|
HC FA STAIN INFLUENZA A
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 87276
|
| Hospital Charge Code |
900911781
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$79.75 |
| Rate for Payer: Adventist Health Medi-Cal |
$16.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$65.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.75
|
| Rate for Payer: Blue Distinction Transplant |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$24.10
|
| Rate for Payer: Blue Shield of California EPN |
$18.95
|
| Rate for Payer: Caremore Medicare Advantage |
$16.07
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Central Health Plan Commercial |
$31.20
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.10
|
| Rate for Payer: Dignity Health Media |
$16.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.69
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$16.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.07
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$26.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$26.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.07
|
| Rate for Payer: InnovAge PACE Commercial |
$24.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.53
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Prime Health Services Medicare |
$17.03
|
| Rate for Payer: Riverside University Health System MISP |
$17.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.01
|
| Rate for Payer: United Healthcare All Other HMO |
$13.01
|
| Rate for Payer: United Healthcare HMO Rider |
$13.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.68
|
| Rate for Payer: Vantage Medical Group Senior |
$16.07
|
|
|
HC FA STAIN INFLUENZA B
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT 87275
|
| Hospital Charge Code |
900911782
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$67.80 |
| Max. Negotiated Rate |
$305.10 |
| Rate for Payer: Cash Price |
$152.55
|
| Rate for Payer: Central Health Plan Commercial |
$271.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.60
|
| Rate for Payer: Galaxy Health WC |
$288.15
|
| Rate for Payer: Global Benefits Group Commercial |
$203.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$305.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$226.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$129.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.80
|
| Rate for Payer: Multiplan Commercial |
$254.25
|
| Rate for Payer: Networks By Design Commercial |
$220.35
|
| Rate for Payer: Prime Health Services Commercial |
$288.15
|
|
|
HC FA STAIN INFLUENZA B
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 87275
|
| Hospital Charge Code |
900911782
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$82.38 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$67.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$82.38
|
| Rate for Payer: Blue Distinction Transplant |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$24.10
|
| Rate for Payer: Blue Shield of California EPN |
$18.95
|
| Rate for Payer: Caremore Medicare Advantage |
$12.25
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Central Health Plan Commercial |
$31.20
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.38
|
| Rate for Payer: Dignity Health Media |
$12.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.54
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.25
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.25
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$20.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.25
|
| Rate for Payer: InnovAge PACE Commercial |
$18.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.42
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Prime Health Services Medicare |
$12.98
|
| Rate for Payer: Riverside University Health System MISP |
$13.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.93
|
| Rate for Payer: United Healthcare All Other HMO |
$9.93
|
| Rate for Payer: United Healthcare HMO Rider |
$9.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.48
|
| Rate for Payer: Vantage Medical Group Senior |
$12.25
|
|
|
HC FA STAIN LEGIONELLA
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 87278
|
| Hospital Charge Code |
900911733
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$79.75 |
| Rate for Payer: Adventist Health Medi-Cal |
$15.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$65.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.75
|
| Rate for Payer: Blue Distinction Transplant |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$24.10
|
| Rate for Payer: Blue Shield of California EPN |
$18.95
|
| Rate for Payer: Caremore Medicare Advantage |
$15.60
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Central Health Plan Commercial |
$31.20
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.40
|
| Rate for Payer: Dignity Health Media |
$15.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.06
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$15.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.60
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$25.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.60
|
| Rate for Payer: InnovAge PACE Commercial |
$23.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.90
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Prime Health Services Medicare |
$16.54
|
| Rate for Payer: Riverside University Health System MISP |
$17.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.64
|
| Rate for Payer: United Healthcare All Other HMO |
$12.64
|
| Rate for Payer: United Healthcare HMO Rider |
$12.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.16
|
| Rate for Payer: Vantage Medical Group Senior |
$15.60
|
|
|
HC FA STAIN LEGIONELLA
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT 87278
|
| Hospital Charge Code |
900911733
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$67.80 |
| Max. Negotiated Rate |
$305.10 |
| Rate for Payer: Cash Price |
$152.55
|
| Rate for Payer: Central Health Plan Commercial |
$271.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.60
|
| Rate for Payer: Galaxy Health WC |
$288.15
|
| Rate for Payer: Global Benefits Group Commercial |
$203.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$305.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$226.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$129.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.80
|
| Rate for Payer: Multiplan Commercial |
$254.25
|
| Rate for Payer: Networks By Design Commercial |
$220.35
|
| Rate for Payer: Prime Health Services Commercial |
$288.15
|
|
|
HC FA STAIN PARAINFLUENZA
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT 87279
|
| Hospital Charge Code |
900911783
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$67.80 |
| Max. Negotiated Rate |
$305.10 |
| Rate for Payer: Cash Price |
$152.55
|
| Rate for Payer: Central Health Plan Commercial |
$271.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.60
|
| Rate for Payer: Galaxy Health WC |
$288.15
|
| Rate for Payer: Global Benefits Group Commercial |
$203.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$305.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$226.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$129.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.80
|
| Rate for Payer: Multiplan Commercial |
$254.25
|
| Rate for Payer: Networks By Design Commercial |
$220.35
|
| Rate for Payer: Prime Health Services Commercial |
$288.15
|
|
|
HC FA STAIN PARAINFLUENZA
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 87279
|
| Hospital Charge Code |
900911783
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$82.38 |
| Rate for Payer: Adventist Health Medi-Cal |
$16.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$67.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$82.38
|
| Rate for Payer: Blue Distinction Transplant |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$24.10
|
| Rate for Payer: Blue Shield of California EPN |
$18.95
|
| Rate for Payer: Caremore Medicare Advantage |
$16.43
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Central Health Plan Commercial |
$31.20
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.64
|
| Rate for Payer: Dignity Health Media |
$16.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.18
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$16.43
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.43
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$26.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.43
|
| Rate for Payer: InnovAge PACE Commercial |
$24.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.02
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Prime Health Services Medicare |
$17.42
|
| Rate for Payer: Riverside University Health System MISP |
$18.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.31
|
| Rate for Payer: United Healthcare All Other HMO |
$13.31
|
| Rate for Payer: United Healthcare HMO Rider |
$13.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.07
|
| Rate for Payer: Vantage Medical Group Senior |
$16.43
|
|
|
HC FEEDER HABERMAN MINI
|
Facility
|
OP
|
$144.10
|
|
| Hospital Charge Code |
901603839
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.82 |
| Max. Negotiated Rate |
$129.69 |
| Rate for Payer: Aetna of CA HMO/PPO |
$87.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$122.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$79.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$79.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$69.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.13
|
| Rate for Payer: Blue Distinction Transplant |
$86.46
|
| Rate for Payer: Blue Shield of California Commercial |
$90.64
|
| Rate for Payer: Blue Shield of California EPN |
$70.46
|
| Rate for Payer: Cash Price |
$64.85
|
| Rate for Payer: Central Health Plan Commercial |
$115.28
|
| Rate for Payer: Cigna of CA HMO |
$92.22
|
| Rate for Payer: Cigna of CA PPO |
$106.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$122.48
|
| Rate for Payer: Dignity Health Media |
$122.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$122.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$57.64
|
| Rate for Payer: Galaxy Health WC |
$122.48
|
| Rate for Payer: Global Benefits Group Commercial |
$86.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$129.69
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$108.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$50.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$96.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.82
|
| Rate for Payer: Multiplan Commercial |
$108.08
|
| Rate for Payer: Networks By Design Commercial |
$93.66
|
| Rate for Payer: Prime Health Services Commercial |
$122.48
|
| Rate for Payer: Riverside University Health System MISP |
$57.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$86.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$86.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$72.05
|
| Rate for Payer: United Healthcare All Other HMO |
$72.05
|
| Rate for Payer: United Healthcare HMO Rider |
$72.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$72.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$122.48
|
| Rate for Payer: Vantage Medical Group Senior |
$122.48
|
|
|
HC FEEDER HABERMAN MINI
|
Facility
|
IP
|
$144.10
|
|
| Hospital Charge Code |
901603839
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.82 |
| Max. Negotiated Rate |
$129.69 |
| Rate for Payer: Cash Price |
$64.85
|
| Rate for Payer: Central Health Plan Commercial |
$115.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.64
|
| Rate for Payer: Galaxy Health WC |
$122.48
|
| Rate for Payer: Global Benefits Group Commercial |
$86.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$129.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$96.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.82
|
| Rate for Payer: Multiplan Commercial |
$108.08
|
| Rate for Payer: Networks By Design Commercial |
$93.66
|
| Rate for Payer: Prime Health Services Commercial |
$122.48
|
|
|
HC FEEDER HABERMAN REGULAR
|
Facility
|
OP
|
$139.08
|
|
| Hospital Charge Code |
901603250
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.82 |
| Max. Negotiated Rate |
$125.17 |
| Rate for Payer: Aetna of CA HMO/PPO |
$84.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$118.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$76.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$76.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$67.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$82.17
|
| Rate for Payer: Blue Distinction Transplant |
$83.45
|
| Rate for Payer: Blue Shield of California Commercial |
$87.48
|
| Rate for Payer: Blue Shield of California EPN |
$68.01
|
| Rate for Payer: Cash Price |
$62.59
|
| Rate for Payer: Central Health Plan Commercial |
$111.26
|
| Rate for Payer: Cigna of CA HMO |
$89.01
|
| Rate for Payer: Cigna of CA PPO |
$102.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$118.22
|
| Rate for Payer: Dignity Health Media |
$118.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$118.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$55.63
|
| Rate for Payer: Galaxy Health WC |
$118.22
|
| Rate for Payer: Global Benefits Group Commercial |
$83.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$125.17
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$104.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$48.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$92.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.82
|
| Rate for Payer: Multiplan Commercial |
$104.31
|
| Rate for Payer: Networks By Design Commercial |
$90.40
|
| Rate for Payer: Prime Health Services Commercial |
$118.22
|
| Rate for Payer: Riverside University Health System MISP |
$55.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$83.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$83.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$69.54
|
| Rate for Payer: United Healthcare All Other HMO |
$69.54
|
| Rate for Payer: United Healthcare HMO Rider |
$69.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$69.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$118.22
|
| Rate for Payer: Vantage Medical Group Senior |
$118.22
|
|
|
HC FEEDER HABERMAN REGULAR
|
Facility
|
IP
|
$139.08
|
|
| Hospital Charge Code |
901603250
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.82 |
| Max. Negotiated Rate |
$125.17 |
| Rate for Payer: Cash Price |
$62.59
|
| Rate for Payer: Central Health Plan Commercial |
$111.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.63
|
| Rate for Payer: Galaxy Health WC |
$118.22
|
| Rate for Payer: Global Benefits Group Commercial |
$83.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$125.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$92.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.82
|
| Rate for Payer: Multiplan Commercial |
$104.31
|
| Rate for Payer: Networks By Design Commercial |
$90.40
|
| Rate for Payer: Prime Health Services Commercial |
$118.22
|
|
|
HC FEET BOTH 1 VIEW
|
Facility
|
OP
|
$768.00
|
|
|
Service Code
|
CPT 73620
|
| Hospital Charge Code |
909001641
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.87 |
| Max. Negotiated Rate |
$691.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$113.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$109.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$102.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.22
|
| Rate for Payer: Blue Distinction Transplant |
$460.80
|
| Rate for Payer: Blue Shield of California Commercial |
$474.62
|
| Rate for Payer: Blue Shield of California EPN |
$373.25
|
| Rate for Payer: Caremore Medicare Advantage |
$113.54
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Central Health Plan Commercial |
$614.40
|
| Rate for Payer: Cigna of CA HMO |
$491.52
|
| Rate for Payer: Cigna of CA PPO |
$568.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Media |
$113.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.54
|
| Rate for Payer: Galaxy Health WC |
$652.80
|
| Rate for Payer: Global Benefits Group Commercial |
$460.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$691.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$576.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$186.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$187.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$113.54
|
| Rate for Payer: InnovAge PACE Commercial |
$170.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$512.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$152.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$576.00
|
| Rate for Payer: Networks By Design Commercial |
$499.20
|
| Rate for Payer: Prime Health Services Commercial |
$652.80
|
| Rate for Payer: Prime Health Services Medicare |
$120.35
|
| Rate for Payer: Riverside University Health System MISP |
$124.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$460.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$460.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC FEET BOTH 1 VIEW
|
Facility
|
IP
|
$768.00
|
|
|
Service Code
|
CPT 73620
|
| Hospital Charge Code |
909001641
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$153.60 |
| Max. Negotiated Rate |
$691.20 |
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Central Health Plan Commercial |
$614.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$307.20
|
| Rate for Payer: Galaxy Health WC |
$652.80
|
| Rate for Payer: Global Benefits Group Commercial |
$460.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$691.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$512.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$292.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.60
|
| Rate for Payer: Multiplan Commercial |
$576.00
|
| Rate for Payer: Networks By Design Commercial |
$499.20
|
| Rate for Payer: Prime Health Services Commercial |
$652.80
|
|
|
HC FEMALE GENITAL SYTM PROC UNLST
|
Facility
|
OP
|
$1,221.00
|
|
|
Service Code
|
CPT 58999
|
| Hospital Charge Code |
900501441
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$244.20 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$373.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$273.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$248.97
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$732.60
|
| Rate for Payer: Caremore Medicare Advantage |
$248.97
|
| Rate for Payer: Cash Price |
$549.45
|
| Rate for Payer: Cash Price |
$549.45
|
| Rate for Payer: Cash Price |
$549.45
|
| Rate for Payer: Cash Price |
$549.45
|
| Rate for Payer: Central Health Plan Commercial |
$976.80
|
| Rate for Payer: Cigna of CA PPO |
$903.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$373.46
|
| Rate for Payer: Dignity Health Media |
$248.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$273.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$336.11
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$248.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$248.97
|
| Rate for Payer: Galaxy Health WC |
$1,037.85
|
| Rate for Payer: Global Benefits Group Commercial |
$732.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,098.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$915.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$408.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$248.97
|
| Rate for Payer: InnovAge PACE Commercial |
$373.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$814.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$248.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$244.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$333.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$333.62
|
| Rate for Payer: Multiplan Commercial |
$915.75
|
| Rate for Payer: Networks By Design Commercial |
$793.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,037.85
|
| Rate for Payer: Prime Health Services Medicare |
$263.91
|
| Rate for Payer: Riverside University Health System MISP |
$273.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$732.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$610.50
|
| Rate for Payer: United Healthcare All Other HMO |
$610.50
|
| Rate for Payer: United Healthcare HMO Rider |
$610.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$610.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$373.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$273.87
|
| Rate for Payer: Vantage Medical Group Senior |
$248.97
|
|
|
HC FEMALE GENITAL SYTM PROC UNLST
|
Facility
|
IP
|
$1,221.00
|
|
|
Service Code
|
CPT 58999
|
| Hospital Charge Code |
900501441
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$244.20 |
| Max. Negotiated Rate |
$1,098.90 |
| Rate for Payer: Cash Price |
$549.45
|
| Rate for Payer: Central Health Plan Commercial |
$976.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$488.40
|
| Rate for Payer: Galaxy Health WC |
$1,037.85
|
| Rate for Payer: Global Benefits Group Commercial |
$732.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,098.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$814.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$465.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$244.20
|
| Rate for Payer: Multiplan Commercial |
$915.75
|
| Rate for Payer: Networks By Design Commercial |
$793.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,037.85
|
|
|
HC FEMALE GENITAL SYTM PROC UNLST
|
Facility
|
OP
|
$1,221.00
|
|
|
Service Code
|
CPT 58999
|
| Hospital Charge Code |
900501441
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$244.20 |
| Max. Negotiated Rate |
$3,079.84 |
| Rate for Payer: Adventist Health Medi-Cal |
$248.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$373.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$273.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$248.97
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$591.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$721.37
|
| Rate for Payer: Blue Distinction Transplant |
$732.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$248.97
|
| Rate for Payer: Cash Price |
$549.45
|
| Rate for Payer: Cash Price |
$549.45
|
| Rate for Payer: Central Health Plan Commercial |
$976.80
|
| Rate for Payer: Cigna of CA PPO |
$903.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$373.46
|
| Rate for Payer: Dignity Health Media |
$248.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$273.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$336.11
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$248.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$248.97
|
| Rate for Payer: Galaxy Health WC |
$1,037.85
|
| Rate for Payer: Global Benefits Group Commercial |
$732.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,098.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$915.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$408.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$410.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$248.97
|
| Rate for Payer: InnovAge PACE Commercial |
$373.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$814.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$248.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$244.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$333.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$333.62
|
| Rate for Payer: Multiplan Commercial |
$915.75
|
| Rate for Payer: Networks By Design Commercial |
$793.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,037.85
|
| Rate for Payer: Prime Health Services Medicare |
$263.91
|
| Rate for Payer: Riverside University Health System MISP |
$273.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$732.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$373.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$273.87
|
| Rate for Payer: Vantage Medical Group Senior |
$248.97
|
|
|
HC FEMALE GENITAL SYTM PROC UNLST
|
Facility
|
IP
|
$1,221.00
|
|
|
Service Code
|
CPT 58999
|
| Hospital Charge Code |
900501441
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$244.20 |
| Max. Negotiated Rate |
$1,098.90 |
| Rate for Payer: Cash Price |
$549.45
|
| Rate for Payer: Central Health Plan Commercial |
$976.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$488.40
|
| Rate for Payer: Galaxy Health WC |
$1,037.85
|
| Rate for Payer: Global Benefits Group Commercial |
$732.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,098.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$814.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$465.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$244.20
|
| Rate for Payer: Multiplan Commercial |
$915.75
|
| Rate for Payer: Networks By Design Commercial |
$793.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,037.85
|
|
|
HC FEMORAL LENGTH SOCK
|
Facility
|
IP
|
$224.00
|
|
|
Service Code
|
CPT L2850
|
| Hospital Charge Code |
905352850
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$44.80 |
| Max. Negotiated Rate |
$201.60 |
| Rate for Payer: Blue Shield of California EPN |
$119.62
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Central Health Plan Commercial |
$179.20
|
| Rate for Payer: Cigna of CA HMO |
$156.80
|
| Rate for Payer: Cigna of CA PPO |
$156.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$89.60
|
| Rate for Payer: Galaxy Health WC |
$190.40
|
| Rate for Payer: Global Benefits Group Commercial |
$134.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$201.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$149.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.80
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: Networks By Design Commercial |
$112.00
|
| Rate for Payer: Prime Health Services Commercial |
$190.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$84.58
|
| Rate for Payer: United Healthcare All Other HMO |
$82.61
|
| Rate for Payer: United Healthcare HMO Rider |
$80.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$73.92
|
|
|
HC FEMORAL LENGTH SOCK
|
Facility
|
OP
|
$224.00
|
|
|
Service Code
|
CPT L2850
|
| Hospital Charge Code |
905352850
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$46.82 |
| Max. Negotiated Rate |
$201.60 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$190.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$123.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$108.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.34
|
| Rate for Payer: Blue Distinction Transplant |
$134.40
|
| Rate for Payer: Blue Shield of California Commercial |
$168.00
|
| Rate for Payer: Blue Shield of California EPN |
$121.86
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Central Health Plan Commercial |
$179.20
|
| Rate for Payer: Cigna of CA HMO |
$156.80
|
| Rate for Payer: Cigna of CA PPO |
$156.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$190.40
|
| Rate for Payer: Dignity Health Media |
$190.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$190.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$89.60
|
| Rate for Payer: Galaxy Health WC |
$190.40
|
| Rate for Payer: Global Benefits Group Commercial |
$134.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$201.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$168.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$78.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$149.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.84
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: Networks By Design Commercial |
$112.00
|
| Rate for Payer: Prime Health Services Commercial |
$190.40
|
| Rate for Payer: Riverside University Health System MISP |
$89.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$134.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$134.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$112.00
|
| Rate for Payer: United Healthcare All Other HMO |
$112.00
|
| Rate for Payer: United Healthcare HMO Rider |
$112.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$112.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$190.40
|
| Rate for Payer: Vantage Medical Group Senior |
$190.40
|
|
|
HC FEMORAL NERVE BLOCK SINGLE
|
Facility
|
OP
|
$1,824.00
|
|
|
Service Code
|
CPT 64447
|
| Hospital Charge Code |
900501590
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$93.37 |
| Max. Negotiated Rate |
$2,696.00 |
| 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 |
$1,296.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$864.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,094.40
|
| Rate for Payer: Caremore Medicare Advantage |
$864.04
|
| Rate for Payer: Cash Price |
$820.80
|
| Rate for Payer: Cash Price |
$820.80
|
| Rate for Payer: Cash Price |
$820.80
|
| Rate for Payer: Cash Price |
$820.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,459.20
|
| Rate for Payer: Cigna of CA PPO |
$1,349.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Dignity Health Media |
$864.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$950.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,166.45
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$864.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$864.04
|
| Rate for Payer: Galaxy Health WC |
$1,550.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,094.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,641.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,368.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,417.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$864.04
|
| Rate for Payer: InnovAge PACE Commercial |
$1,296.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,216.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$864.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$364.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,157.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,157.81
|
| Rate for Payer: Multiplan Commercial |
$1,368.00
|
| Rate for Payer: Networks By Design Commercial |
$1,185.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,550.40
|
| Rate for Payer: Prime Health Services Medicare |
$915.88
|
| Rate for Payer: Riverside University Health System MISP |
$950.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,094.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$912.00
|
| Rate for Payer: United Healthcare All Other HMO |
$912.00
|
| Rate for Payer: United Healthcare HMO Rider |
$912.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$912.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Vantage Medical Group Senior |
$864.04
|
|
|
HC FEMORAL NERVE BLOCK SINGLE
|
Facility
|
IP
|
$1,824.00
|
|
|
Service Code
|
CPT 64447
|
| Hospital Charge Code |
900501590
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$364.80 |
| Max. Negotiated Rate |
$1,641.60 |
| Rate for Payer: Cash Price |
$820.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,459.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$729.60
|
| Rate for Payer: Galaxy Health WC |
$1,550.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,094.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,641.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,216.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$694.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$364.80
|
| Rate for Payer: Multiplan Commercial |
$1,368.00
|
| Rate for Payer: Networks By Design Commercial |
$1,185.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,550.40
|
|
|
HC FERRITIN
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 82728
|
| Hospital Charge Code |
900910819
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$120.91 |
| Rate for Payer: Adventist Health Medi-Cal |
$13.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$99.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$99.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$120.91
|
| Rate for Payer: Blue Distinction Transplant |
$15.00
|
| Rate for Payer: Blue Shield of California Commercial |
$15.45
|
| Rate for Payer: Blue Shield of California EPN |
$12.15
|
| Rate for Payer: Caremore Medicare Advantage |
$13.63
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: Cigna of CA HMO |
$16.00
|
| Rate for Payer: Cigna of CA PPO |
$18.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.44
|
| Rate for Payer: Dignity Health Media |
$13.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.40
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.63
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$18.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.63
|
| Rate for Payer: InnovAge PACE Commercial |
$20.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.26
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Prime Health Services Medicare |
$14.45
|
| Rate for Payer: Riverside University Health System MISP |
$14.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.04
|
| Rate for Payer: United Healthcare All Other HMO |
$11.04
|
| Rate for Payer: United Healthcare HMO Rider |
$11.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.99
|
| Rate for Payer: Vantage Medical Group Senior |
$13.63
|
|
|
HC FERRITIN
|
Facility
|
IP
|
$244.00
|
|
|
Service Code
|
CPT 82728
|
| Hospital Charge Code |
900910819
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.80 |
| Max. Negotiated Rate |
$219.60 |
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Central Health Plan Commercial |
$195.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.60
|
| Rate for Payer: Galaxy Health WC |
$207.40
|
| Rate for Payer: Global Benefits Group Commercial |
$146.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$219.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$162.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.80
|
| Rate for Payer: Multiplan Commercial |
$183.00
|
| Rate for Payer: Networks By Design Commercial |
$158.60
|
| Rate for Payer: Prime Health Services Commercial |
$207.40
|
|
|
HC FETAL BLEED SCREEN
|
Facility
|
IP
|
$312.00
|
|
|
Service Code
|
CPT 85461
|
| Hospital Charge Code |
900904562
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$62.40 |
| Max. Negotiated Rate |
$280.80 |
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Central Health Plan Commercial |
$249.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.80
|
| Rate for Payer: Galaxy Health WC |
$265.20
|
| Rate for Payer: Global Benefits Group Commercial |
$187.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$280.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$208.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.40
|
| Rate for Payer: Multiplan Commercial |
$234.00
|
| Rate for Payer: Networks By Design Commercial |
$202.80
|
| Rate for Payer: Prime Health Services Commercial |
$265.20
|
|
|
HC FETAL BLEED SCREEN
|
Facility
|
OP
|
$312.00
|
|
|
Service Code
|
CPT 85461
|
| Hospital Charge Code |
900904562
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.58 |
| Max. Negotiated Rate |
$280.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$9.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$48.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$111.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$135.73
|
| Rate for Payer: Blue Distinction Transplant |
$187.20
|
| Rate for Payer: Blue Shield of California Commercial |
$192.82
|
| Rate for Payer: Blue Shield of California EPN |
$151.63
|
| Rate for Payer: Caremore Medicare Advantage |
$9.36
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Central Health Plan Commercial |
$249.60
|
| Rate for Payer: Cigna of CA HMO |
$199.68
|
| Rate for Payer: Cigna of CA PPO |
$230.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.04
|
| Rate for Payer: Dignity Health Media |
$9.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.64
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$9.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.36
|
| Rate for Payer: Galaxy Health WC |
$265.20
|
| Rate for Payer: Global Benefits Group Commercial |
$187.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$280.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$234.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$15.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.36
|
| Rate for Payer: InnovAge PACE Commercial |
$14.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$208.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.54
|
| Rate for Payer: Multiplan Commercial |
$234.00
|
| Rate for Payer: Networks By Design Commercial |
$202.80
|
| Rate for Payer: Prime Health Services Commercial |
$265.20
|
| Rate for Payer: Prime Health Services Medicare |
$9.92
|
| Rate for Payer: Riverside University Health System MISP |
$10.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$187.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$187.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.58
|
| Rate for Payer: United Healthcare All Other HMO |
$7.58
|
| Rate for Payer: United Healthcare HMO Rider |
$7.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.30
|
| Rate for Payer: Vantage Medical Group Senior |
$9.36
|
|
