|
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 |
$295.90
|
| Rate for Payer: Central Health Plan Commercial |
$430.40
|
| 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 Permanente of CA Commercial/Self Funded |
$358.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$204.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$333.02
|
| 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 |
$13.96 |
| 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 |
$326.73
|
| 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 |
$13.96
|
| Rate for Payer: Blue Shield of California Commercial |
$326.57
|
| Rate for Payer: Blue Shield of California EPN |
$213.59
|
| Rate for Payer: Cash Price |
$295.90
|
| Rate for Payer: Cash Price |
$295.90
|
| 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: EPIC Health Plan Commercial |
$25.53
|
| Rate for Payer: EPIC Health Plan Senior |
$18.91
|
| 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: InnovAge PACE Commercial |
$28.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$358.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.34
|
| Rate for Payer: Molina Healthcare of CA 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 |
$23.65
|
| Rate for Payer: Central Health Plan Commercial |
$34.40
|
| 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 Permanente of CA Commercial/Self Funded |
$28.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.62
|
| 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 |
$25.25
|
| Rate for Payer: Blue Shield of California Commercial |
$26.27
|
| Rate for Payer: Blue Shield of California EPN |
$17.16
|
| Rate for Payer: Cash Price |
$23.65
|
| Rate for Payer: Cash Price |
$23.65
|
| 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: 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: InnovAge PACE Commercial |
$21.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.10
|
| Rate for Payer: Molina Healthcare of CA 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 |
$710.54
|
| 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 |
$687.14
|
| Rate for Payer: Cash Price |
$643.50
|
| Rate for Payer: Cash Price |
$643.50
|
| Rate for Payer: Cash Price |
$643.50
|
| Rate for Payer: Cash Price |
$643.50
|
| 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: 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: InnovAge PACE Commercial |
$585.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$780.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$154.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$724.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$819.00
|
| Rate for Payer: Molina Healthcare of CA 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 |
$643.50
|
| Rate for Payer: Central Health Plan Commercial |
$936.00
|
| 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 Permanente of CA Commercial/Self Funded |
$780.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$445.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$724.23
|
| 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 |
$727.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,057.60
|
| 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 Permanente of CA Commercial/Self Funded |
$881.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$503.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$818.32
|
| 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 |
$1,189.80 |
| Rate for Payer: Adventist Health Commercial |
$264.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$255.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$802.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$383.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$281.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$255.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$342.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$776.41
|
| Rate for Payer: Blue Shield of California Commercial |
$807.74
|
| Rate for Payer: Blue Shield of California EPN |
$527.48
|
| Rate for Payer: Cash Price |
$727.10
|
| Rate for Payer: Cash Price |
$727.10
|
| Rate for Payer: Cash Price |
$727.10
|
| 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 |
$383.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$281.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$255.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$345.07
|
| Rate for Payer: EPIC Health Plan Senior |
$255.61
|
| 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 |
$419.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$39.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$255.61
|
| Rate for Payer: InnovAge PACE Commercial |
$383.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$881.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$255.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$342.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$342.52
|
| 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 |
$255.61
|
| Rate for Payer: Prime Health Services Commercial |
$1,123.70
|
| Rate for Payer: Prime Health Services Medicare |
$270.95
|
| Rate for Payer: Riverside University Health System MISP |
$281.17
|
| 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 |
$255.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$383.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$281.17
|
| Rate for Payer: Vantage Medical Group Senior |
$255.61
|
|
|
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 |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$202.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$386.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$386.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$617.72
|
| Rate for Payer: Blue Shield of California EPN |
$403.39
|
| Rate for Payer: Cash Price |
$556.05
|
| Rate for Payer: Cash Price |
$556.05
|
| Rate for Payer: Cash Price |
$556.05
|
| 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 |
$579.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$425.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$386.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$521.77
|
| Rate for Payer: EPIC Health Plan Senior |
$386.50
|
| 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 |
$633.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$759.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$386.50
|
| Rate for Payer: InnovAge PACE Commercial |
$579.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$674.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$839.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$386.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$517.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$517.91
|
| 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 |
$386.50
|
| Rate for Payer: Prime Health Services Commercial |
$859.35
|
| Rate for Payer: Prime Health Services Medicare |
$409.69
|
| Rate for Payer: Riverside University Health System MISP |
$425.15
|
| 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 |
$386.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Vantage Medical Group Senior |
$386.50
|
|
|
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 |
$556.05
|
| Rate for Payer: Central Health Plan Commercial |
$808.80
|
| 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 Permanente of CA Commercial/Self Funded |
$674.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$385.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$625.81
|
| 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 FFP PED PAK ALIQUOT
|
Facility
|
IP
|
$695.00
|
|
|
Service Code
|
CPT P9011
|
| Hospital Charge Code |
900904530
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$139.00 |
| Max. Negotiated Rate |
$625.50 |
| Rate for Payer: Adventist Health Commercial |
$139.00
|
| Rate for Payer: Cash Price |
$382.25
|
| Rate for Payer: Central Health Plan Commercial |
$556.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$278.00
|
| Rate for Payer: EPIC Health Plan Senior |
$278.00
|
| Rate for Payer: Galaxy Health WC |
$590.75
|
| Rate for Payer: Global Benefits Group Commercial |
$417.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$625.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$463.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$264.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$430.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.00
|
| Rate for Payer: Multiplan Commercial |
$521.25
|
| Rate for Payer: Networks By Design Commercial |
$451.75
|
| Rate for Payer: Prime Health Services Commercial |
$590.75
|
|
|
HC FFP PED PAK ALIQUOT
|
Facility
|
OP
|
$695.00
|
|
|
Service Code
|
CPT P9011
|
| Hospital Charge Code |
900904530
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$139.00 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Adventist Health Commercial |
$139.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$180.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$422.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$270.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$198.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$180.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.17
|
| Rate for Payer: Blue Shield of California Commercial |
$424.64
|
| Rate for Payer: Blue Shield of California EPN |
$277.31
|
| Rate for Payer: Cash Price |
$382.25
|
| Rate for Payer: Cash Price |
$382.25
|
| Rate for Payer: Cash Price |
$382.25
|
| Rate for Payer: Central Health Plan Commercial |
$556.00
|
| Rate for Payer: Cigna of CA HMO |
$444.80
|
| Rate for Payer: Cigna of CA PPO |
$514.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$270.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$198.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$180.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$243.23
|
| Rate for Payer: EPIC Health Plan Senior |
$180.17
|
| Rate for Payer: Galaxy Health WC |
$590.75
|
| Rate for Payer: Global Benefits Group Commercial |
$417.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$625.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$295.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$256.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$180.17
|
| Rate for Payer: InnovAge PACE Commercial |
$270.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$463.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$283.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$180.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$241.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$241.43
|
| Rate for Payer: Multiplan Commercial |
$521.25
|
| Rate for Payer: Networks By Design Commercial |
$451.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$180.17
|
| Rate for Payer: Prime Health Services Commercial |
$590.75
|
| Rate for Payer: Prime Health Services Medicare |
$190.98
|
| Rate for Payer: Riverside University Health System MISP |
$198.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$417.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$417.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$180.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$270.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$198.19
|
| Rate for Payer: Vantage Medical Group Senior |
$180.17
|
|
|
HC FFP SPLIT UNIT GT 150 ML
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
CPT P9011
|
| Hospital Charge Code |
900904533
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$66.20 |
| Max. Negotiated Rate |
$297.90 |
| Rate for Payer: Adventist Health Commercial |
$66.20
|
| Rate for Payer: Cash Price |
$182.05
|
| Rate for Payer: Central Health Plan Commercial |
$264.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$132.40
|
| Rate for Payer: EPIC Health Plan Senior |
$132.40
|
| Rate for Payer: Galaxy Health WC |
$281.35
|
| Rate for Payer: Global Benefits Group Commercial |
$198.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$297.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$220.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$126.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$204.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.20
|
| Rate for Payer: Multiplan Commercial |
$248.25
|
| Rate for Payer: Networks By Design Commercial |
$215.15
|
| Rate for Payer: Prime Health Services Commercial |
$281.35
|
|
|
HC FFP SPLIT UNIT GT 150 ML
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
CPT P9011
|
| Hospital Charge Code |
900904533
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$66.20 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Adventist Health Commercial |
$66.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$180.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$201.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$270.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$198.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$180.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$160.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$194.40
|
| Rate for Payer: Blue Shield of California Commercial |
$202.24
|
| Rate for Payer: Blue Shield of California EPN |
$132.07
|
| Rate for Payer: Cash Price |
$182.05
|
| Rate for Payer: Cash Price |
$182.05
|
| Rate for Payer: Cash Price |
$182.05
|
| Rate for Payer: Central Health Plan Commercial |
$264.80
|
| Rate for Payer: Cigna of CA HMO |
$211.84
|
| Rate for Payer: Cigna of CA PPO |
$244.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$270.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$198.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$180.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$243.23
|
| Rate for Payer: EPIC Health Plan Senior |
$180.17
|
| Rate for Payer: Galaxy Health WC |
$281.35
|
| Rate for Payer: Global Benefits Group Commercial |
$198.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$297.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$295.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$256.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$180.17
|
| Rate for Payer: InnovAge PACE Commercial |
$270.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$220.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$283.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$180.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$241.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$241.43
|
| Rate for Payer: Multiplan Commercial |
$248.25
|
| Rate for Payer: Networks By Design Commercial |
$215.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$180.17
|
| Rate for Payer: Prime Health Services Commercial |
$281.35
|
| Rate for Payer: Prime Health Services Medicare |
$190.98
|
| Rate for Payer: Riverside University Health System MISP |
$198.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$198.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$198.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$180.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$270.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$198.19
|
| Rate for Payer: Vantage Medical Group Senior |
$180.17
|
|
|
HC FIBRIN DEGRAD SPLIT PRODUCTS
|
Facility
|
OP
|
$37.00
|
|
|
Service Code
|
CPT 85362
|
| Hospital Charge Code |
900910069
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.58 |
| Max. Negotiated Rate |
$50.05 |
| Rate for Payer: Adventist Health Commercial |
$7.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$6.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22.47
|
| 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 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 HMO/PPO |
$10.16
|
| Rate for Payer: Blue Shield of California Commercial |
$22.46
|
| Rate for Payer: Blue Shield of California EPN |
$14.69
|
| Rate for Payer: Cash Price |
$20.35
|
| Rate for Payer: Cash Price |
$20.35
|
| Rate for Payer: Central Health Plan Commercial |
$29.60
|
| Rate for Payer: Cigna of CA HMO |
$23.68
|
| Rate for Payer: Cigna of CA PPO |
$27.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.30
|
| Rate for Payer: EPIC Health Plan Senior |
$6.89
|
| Rate for Payer: Galaxy Health WC |
$31.45
|
| Rate for Payer: Global Benefits Group Commercial |
$22.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.30
|
| 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) Medicare Advantage |
$6.89
|
| Rate for Payer: InnovAge PACE Commercial |
$10.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.23
|
| Rate for Payer: Multiplan Commercial |
$27.75
|
| Rate for Payer: Networks By Design Commercial |
$24.05
|
| 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 Medicare |
$7.30
|
| Rate for Payer: Riverside University Health System MISP |
$7.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.20
|
| 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 HMO Rider |
$5.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.58
|
| 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 Medi-Cal |
$7.58
|
| Rate for Payer: Vantage Medical Group Senior |
$6.89
|
|
|
HC FIBRIN DEGRAD SPLIT PRODUCTS
|
Facility
|
IP
|
$37.00
|
|
|
Service Code
|
CPT 85362
|
| Hospital Charge Code |
900910069
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.40 |
| Max. Negotiated Rate |
$33.30 |
| Rate for Payer: Adventist Health Commercial |
$7.40
|
| Rate for Payer: Cash Price |
$20.35
|
| Rate for Payer: Central Health Plan Commercial |
$29.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.80
|
| Rate for Payer: EPIC Health Plan Senior |
$14.80
|
| Rate for Payer: Galaxy Health WC |
$31.45
|
| Rate for Payer: Global Benefits Group Commercial |
$22.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.40
|
| Rate for Payer: Multiplan Commercial |
$27.75
|
| Rate for Payer: Networks By Design Commercial |
$24.05
|
| Rate for Payer: Prime Health Services Commercial |
$31.45
|
|
|
HC FIBRINOGEN ASSAY
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
CPT 85384
|
| Hospital Charge Code |
900910013
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$75.60 |
| Rate for Payer: Adventist Health Commercial |
$16.80
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Central Health Plan Commercial |
$67.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.60
|
| Rate for Payer: EPIC Health Plan Senior |
$33.60
|
| Rate for Payer: Galaxy Health WC |
$71.40
|
| Rate for Payer: Global Benefits Group Commercial |
$50.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$75.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$52.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.80
|
| Rate for Payer: Multiplan Commercial |
$63.00
|
| Rate for Payer: Networks By Design Commercial |
$54.60
|
| Rate for Payer: Prime Health Services Commercial |
$71.40
|
|
|
HC FIBRINOGEN ASSAY
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
CPT 85384
|
| Hospital Charge Code |
900910013
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.88 |
| Max. Negotiated Rate |
$75.60 |
| Rate for Payer: Adventist Health Commercial |
$16.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$9.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$51.01
|
| 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 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 HMO/PPO |
$12.46
|
| Rate for Payer: Blue Shield of California Commercial |
$50.99
|
| Rate for Payer: Blue Shield of California EPN |
$33.35
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Central Health Plan Commercial |
$67.20
|
| Rate for Payer: Cigna of CA HMO |
$53.76
|
| Rate for Payer: Cigna of CA PPO |
$62.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.12
|
| Rate for Payer: EPIC Health Plan Senior |
$9.72
|
| Rate for Payer: Galaxy Health WC |
$71.40
|
| Rate for Payer: Global Benefits Group Commercial |
$50.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$75.60
|
| 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) Medicare Advantage |
$9.72
|
| Rate for Payer: InnovAge PACE Commercial |
$14.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.02
|
| Rate for Payer: Multiplan Commercial |
$63.00
|
| Rate for Payer: Networks By Design Commercial |
$54.60
|
| 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 Medicare |
$10.30
|
| Rate for Payer: Riverside University Health System MISP |
$10.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$50.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$50.40
|
| 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 HMO Rider |
$7.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.88
|
| 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 Medi-Cal |
$10.69
|
| Rate for Payer: Vantage Medical Group Senior |
$9.72
|
|
|
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 |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$154.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| 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 |
$372.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$452.22
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$423.50
|
| Rate for Payer: Cash Price |
$423.50
|
| Rate for Payer: Cash Price |
$423.50
|
| 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: 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: InnovAge PACE Commercial |
$385.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$513.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$476.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$539.00
|
| Rate for Payer: Molina Healthcare of CA 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 |
$1,932.00
|
| 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 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 |
$423.50
|
| Rate for Payer: Central Health Plan Commercial |
$616.00
|
| 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 Permanente of CA Commercial/Self Funded |
$513.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$293.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$476.63
|
| 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 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 |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$687.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$893.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$893.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,424.40
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,890.35
|
| Rate for Payer: Cash Price |
$1,890.35
|
| Rate for Payer: Cash Price |
$1,890.35
|
| 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 |
$1,340.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$983.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$893.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,206.87
|
| Rate for Payer: EPIC Health Plan Senior |
$893.98
|
| 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 |
$1,466.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$200.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$893.98
|
| Rate for Payer: InnovAge PACE Commercial |
$1,340.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,292.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$221.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$893.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$687.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,197.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,197.93
|
| 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 |
$893.98
|
| 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 |
$947.62
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Riverside University Health System MISP |
$983.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,062.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| 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 |
$893.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Vantage Medical Group Senior |
$893.98
|
|
|
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 |
$1,890.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,749.60
|
| 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 Permanente of CA Commercial/Self Funded |
$2,292.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,309.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,127.50
|
| 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
|
IP
|
$328.00
|
|
|
Service Code
|
CPT 88173
|
| Hospital Charge Code |
903800007
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$65.60 |
| Max. Negotiated Rate |
$295.20 |
| Rate for Payer: Adventist Health Commercial |
$65.60
|
| Rate for Payer: Cash Price |
$180.40
|
| Rate for Payer: Central Health Plan Commercial |
$262.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$131.20
|
| Rate for Payer: EPIC Health Plan Senior |
$131.20
|
| Rate for Payer: Galaxy Health WC |
$278.80
|
| Rate for Payer: Global Benefits Group Commercial |
$196.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$295.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$218.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$124.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$203.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.60
|
| Rate for Payer: Multiplan Commercial |
$246.00
|
| Rate for Payer: Networks By Design Commercial |
$213.20
|
| Rate for Payer: Prime Health Services Commercial |
$278.80
|
|
|
HC FINE NEEDLE ASPIRATION
|
Facility
|
OP
|
$328.00
|
|
|
Service Code
|
CPT 88173
|
| Hospital Charge Code |
903800007
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$16.14 |
| Max. Negotiated Rate |
$295.20 |
| Rate for Payer: Adventist Health Commercial |
$65.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$67.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$199.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$101.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.89
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$79.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.14
|
| Rate for Payer: Blue Shield of California Commercial |
$199.10
|
| Rate for Payer: Blue Shield of California EPN |
$130.22
|
| Rate for Payer: Cash Price |
$180.40
|
| Rate for Payer: Cash Price |
$180.40
|
| Rate for Payer: Central Health Plan Commercial |
$262.40
|
| Rate for Payer: Cigna of CA HMO |
$209.92
|
| Rate for Payer: Cigna of CA PPO |
$242.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$101.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.65
|
| Rate for Payer: EPIC Health Plan Senior |
$67.89
|
| Rate for Payer: Galaxy Health WC |
$278.80
|
| Rate for Payer: Global Benefits Group Commercial |
$196.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$295.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$111.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$89.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67.89
|
| Rate for Payer: InnovAge PACE Commercial |
$101.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$218.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$90.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$90.97
|
| Rate for Payer: Multiplan Commercial |
$246.00
|
| Rate for Payer: Networks By Design Commercial |
$213.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$67.89
|
| Rate for Payer: Prime Health Services Commercial |
$278.80
|
| Rate for Payer: Prime Health Services Medicare |
$71.96
|
| Rate for Payer: Riverside University Health System MISP |
$74.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$196.80
|
| 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 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 |
$67.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$101.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.68
|
| Rate for Payer: Vantage Medical Group Senior |
$67.89
|
|
|
HC FINE NEEDLE ASPIRATION PG
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
CPT 88173
|
| Hospital Charge Code |
903800290
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$16.14 |
| Max. Negotiated Rate |
$111.34 |
| Rate for Payer: Adventist Health Commercial |
$24.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$67.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$74.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$101.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.89
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$79.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.14
|
| Rate for Payer: Blue Shield of California Commercial |
$74.05
|
| Rate for Payer: Blue Shield of California EPN |
$48.43
|
| Rate for Payer: Cash Price |
$67.10
|
| Rate for Payer: Cash Price |
$67.10
|
| 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 |
$101.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.65
|
| Rate for Payer: EPIC Health Plan Senior |
$67.89
|
| 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 |
$111.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$89.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67.89
|
| Rate for Payer: InnovAge PACE Commercial |
$101.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$81.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$90.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$90.97
|
| 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 |
$67.89
|
| Rate for Payer: Prime Health Services Commercial |
$103.70
|
| Rate for Payer: Prime Health Services Medicare |
$71.96
|
| Rate for Payer: Riverside University Health System MISP |
$74.68
|
| 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 |
$67.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$101.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.68
|
| Rate for Payer: Vantage Medical Group Senior |
$67.89
|
|
