Rate for Payer: Riverside University Health System MISP |
$4.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.19
|
| Rate for Payer: United Healthcare All Other HMO |
$3.19
|
| Rate for Payer: United Healthcare All Other HMO |
$3.19
|
| Rate for Payer: United Healthcare HMO Rider |
$3.19
|
| Rate for Payer: United Healthcare HMO Rider |
$3.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.19
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.93
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.32
|
| Rate for Payer: Vantage Medical Group Senior |
$3.93
|
| Rate for Payer: Vantage Medical Group Senior |
$3.93
|
|
|
HC GLUCOSE URINE
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
CPT 82945
|
| Hospital Charge Code |
900910311
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$48.60 |
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Central Health Plan Commercial |
$43.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.60
|
| Rate for Payer: EPIC Health Plan Senior |
$21.60
|
| Rate for Payer: Galaxy Health WC |
$45.90
|
| Rate for Payer: Global Benefits Group Commercial |
$32.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.80
|
| Rate for Payer: Multiplan Commercial |
$40.50
|
| Rate for Payer: Networks By Design Commercial |
$35.10
|
| Rate for Payer: Prime Health Services Commercial |
$45.90
|
|
|
HC GLUCOSE URINE 24 HOURS
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
CPT 82945
|
| Hospital Charge Code |
900912205
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$48.60 |
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Central Health Plan Commercial |
$43.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.60
|
| Rate for Payer: EPIC Health Plan Senior |
$21.60
|
| Rate for Payer: Galaxy Health WC |
$45.90
|
| Rate for Payer: Global Benefits Group Commercial |
$32.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.80
|
| Rate for Payer: Multiplan Commercial |
$40.50
|
| Rate for Payer: Networks By Design Commercial |
$35.10
|
| Rate for Payer: Prime Health Services Commercial |
$45.90
|
|
|
HC GLUCOSE URINE 24 HOURS
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 82945
|
| Hospital Charge Code |
900912205
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.19 |
| Max. Negotiated Rate |
$39.63 |
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$3.93
|
| Rate for Payer: Adventist Health Medi-Cal |
$3.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$28.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$28.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.63
|
| Rate for Payer: Blue Shield of California Commercial |
$34.02
|
| Rate for Payer: Blue Shield of California Commercial |
$26.46
|
| Rate for Payer: Blue Shield of California EPN |
$21.44
|
| Rate for Payer: Blue Shield of California EPN |
$16.67
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Central Health Plan Commercial |
$33.60
|
| Rate for Payer: Central Health Plan Commercial |
$43.20
|
| Rate for Payer: Cigna of CA HMO |
$34.56
|
| Rate for Payer: Cigna of CA HMO |
$26.88
|
| Rate for Payer: Cigna of CA PPO |
$39.96
|
| Rate for Payer: Cigna of CA PPO |
$31.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.48
|
| Rate for Payer: EPIC Health Plan Senior |
$4.32
|
| Rate for Payer: EPIC Health Plan Senior |
$4.32
|
| Rate for Payer: Galaxy Health WC |
$45.90
|
| Rate for Payer: Galaxy Health WC |
$35.70
|
| Rate for Payer: Global Benefits Group Commercial |
$32.40
|
| Rate for Payer: Global Benefits Group Commercial |
$25.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$37.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6.45
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.27
|
| Rate for Payer: Multiplan Commercial |
$40.50
|
| Rate for Payer: Multiplan Commercial |
$31.50
|
| Rate for Payer: Networks By Design Commercial |
$27.30
|
| Rate for Payer: Networks By Design Commercial |
$35.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3.93
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3.93
|
| Rate for Payer: Prime Health Services Commercial |
$45.90
|
| Rate for Payer: Prime Health Services Commercial |
$35.70
|
| Rate for Payer: Prime Health Services Medicare |
$4.17
|
| Rate for Payer: Prime Health Services Medicare |
$4.17
|
| Rate for Payer: Riverside University Health System MISP |
$4.32
|
| Rate for Payer: Riverside University Health System MISP |
$4.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.19
|
| Rate for Payer: United Healthcare All Other HMO |
$3.19
|
| Rate for Payer: United Healthcare All Other HMO |
$3.19
|
| Rate for Payer: United Healthcare HMO Rider |
$3.19
|
| Rate for Payer: United Healthcare HMO Rider |
$3.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.19
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.93
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.32
|
| Rate for Payer: Vantage Medical Group Senior |
$3.93
|
| Rate for Payer: Vantage Medical Group Senior |
$3.93
|
|
|
HC GLUCOSE URINE RANDOM
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
CPT 82945
|
| Hospital Charge Code |
900912204
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$48.60 |
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Central Health Plan Commercial |
$43.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.60
|
| Rate for Payer: EPIC Health Plan Senior |
$21.60
|
| Rate for Payer: Galaxy Health WC |
$45.90
|
| Rate for Payer: Global Benefits Group Commercial |
$32.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.80
|
| Rate for Payer: Multiplan Commercial |
$40.50
|
| Rate for Payer: Networks By Design Commercial |
$35.10
|
| Rate for Payer: Prime Health Services Commercial |
$45.90
|
|
|
HC GLUCOSE URINE RANDOM
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 82945
|
| Hospital Charge Code |
900912204
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.19 |
| Max. Negotiated Rate |
$39.63 |
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$3.93
|
| Rate for Payer: Adventist Health Medi-Cal |
$3.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$28.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$28.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.63
|
| Rate for Payer: Blue Shield of California Commercial |
$34.02
|
| Rate for Payer: Blue Shield of California Commercial |
$26.46
|
| Rate for Payer: Blue Shield of California EPN |
$21.44
|
| Rate for Payer: Blue Shield of California EPN |
$16.67
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Central Health Plan Commercial |
$33.60
|
| Rate for Payer: Central Health Plan Commercial |
$43.20
|
| Rate for Payer: Cigna of CA HMO |
$34.56
|
| Rate for Payer: Cigna of CA HMO |
$26.88
|
| Rate for Payer: Cigna of CA PPO |
$39.96
|
| Rate for Payer: Cigna of CA PPO |
$31.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.48
|
| Rate for Payer: EPIC Health Plan Senior |
$4.32
|
| Rate for Payer: EPIC Health Plan Senior |
$4.32
|
| Rate for Payer: Galaxy Health WC |
$45.90
|
| Rate for Payer: Galaxy Health WC |
$35.70
|
| Rate for Payer: Global Benefits Group Commercial |
$32.40
|
| Rate for Payer: Global Benefits Group Commercial |
$25.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$37.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6.45
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.27
|
| Rate for Payer: Multiplan Commercial |
$40.50
|
| Rate for Payer: Multiplan Commercial |
$31.50
|
| Rate for Payer: Networks By Design Commercial |
$27.30
|
| Rate for Payer: Networks By Design Commercial |
$35.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3.93
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3.93
|
| Rate for Payer: Prime Health Services Commercial |
$45.90
|
| Rate for Payer: Prime Health Services Commercial |
$35.70
|
| Rate for Payer: Prime Health Services Medicare |
$4.17
|
| Rate for Payer: Prime Health Services Medicare |
$4.17
|
| Rate for Payer: Riverside University Health System MISP |
$4.32
|
| Rate for Payer: Riverside University Health System MISP |
$4.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.19
|
| Rate for Payer: United Healthcare All Other HMO |
$3.19
|
| Rate for Payer: United Healthcare All Other HMO |
$3.19
|
| Rate for Payer: United Healthcare HMO Rider |
$3.19
|
| Rate for Payer: United Healthcare HMO Rider |
$3.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.19
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.93
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.32
|
| Rate for Payer: Vantage Medical Group Senior |
$3.93
|
| Rate for Payer: Vantage Medical Group Senior |
$3.93
|
|
|
HC GLUTEAL PAD EA ADD. LE
|
Facility
|
IP
|
$265.00
|
|
|
Service Code
|
CPT L2650
|
| Hospital Charge Code |
915352650
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$53.00 |
| Max. Negotiated Rate |
$238.50 |
| Rate for Payer: Adventist Health Commercial |
$53.00
|
| Rate for Payer: Blue Shield of California Commercial |
$212.53
|
| Rate for Payer: Blue Shield of California EPN |
$133.56
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Central Health Plan Commercial |
$212.00
|
| Rate for Payer: Cigna of CA HMO |
$185.50
|
| Rate for Payer: Cigna of CA PPO |
$185.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$185.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.00
|
| Rate for Payer: EPIC Health Plan Senior |
$106.00
|
| Rate for Payer: Galaxy Health WC |
$225.25
|
| Rate for Payer: Global Benefits Group Commercial |
$159.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$238.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$168.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.00
|
| Rate for Payer: Multiplan Commercial |
$198.75
|
| Rate for Payer: Networks By Design Commercial |
$172.25
|
| Rate for Payer: Prime Health Services Commercial |
$225.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.45
|
| Rate for Payer: United Healthcare All Other HMO |
$96.80
|
| Rate for Payer: United Healthcare HMO Rider |
$94.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.79
|
|
|
HC GLUTEAL PAD EA ADD. LE
|
Facility
|
IP
|
$265.00
|
|
|
Service Code
|
CPT L2650
|
| Hospital Charge Code |
905352650
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$53.00 |
| Max. Negotiated Rate |
$238.50 |
| Rate for Payer: Adventist Health Commercial |
$53.00
|
| Rate for Payer: Blue Shield of California Commercial |
$212.53
|
| Rate for Payer: Blue Shield of California EPN |
$133.56
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Central Health Plan Commercial |
$212.00
|
| Rate for Payer: Cigna of CA HMO |
$185.50
|
| Rate for Payer: Cigna of CA PPO |
$185.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$185.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.00
|
| Rate for Payer: EPIC Health Plan Senior |
$106.00
|
| Rate for Payer: Galaxy Health WC |
$225.25
|
| Rate for Payer: Global Benefits Group Commercial |
$159.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$238.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$168.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.00
|
| Rate for Payer: Multiplan Commercial |
$198.75
|
| Rate for Payer: Networks By Design Commercial |
$172.25
|
| Rate for Payer: Prime Health Services Commercial |
$225.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.45
|
| Rate for Payer: United Healthcare All Other HMO |
$96.80
|
| Rate for Payer: United Healthcare HMO Rider |
$94.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.79
|
|
|
HC GLUTEAL PAD EA ADD. LE
|
Facility
|
OP
|
$265.00
|
|
|
Service Code
|
CPT L2650
|
| Hospital Charge Code |
905352650
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$82.87 |
| Max. Negotiated Rate |
$238.50 |
| Rate for Payer: Adventist Health Commercial |
$108.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$225.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$145.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$154.15
|
| Rate for Payer: Blue Shield of California Commercial |
$212.53
|
| Rate for Payer: Blue Shield of California EPN |
$133.56
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Central Health Plan Commercial |
$212.00
|
| Rate for Payer: Cigna of CA HMO |
$185.50
|
| Rate for Payer: Cigna of CA PPO |
$185.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$225.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$185.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.00
|
| Rate for Payer: EPIC Health Plan Senior |
$106.00
|
| Rate for Payer: Galaxy Health WC |
$225.25
|
| Rate for Payer: Global Benefits Group Commercial |
$159.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$238.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$82.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$168.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$91.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$185.50
|
| Rate for Payer: Multiplan Commercial |
$198.75
|
| Rate for Payer: Networks By Design Commercial |
$132.50
|
| Rate for Payer: Prime Health Services Commercial |
$225.25
|
| Rate for Payer: Riverside University Health System MISP |
$106.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$159.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$159.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.45
|
| Rate for Payer: United Healthcare All Other HMO |
$96.80
|
| Rate for Payer: United Healthcare HMO Rider |
$94.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$225.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$225.25
|
| Rate for Payer: Vantage Medical Group Senior |
$225.25
|
|
|
HC GLUTEAL PAD EA ADD. LE
|
Facility
|
OP
|
$265.00
|
|
|
Service Code
|
CPT L2650
|
| Hospital Charge Code |
915352650
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$82.87 |
| Max. Negotiated Rate |
$238.50 |
| Rate for Payer: Adventist Health Commercial |
$108.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$225.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$145.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$154.15
|
| Rate for Payer: Blue Shield of California Commercial |
$212.53
|
| Rate for Payer: Blue Shield of California EPN |
$133.56
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Central Health Plan Commercial |
$212.00
|
| Rate for Payer: Cigna of CA HMO |
$185.50
|
| Rate for Payer: Cigna of CA PPO |
$185.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$225.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$185.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.00
|
| Rate for Payer: EPIC Health Plan Senior |
$106.00
|
| Rate for Payer: Galaxy Health WC |
$225.25
|
| Rate for Payer: Global Benefits Group Commercial |
$159.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$238.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$82.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$168.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$91.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$185.50
|
| Rate for Payer: Multiplan Commercial |
$198.75
|
| Rate for Payer: Networks By Design Commercial |
$132.50
|
| Rate for Payer: Prime Health Services Commercial |
$225.25
|
| Rate for Payer: Riverside University Health System MISP |
$106.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$159.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$159.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.45
|
| Rate for Payer: United Healthcare All Other HMO |
$96.80
|
| Rate for Payer: United Healthcare HMO Rider |
$94.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$225.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$225.25
|
| Rate for Payer: Vantage Medical Group Senior |
$225.25
|
|
|
HC GRAFIX CORE 5X5
|
Facility
|
OP
|
$385.00
|
|
|
Service Code
|
CPT Q4132
|
| Hospital Charge Code |
900101472
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$77.00 |
| Max. Negotiated Rate |
$363.21 |
| Rate for Payer: Adventist Health Commercial |
$77.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$160.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$232.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$160.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$291.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$363.21
|
| Rate for Payer: Blue Shield of California Commercial |
$244.09
|
| Rate for Payer: Blue Shield of California EPN |
$153.62
|
| Rate for Payer: Cash Price |
$173.25
|
| Rate for Payer: Cash Price |
$173.25
|
| Rate for Payer: Central Health Plan Commercial |
$308.00
|
| Rate for Payer: Cigna of CA HMO |
$269.50
|
| Rate for Payer: Cigna of CA PPO |
$269.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$240.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$160.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$269.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.10
|
| Rate for Payer: EPIC Health Plan Senior |
$176.07
|
| Rate for Payer: Galaxy Health WC |
$327.25
|
| Rate for Payer: Global Benefits Group Commercial |
$231.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$346.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$262.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$226.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$244.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$249.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$224.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$288.75
|
| Rate for Payer: Networks By Design Commercial |
$192.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$160.06
|
| Rate for Payer: Prime Health Services Commercial |
$327.25
|
| Rate for Payer: Prime Health Services Medicare |
$169.66
|
| Rate for Payer: Riverside University Health System MISP |
$176.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$231.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$231.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$144.49
|
| Rate for Payer: United Healthcare All Other HMO |
$140.64
|
| Rate for Payer: United Healthcare HMO Rider |
$137.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$126.09
|
| Rate for Payer: Upland Medical Group Pediatric |
$160.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Vantage Medical Group Senior |
$160.06
|
|
|
HC GRAFIX CORE 5X5
|
Facility
|
IP
|
$385.00
|
|
|
Service Code
|
CPT Q4132
|
| Hospital Charge Code |
900101472
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$77.00 |
| Max. Negotiated Rate |
$346.50 |
| Rate for Payer: Adventist Health Commercial |
$77.00
|
| Rate for Payer: Blue Shield of California Commercial |
$308.77
|
| Rate for Payer: Blue Shield of California EPN |
$194.04
|
| Rate for Payer: Cash Price |
$173.25
|
| Rate for Payer: Central Health Plan Commercial |
$308.00
|
| Rate for Payer: Cigna of CA HMO |
$269.50
|
| Rate for Payer: Cigna of CA PPO |
$269.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$269.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$154.00
|
| Rate for Payer: EPIC Health Plan Senior |
$154.00
|
| Rate for Payer: Galaxy Health WC |
$327.25
|
| Rate for Payer: Global Benefits Group Commercial |
$231.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$346.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$244.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$227.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.00
|
| Rate for Payer: Multiplan Commercial |
$288.75
|
| Rate for Payer: Networks By Design Commercial |
$192.50
|
| Rate for Payer: Prime Health Services Commercial |
$327.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$144.49
|
| Rate for Payer: United Healthcare All Other HMO |
$140.64
|
| Rate for Payer: United Healthcare HMO Rider |
$137.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$126.09
|
|
|
HC GRAFIX PRIME 3X4
|
Facility
|
IP
|
$416.00
|
|
|
Service Code
|
CPT Q4133 JW
|
| Hospital Charge Code |
900101475
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$83.20 |
| Max. Negotiated Rate |
$374.40 |
| Rate for Payer: Adventist Health Commercial |
$83.20
|
| Rate for Payer: Blue Shield of California Commercial |
$333.63
|
| Rate for Payer: Blue Shield of California EPN |
$209.66
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Central Health Plan Commercial |
$332.80
|
| Rate for Payer: Cigna of CA HMO |
$291.20
|
| Rate for Payer: Cigna of CA PPO |
$291.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$291.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$166.40
|
| Rate for Payer: EPIC Health Plan Senior |
$166.40
|
| Rate for Payer: Galaxy Health WC |
$353.60
|
| Rate for Payer: Global Benefits Group Commercial |
$249.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$374.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$264.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$245.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.20
|
| Rate for Payer: Multiplan Commercial |
$312.00
|
| Rate for Payer: Networks By Design Commercial |
$208.00
|
| Rate for Payer: Prime Health Services Commercial |
$353.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$156.12
|
| Rate for Payer: United Healthcare All Other HMO |
$151.96
|
| Rate for Payer: United Healthcare HMO Rider |
$148.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$136.24
|
|
|
HC GRAFIX PRIME 3X4
|
Facility
|
OP
|
$416.00
|
|
|
Service Code
|
CPT Q4133 JW
|
| Hospital Charge Code |
900101475
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$83.20 |
| Max. Negotiated Rate |
$845.07 |
| Rate for Payer: Adventist Health Commercial |
$83.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$845.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$353.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$228.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$312.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$291.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$363.21
|
| Rate for Payer: Blue Shield of California Commercial |
$263.74
|
| Rate for Payer: Blue Shield of California EPN |
$165.98
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Central Health Plan Commercial |
$332.80
|
| Rate for Payer: Cigna of CA HMO |
$291.20
|
| Rate for Payer: Cigna of CA PPO |
$291.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$353.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$353.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$353.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$291.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$166.40
|
| Rate for Payer: EPIC Health Plan Senior |
$166.40
|
| Rate for Payer: Galaxy Health WC |
$353.60
|
| Rate for Payer: Global Benefits Group Commercial |
$249.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$374.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$230.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$264.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$254.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$245.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$291.20
|
| Rate for Payer: Multiplan Commercial |
$312.00
|
| Rate for Payer: Networks By Design Commercial |
$208.00
|
| Rate for Payer: Prime Health Services Commercial |
$353.60
|
| Rate for Payer: Riverside University Health System MISP |
$166.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$249.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$249.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$156.12
|
| Rate for Payer: United Healthcare All Other HMO |
$151.96
|
| Rate for Payer: United Healthcare HMO Rider |
$148.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$136.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$353.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$353.60
|
| Rate for Payer: Vantage Medical Group Senior |
$353.60
|
|
|
HC GRAFIX PRIME 5X5
|
Facility
|
OP
|
$416.00
|
|
|
Service Code
|
CPT Q4133
|
| Hospital Charge Code |
900101474
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$83.20 |
| Max. Negotiated Rate |
$845.07 |
| Rate for Payer: Adventist Health Commercial |
$83.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$160.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$845.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$160.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$291.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$363.21
|
| Rate for Payer: Blue Shield of California Commercial |
$263.74
|
| Rate for Payer: Blue Shield of California EPN |
$165.98
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Central Health Plan Commercial |
$332.80
|
| Rate for Payer: Cigna of CA HMO |
$291.20
|
| Rate for Payer: Cigna of CA PPO |
$291.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$240.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$160.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$291.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.10
|
| Rate for Payer: EPIC Health Plan Senior |
$176.07
|
| Rate for Payer: Galaxy Health WC |
$353.60
|
| Rate for Payer: Global Benefits Group Commercial |
$249.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$374.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$262.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$230.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$264.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$254.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$224.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$312.00
|
| Rate for Payer: Networks By Design Commercial |
$208.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$160.06
|
| Rate for Payer: Prime Health Services Commercial |
$353.60
|
| Rate for Payer: Prime Health Services Medicare |
$169.66
|
| Rate for Payer: Riverside University Health System MISP |
$176.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$249.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$249.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$156.12
|
| Rate for Payer: United Healthcare All Other HMO |
$151.96
|
| Rate for Payer: United Healthcare HMO Rider |
$148.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$136.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$160.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Vantage Medical Group Senior |
$160.06
|
|
|
HC GRAFIX PRIME 5X5
|
Facility
|
IP
|
$416.00
|
|
|
Service Code
|
CPT Q4133
|
| Hospital Charge Code |
900101474
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$83.20 |
| Max. Negotiated Rate |
$374.40 |
| Rate for Payer: Adventist Health Commercial |
$83.20
|
| Rate for Payer: Blue Shield of California Commercial |
$333.63
|
| Rate for Payer: Blue Shield of California EPN |
$209.66
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Central Health Plan Commercial |
$332.80
|
| Rate for Payer: Cigna of CA HMO |
$291.20
|
| Rate for Payer: Cigna of CA PPO |
$291.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$291.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$166.40
|
| Rate for Payer: EPIC Health Plan Senior |
$166.40
|
| Rate for Payer: Galaxy Health WC |
$353.60
|
| Rate for Payer: Global Benefits Group Commercial |
$249.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$374.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$264.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$245.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.20
|
| Rate for Payer: Multiplan Commercial |
$312.00
|
| Rate for Payer: Networks By Design Commercial |
$208.00
|
| Rate for Payer: Prime Health Services Commercial |
$353.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$156.12
|
| Rate for Payer: United Healthcare All Other HMO |
$151.96
|
| Rate for Payer: United Healthcare HMO Rider |
$148.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$136.24
|
|
|
HC GRAFT APLIGRAF 44 SQ CM
|
Facility
|
IP
|
$273.00
|
|
|
Service Code
|
CPT Q4101
|
| Hospital Charge Code |
900101456
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.60 |
| Max. Negotiated Rate |
$245.70 |
| Rate for Payer: Adventist Health Commercial |
$54.60
|
| Rate for Payer: Blue Shield of California Commercial |
$218.95
|
| Rate for Payer: Blue Shield of California EPN |
$137.59
|
| Rate for Payer: Cash Price |
$122.85
|
| Rate for Payer: Central Health Plan Commercial |
$218.40
|
| Rate for Payer: Cigna of CA HMO |
$191.10
|
| Rate for Payer: Cigna of CA PPO |
$191.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$191.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.20
|
| Rate for Payer: EPIC Health Plan Senior |
$109.20
|
| Rate for Payer: Galaxy Health WC |
$232.05
|
| Rate for Payer: Global Benefits Group Commercial |
$163.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$245.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$173.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$161.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.60
|
| Rate for Payer: Multiplan Commercial |
$204.75
|
| Rate for Payer: Networks By Design Commercial |
$136.50
|
| Rate for Payer: Prime Health Services Commercial |
$232.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$102.46
|
| Rate for Payer: United Healthcare All Other HMO |
$99.73
|
| Rate for Payer: United Healthcare HMO Rider |
$97.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$89.41
|
|
|
HC GRAFT APLIGRAF 44 SQ CM
|
Facility
|
OP
|
$273.00
|
|
|
Service Code
|
CPT Q4101
|
| Hospital Charge Code |
900101456
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$52.22 |
| Max. Negotiated Rate |
$264.10 |
| Rate for Payer: Adventist Health Commercial |
$54.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$160.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$188.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$160.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$67.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$84.84
|
| Rate for Payer: Blue Shield of California Commercial |
$173.08
|
| Rate for Payer: Blue Shield of California EPN |
$108.93
|
| Rate for Payer: Cash Price |
$122.85
|
| Rate for Payer: Cash Price |
$122.85
|
| Rate for Payer: Central Health Plan Commercial |
$218.40
|
| Rate for Payer: Cigna of CA HMO |
$191.10
|
| Rate for Payer: Cigna of CA PPO |
$191.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$240.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$160.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$191.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.10
|
| Rate for Payer: EPIC Health Plan Senior |
$176.07
|
| Rate for Payer: Galaxy Health WC |
$232.05
|
| Rate for Payer: Global Benefits Group Commercial |
$163.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$245.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$262.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$52.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$173.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$224.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$204.75
|
| Rate for Payer: Networks By Design Commercial |
$136.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$160.06
|
| Rate for Payer: Prime Health Services Commercial |
$232.05
|
| Rate for Payer: Prime Health Services Medicare |
$169.66
|
| Rate for Payer: Riverside University Health System MISP |
$176.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$163.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$163.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$102.46
|
| Rate for Payer: United Healthcare All Other HMO |
$99.73
|
| Rate for Payer: United Healthcare HMO Rider |
$97.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$89.41
|
| Rate for Payer: Upland Medical Group Pediatric |
$160.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Vantage Medical Group Senior |
$160.06
|
|
|
HC GRAFT COMPOSITE EAR OR NASAL
|
Facility
|
IP
|
$9,868.00
|
|
|
Service Code
|
CPT 15760
|
| Hospital Charge Code |
900515760
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,973.60 |
| Max. Negotiated Rate |
$8,881.20 |
| Rate for Payer: Adventist Health Commercial |
$1,973.60
|
| Rate for Payer: Cash Price |
$4,440.60
|
| Rate for Payer: Central Health Plan Commercial |
$7,894.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,907.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,947.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,947.20
|
| Rate for Payer: Galaxy Health WC |
$8,387.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,920.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,881.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,266.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,822.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,973.60
|
| Rate for Payer: Multiplan Commercial |
$7,401.00
|
| Rate for Payer: Networks By Design Commercial |
$6,414.20
|
| Rate for Payer: Prime Health Services Commercial |
$8,387.80
|
|
|
HC GRAFT COMPOSITE EAR OR NASAL
|
Facility
|
OP
|
$9,868.00
|
|
|
Service Code
|
CPT 15760
|
| Hospital Charge Code |
900515760
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$8,881.20 |
| Rate for Payer: Adventist Health Commercial |
$1,973.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,653.72
|
| 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: Anthem Blue Cross of CA Workers' Comp |
$3,703.23
|
| Rate for Payer: Cash Price |
$4,440.60
|
| Rate for Payer: Cash Price |
$4,440.60
|
| Rate for Payer: Cash Price |
$4,440.60
|
| Rate for Payer: Cash Price |
$4,440.60
|
| Rate for Payer: Central Health Plan Commercial |
$7,894.40
|
| Rate for Payer: Cigna of CA HMO |
$6,315.52
|
| Rate for Payer: Cigna of CA PPO |
$7,302.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,919.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,653.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,907.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,378.64
|
| Rate for Payer: EPIC Health Plan Senior |
$2,919.09
|
| Rate for Payer: Galaxy Health WC |
$8,387.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,920.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,881.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,352.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,653.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,266.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$801.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,852.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,973.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,555.98
|
| Rate for Payer: Multiplan Commercial |
$7,401.00
|
| Rate for Payer: Multiplan WC |
$3,703.23
|
| Rate for Payer: Networks By Design Commercial |
$6,414.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,653.72
|
| Rate for Payer: Preferred Health Network WC |
$3,778.81
|
| Rate for Payer: Prime Health Services Commercial |
$8,387.80
|
| Rate for Payer: Prime Health Services Medicare |
$2,812.94
|
| Rate for Payer: Prime Health Services WC |
$3,665.45
|
| Rate for Payer: Riverside University Health System MISP |
$2,919.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,920.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,934.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,934.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,934.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,934.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,653.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,653.72
|
|
