|
HC FETAL DOPPLER UMBILICAL ARTERY
|
Facility
|
IP
|
$1,756.00
|
|
|
Service Code
|
CPT 76820
|
| Hospital Charge Code |
906601315
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$351.20 |
| Max. Negotiated Rate |
$1,580.40 |
| Rate for Payer: Cash Price |
$790.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,404.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$702.40
|
| Rate for Payer: Galaxy Health WC |
$1,492.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,053.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,580.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,171.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$669.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$351.20
|
| Rate for Payer: Multiplan Commercial |
$1,317.00
|
| Rate for Payer: Networks By Design Commercial |
$1,141.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,492.60
|
|
|
HC FETAL DOPPLER UMBILICAL ARTERY
|
Facility
|
OP
|
$1,756.00
|
|
|
Service Code
|
CPT 76820
|
| Hospital Charge Code |
906601315
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$73.59 |
| Max. Negotiated Rate |
$1,580.40 |
| Rate for Payer: Adventist Health Medi-Cal |
$137.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$125.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$332.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,037.44
|
| Rate for Payer: Blue Distinction Transplant |
$1,053.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,085.21
|
| Rate for Payer: Blue Shield of California EPN |
$853.42
|
| Rate for Payer: Caremore Medicare Advantage |
$137.36
|
| Rate for Payer: Cash Price |
$790.20
|
| Rate for Payer: Cash Price |
$790.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,404.80
|
| Rate for Payer: Cigna of CA HMO |
$1,123.84
|
| Rate for Payer: Cigna of CA PPO |
$1,299.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$1,492.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,053.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,580.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,317.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$226.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: InnovAge PACE Commercial |
$206.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,171.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$351.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$1,317.00
|
| Rate for Payer: Networks By Design Commercial |
$1,141.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,492.60
|
| Rate for Payer: Prime Health Services Medicare |
$145.60
|
| Rate for Payer: Riverside University Health System MISP |
$151.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,053.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,053.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$161.07
|
| Rate for Payer: United Healthcare All Other HMO |
$161.07
|
| Rate for Payer: United Healthcare HMO Rider |
$161.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$161.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC FETAL FIBRONECTIN
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
CPT 82731
|
| Hospital Charge Code |
900912319
|
|
Hospital Revenue Code
|
304
|
| Min. Negotiated Rate |
$37.00 |
| Max. Negotiated Rate |
$1,194.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$64.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$472.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$96.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$70.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$64.41
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$979.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,194.80
|
| Rate for Payer: Blue Distinction Transplant |
$111.00
|
| Rate for Payer: Blue Shield of California Commercial |
$114.33
|
| Rate for Payer: Blue Shield of California EPN |
$89.91
|
| Rate for Payer: Caremore Medicare Advantage |
$64.41
|
| Rate for Payer: Cash Price |
$83.25
|
| Rate for Payer: Cash Price |
$83.25
|
| Rate for Payer: Central Health Plan Commercial |
$148.00
|
| Rate for Payer: Cigna of CA HMO |
$118.40
|
| Rate for Payer: Cigna of CA PPO |
$136.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$96.62
|
| Rate for Payer: Dignity Health Media |
$64.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$70.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.95
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$64.41
|
| Rate for Payer: EPIC Health Plan Transplant |
$64.41
|
| Rate for Payer: Galaxy Health WC |
$157.25
|
| Rate for Payer: Global Benefits Group Commercial |
$111.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$166.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$138.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$105.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$106.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$64.41
|
| Rate for Payer: InnovAge PACE Commercial |
$96.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$123.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$64.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$86.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$86.31
|
| Rate for Payer: Multiplan Commercial |
$138.75
|
| Rate for Payer: Networks By Design Commercial |
$120.25
|
| Rate for Payer: Prime Health Services Commercial |
$157.25
|
| Rate for Payer: Prime Health Services Medicare |
$68.27
|
| Rate for Payer: Riverside University Health System MISP |
$70.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$111.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$111.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$52.17
|
| Rate for Payer: United Healthcare All Other HMO |
$52.17
|
| Rate for Payer: United Healthcare HMO Rider |
$52.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$96.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$70.85
|
| Rate for Payer: Vantage Medical Group Senior |
$64.41
|
|
|
HC FETAL FIBRONECTIN
|
Facility
|
IP
|
$1,607.00
|
|
|
Service Code
|
CPT 82731
|
| Hospital Charge Code |
900912319
|
|
Hospital Revenue Code
|
304
|
| Min. Negotiated Rate |
$321.40 |
| Max. Negotiated Rate |
$1,446.30 |
| Rate for Payer: Cash Price |
$723.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,285.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$642.80
|
| Rate for Payer: Galaxy Health WC |
$1,365.95
|
| Rate for Payer: Global Benefits Group Commercial |
$964.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,446.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,071.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$612.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$321.40
|
| Rate for Payer: Multiplan Commercial |
$1,205.25
|
| Rate for Payer: Networks By Design Commercial |
$1,044.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,365.95
|
|
|
HC FETAL FLUID DRAIN INCLUD US GU
|
Facility
|
OP
|
$840.00
|
|
|
Service Code
|
CPT 59074
|
| Hospital Charge Code |
910400098
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$168.00 |
| Max. Negotiated Rate |
$5,779.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$601.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$400.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$504.00
|
| Rate for Payer: Blue Shield of California Commercial |
$528.36
|
| Rate for Payer: Blue Shield of California EPN |
$410.76
|
| Rate for Payer: Caremore Medicare Advantage |
$400.82
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Central Health Plan Commercial |
$672.00
|
| Rate for Payer: Cigna of CA HMO |
$537.60
|
| Rate for Payer: Cigna of CA PPO |
$621.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$601.23
|
| Rate for Payer: Dignity Health Media |
$400.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$440.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$541.11
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$400.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$400.82
|
| Rate for Payer: Galaxy Health WC |
$714.00
|
| Rate for Payer: Global Benefits Group Commercial |
$504.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$756.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$630.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$657.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$661.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$400.82
|
| Rate for Payer: InnovAge PACE Commercial |
$601.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$560.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$638.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$400.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$537.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$537.10
|
| Rate for Payer: Multiplan Commercial |
$630.00
|
| Rate for Payer: Networks By Design Commercial |
$546.00
|
| Rate for Payer: Prime Health Services Commercial |
$714.00
|
| Rate for Payer: Prime Health Services Medicare |
$424.87
|
| Rate for Payer: Riverside University Health System MISP |
$440.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$504.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$504.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,036.00
|
| Rate for Payer: United Healthcare All Other HMO |
$799.00
|
| Rate for Payer: United Healthcare HMO Rider |
$605.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$552.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$601.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: Vantage Medical Group Senior |
$400.82
|
|
|
HC FETAL FLUID DRAIN INCLUD US GU
|
Facility
|
IP
|
$840.00
|
|
|
Service Code
|
CPT 59074
|
| Hospital Charge Code |
910400098
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$168.00 |
| Max. Negotiated Rate |
$756.00 |
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Central Health Plan Commercial |
$672.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$336.00
|
| Rate for Payer: Galaxy Health WC |
$714.00
|
| Rate for Payer: Global Benefits Group Commercial |
$504.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$756.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$560.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$320.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.00
|
| Rate for Payer: Multiplan Commercial |
$630.00
|
| Rate for Payer: Networks By Design Commercial |
$546.00
|
| Rate for Payer: Prime Health Services Commercial |
$714.00
|
|
|
HC FETAL LUNG MATURITY (FLM)
|
Facility
|
OP
|
$486.00
|
|
|
Service Code
|
CPT 83663
|
| Hospital Charge Code |
900910962
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.32 |
| Max. Negotiated Rate |
$437.40 |
| Rate for Payer: Adventist Health Medi-Cal |
$18.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$138.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$68.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$83.87
|
| Rate for Payer: Blue Distinction Transplant |
$291.60
|
| Rate for Payer: Blue Shield of California Commercial |
$300.35
|
| Rate for Payer: Blue Shield of California EPN |
$236.20
|
| Rate for Payer: Caremore Medicare Advantage |
$18.91
|
| Rate for Payer: Cash Price |
$218.70
|
| Rate for Payer: Cash Price |
$218.70
|
| Rate for Payer: Central Health Plan Commercial |
$388.80
|
| Rate for Payer: Cigna of CA HMO |
$311.04
|
| Rate for Payer: Cigna of CA PPO |
$359.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.36
|
| Rate for Payer: Dignity Health Media |
$18.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.53
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$18.91
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.91
|
| Rate for Payer: Galaxy Health WC |
$413.10
|
| Rate for Payer: Global Benefits Group Commercial |
$291.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$437.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$364.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$31.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$31.20
|
| 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 |
$324.16
|
| 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 |
$97.20
|
| 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 |
$364.50
|
| Rate for Payer: Networks By Design Commercial |
$315.90
|
| Rate for Payer: Prime Health Services Commercial |
$413.10
|
| 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 |
$291.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$291.60
|
| 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: 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 LUNG MATURITY (FLM)
|
Facility
|
IP
|
$486.00
|
|
|
Service Code
|
CPT 83663
|
| Hospital Charge Code |
900910962
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$97.20 |
| Max. Negotiated Rate |
$437.40 |
| Rate for Payer: Cash Price |
$218.70
|
| Rate for Payer: Central Health Plan Commercial |
$388.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$194.40
|
| Rate for Payer: Galaxy Health WC |
$413.10
|
| Rate for Payer: Global Benefits Group Commercial |
$291.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$437.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$324.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$185.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.20
|
| Rate for Payer: Multiplan Commercial |
$364.50
|
| Rate for Payer: Networks By Design Commercial |
$315.90
|
| Rate for Payer: Prime Health Services Commercial |
$413.10
|
|
|
HC FETAL MONITOR CONT HRLY
|
Facility
|
IP
|
$41.00
|
|
| Hospital Charge Code |
902400355
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$36.90 |
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Central Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.40
|
| Rate for Payer: Galaxy Health WC |
$34.85
|
| Rate for Payer: Global Benefits Group Commercial |
$24.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.20
|
| Rate for Payer: Multiplan Commercial |
$30.75
|
| Rate for Payer: Networks By Design Commercial |
$26.65
|
| Rate for Payer: Prime Health Services Commercial |
$34.85
|
|
|
HC FETAL MONITOR CONT HRLY
|
Facility
|
OP
|
$41.00
|
|
| Hospital Charge Code |
902400355
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$1,036.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$24.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$19.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.22
|
| Rate for Payer: Blue Distinction Transplant |
$24.60
|
| Rate for Payer: Blue Shield of California Commercial |
$25.79
|
| Rate for Payer: Blue Shield of California EPN |
$20.05
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Central Health Plan Commercial |
$32.80
|
| Rate for Payer: Cigna of CA HMO |
$26.24
|
| Rate for Payer: Cigna of CA PPO |
$30.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.85
|
| Rate for Payer: Dignity Health Media |
$34.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.40
|
| Rate for Payer: Galaxy Health WC |
$34.85
|
| Rate for Payer: Global Benefits Group Commercial |
$24.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$30.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.20
|
| Rate for Payer: Multiplan Commercial |
$30.75
|
| Rate for Payer: Networks By Design Commercial |
$26.65
|
| Rate for Payer: Prime Health Services Commercial |
$34.85
|
| Rate for Payer: Riverside University Health System MISP |
$16.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,036.00
|
| Rate for Payer: United Healthcare All Other HMO |
$799.00
|
| Rate for Payer: United Healthcare HMO Rider |
$605.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$552.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.85
|
| Rate for Payer: Vantage Medical Group Senior |
$34.85
|
|
|
HC FETAL MONITORING W/REPORT
|
Facility
|
OP
|
$884.00
|
|
|
Service Code
|
CPT 59050
|
| Hospital Charge Code |
902890264
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$154.03 |
| Max. Negotiated Rate |
$2,356.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$279.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$751.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$486.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$486.20
|
| 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 |
$530.40
|
| Rate for Payer: Blue Shield of California Commercial |
$556.04
|
| Rate for Payer: Blue Shield of California EPN |
$432.28
|
| Rate for Payer: Cash Price |
$397.80
|
| Rate for Payer: Cash Price |
$397.80
|
| Rate for Payer: Cash Price |
$397.80
|
| Rate for Payer: Central Health Plan Commercial |
$707.20
|
| Rate for Payer: Cigna of CA HMO |
$565.76
|
| Rate for Payer: Cigna of CA PPO |
$654.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$751.40
|
| Rate for Payer: Dignity Health Media |
$751.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$751.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$353.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$353.60
|
| Rate for Payer: Galaxy Health WC |
$751.40
|
| Rate for Payer: Global Benefits Group Commercial |
$530.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$795.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$663.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$309.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$589.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$154.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.80
|
| Rate for Payer: Multiplan Commercial |
$663.00
|
| Rate for Payer: Networks By Design Commercial |
$574.60
|
| Rate for Payer: Prime Health Services Commercial |
$751.40
|
| Rate for Payer: Riverside University Health System MISP |
$353.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$530.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$530.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$442.00
|
| Rate for Payer: United Healthcare All Other HMO |
$442.00
|
| Rate for Payer: United Healthcare HMO Rider |
$442.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$442.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$751.40
|
| Rate for Payer: Vantage Medical Group Senior |
$751.40
|
|
|
HC FETAL MONITORING W/REPORT
|
Facility
|
IP
|
$884.00
|
|
|
Service Code
|
CPT 59050
|
| Hospital Charge Code |
902890264
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$176.80 |
| Max. Negotiated Rate |
$795.60 |
| Rate for Payer: Cash Price |
$397.80
|
| Rate for Payer: Central Health Plan Commercial |
$707.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$353.60
|
| Rate for Payer: Galaxy Health WC |
$751.40
|
| Rate for Payer: Global Benefits Group Commercial |
$530.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$795.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$589.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$336.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.80
|
| Rate for Payer: Multiplan Commercial |
$663.00
|
| Rate for Payer: Networks By Design Commercial |
$574.60
|
| Rate for Payer: Prime Health Services Commercial |
$751.40
|
|
|
HC FETAL NON-STRESS TEST
|
Facility
|
OP
|
$1,210.00
|
|
|
Service Code
|
CPT 59025
|
| Hospital Charge Code |
902400362
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$83.35 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$248.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$104.43
|
| 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 |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$726.00
|
| Rate for Payer: Blue Shield of California Commercial |
$761.09
|
| Rate for Payer: Blue Shield of California EPN |
$591.69
|
| Rate for Payer: Caremore Medicare Advantage |
$248.97
|
| Rate for Payer: Cash Price |
$544.50
|
| Rate for Payer: Cash Price |
$544.50
|
| Rate for Payer: Cash Price |
$544.50
|
| Rate for Payer: Central Health Plan Commercial |
$968.00
|
| Rate for Payer: Cigna of CA HMO |
$774.40
|
| Rate for Payer: Cigna of CA PPO |
$895.40
|
| 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 |
$1,028.50
|
| Rate for Payer: Global Benefits Group Commercial |
$726.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,089.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$907.50
|
| 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 |
$807.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$248.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$242.00
|
| 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 |
$907.50
|
| Rate for Payer: Networks By Design Commercial |
$786.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,028.50
|
| 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 |
$726.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$726.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,036.00
|
| Rate for Payer: United Healthcare All Other HMO |
$799.00
|
| Rate for Payer: United Healthcare HMO Rider |
$605.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$552.00
|
| 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 FETAL NON-STRESS TEST
|
Facility
|
IP
|
$1,210.00
|
|
|
Service Code
|
CPT 59025
|
| Hospital Charge Code |
902400362
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$242.00 |
| Max. Negotiated Rate |
$1,089.00 |
| Rate for Payer: Cash Price |
$544.50
|
| Rate for Payer: Central Health Plan Commercial |
$968.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$484.00
|
| Rate for Payer: Galaxy Health WC |
$1,028.50
|
| Rate for Payer: Global Benefits Group Commercial |
$726.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,089.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$807.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$461.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$242.00
|
| Rate for Payer: Multiplan Commercial |
$907.50
|
| Rate for Payer: Networks By Design Commercial |
$786.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,028.50
|
|
|
HC FETAL SHUNT PLACEMENT
|
Facility
|
OP
|
$764.00
|
|
|
Service Code
|
CPT 59076
|
| Hospital Charge Code |
910400092
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$152.80 |
| Max. Negotiated Rate |
$5,779.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$601.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$400.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$458.40
|
| Rate for Payer: Blue Shield of California Commercial |
$480.56
|
| Rate for Payer: Blue Shield of California EPN |
$373.60
|
| Rate for Payer: Caremore Medicare Advantage |
$400.82
|
| Rate for Payer: Cash Price |
$343.80
|
| Rate for Payer: Cash Price |
$343.80
|
| Rate for Payer: Cash Price |
$343.80
|
| Rate for Payer: Central Health Plan Commercial |
$611.20
|
| Rate for Payer: Cigna of CA HMO |
$488.96
|
| Rate for Payer: Cigna of CA PPO |
$565.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$601.23
|
| Rate for Payer: Dignity Health Media |
$400.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$440.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$541.11
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$400.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$400.82
|
| Rate for Payer: Galaxy Health WC |
$649.40
|
| Rate for Payer: Global Benefits Group Commercial |
$458.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$687.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$573.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$657.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$661.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$400.82
|
| Rate for Payer: InnovAge PACE Commercial |
$601.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$509.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$540.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$400.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$537.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$537.10
|
| Rate for Payer: Multiplan Commercial |
$573.00
|
| Rate for Payer: Networks By Design Commercial |
$496.60
|
| Rate for Payer: Prime Health Services Commercial |
$649.40
|
| Rate for Payer: Prime Health Services Medicare |
$424.87
|
| Rate for Payer: Riverside University Health System MISP |
$440.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$458.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$458.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,036.00
|
| Rate for Payer: United Healthcare All Other HMO |
$799.00
|
| Rate for Payer: United Healthcare HMO Rider |
$605.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$552.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$601.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: Vantage Medical Group Senior |
$400.82
|
|
|
HC FETAL SHUNT PLACEMENT
|
Facility
|
IP
|
$764.00
|
|
|
Service Code
|
CPT 59076
|
| Hospital Charge Code |
910400092
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$152.80 |
| Max. Negotiated Rate |
$687.60 |
| Rate for Payer: Cash Price |
$343.80
|
| Rate for Payer: Central Health Plan Commercial |
$611.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.60
|
| Rate for Payer: Galaxy Health WC |
$649.40
|
| Rate for Payer: Global Benefits Group Commercial |
$458.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$687.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$509.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$291.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.80
|
| Rate for Payer: Multiplan Commercial |
$573.00
|
| Rate for Payer: Networks By Design Commercial |
$496.60
|
| Rate for Payer: Prime Health Services Commercial |
$649.40
|
|
|
HC FFP PED PAK ALIQUOT
|
Facility
|
OP
|
$271.00
|
|
|
Service Code
|
CPT P9011
|
| Hospital Charge Code |
900904530
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$54.20 |
| Max. Negotiated Rate |
$642.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$195.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$338.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$293.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$215.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$195.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$131.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$160.11
|
| Rate for Payer: Blue Distinction Transplant |
$162.60
|
| Rate for Payer: Blue Shield of California Commercial |
$170.46
|
| Rate for Payer: Blue Shield of California EPN |
$132.52
|
| Rate for Payer: Caremore Medicare Advantage |
$195.48
|
| Rate for Payer: Cash Price |
$121.95
|
| Rate for Payer: Cash Price |
$121.95
|
| Rate for Payer: Cash Price |
$121.95
|
| Rate for Payer: Central Health Plan Commercial |
$216.80
|
| Rate for Payer: Cigna of CA HMO |
$173.44
|
| Rate for Payer: Cigna of CA PPO |
$200.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$293.22
|
| Rate for Payer: Dignity Health Media |
$195.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$215.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$263.90
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$195.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$195.48
|
| Rate for Payer: Galaxy Health WC |
$230.35
|
| Rate for Payer: Global Benefits Group Commercial |
$162.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$243.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$203.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$320.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$322.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$195.48
|
| Rate for Payer: InnovAge PACE Commercial |
$293.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$180.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$283.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$195.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$261.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$261.94
|
| Rate for Payer: Multiplan Commercial |
$203.25
|
| Rate for Payer: Networks By Design Commercial |
$176.15
|
| Rate for Payer: Prime Health Services Commercial |
$230.35
|
| Rate for Payer: Prime Health Services Medicare |
$207.21
|
| Rate for Payer: Riverside University Health System MISP |
$215.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$162.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$162.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$642.00
|
| Rate for Payer: United Healthcare All Other HMO |
$631.00
|
| Rate for Payer: United Healthcare HMO Rider |
$630.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$575.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$293.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$215.03
|
| Rate for Payer: Vantage Medical Group Senior |
$195.48
|
|
|
HC FFP PED PAK ALIQUOT
|
Facility
|
IP
|
$271.00
|
|
|
Service Code
|
CPT P9011
|
| Hospital Charge Code |
900904530
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$54.20 |
| Max. Negotiated Rate |
$243.90 |
| Rate for Payer: Cash Price |
$121.95
|
| Rate for Payer: Central Health Plan Commercial |
$216.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.40
|
| Rate for Payer: Galaxy Health WC |
$230.35
|
| Rate for Payer: Global Benefits Group Commercial |
$162.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$243.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$180.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$103.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.20
|
| Rate for Payer: Multiplan Commercial |
$203.25
|
| Rate for Payer: Networks By Design Commercial |
$176.15
|
| Rate for Payer: Prime Health Services Commercial |
$230.35
|
|
|
HC FFP SPLIT UNIT GT 150 ML
|
Facility
|
OP
|
$354.00
|
|
|
Service Code
|
CPT P9011
|
| Hospital Charge Code |
900904533
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$70.80 |
| Max. Negotiated Rate |
$642.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$195.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$338.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$293.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$215.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$195.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$171.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$209.14
|
| Rate for Payer: Blue Distinction Transplant |
$212.40
|
| Rate for Payer: Blue Shield of California Commercial |
$222.67
|
| Rate for Payer: Blue Shield of California EPN |
$173.11
|
| Rate for Payer: Caremore Medicare Advantage |
$195.48
|
| Rate for Payer: Cash Price |
$159.30
|
| Rate for Payer: Cash Price |
$159.30
|
| Rate for Payer: Cash Price |
$159.30
|
| Rate for Payer: Central Health Plan Commercial |
$283.20
|
| Rate for Payer: Cigna of CA HMO |
$226.56
|
| Rate for Payer: Cigna of CA PPO |
$261.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$293.22
|
| Rate for Payer: Dignity Health Media |
$195.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$215.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$263.90
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$195.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$195.48
|
| Rate for Payer: Galaxy Health WC |
$300.90
|
| Rate for Payer: Global Benefits Group Commercial |
$212.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$318.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$265.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$320.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$322.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$195.48
|
| Rate for Payer: InnovAge PACE Commercial |
$293.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$236.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$283.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$195.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$261.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$261.94
|
| Rate for Payer: Multiplan Commercial |
$265.50
|
| Rate for Payer: Networks By Design Commercial |
$230.10
|
| Rate for Payer: Prime Health Services Commercial |
$300.90
|
| Rate for Payer: Prime Health Services Medicare |
$207.21
|
| Rate for Payer: Riverside University Health System MISP |
$215.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$212.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$212.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$642.00
|
| Rate for Payer: United Healthcare All Other HMO |
$631.00
|
| Rate for Payer: United Healthcare HMO Rider |
$630.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$575.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$293.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$215.03
|
| Rate for Payer: Vantage Medical Group Senior |
$195.48
|
|
|
HC FFP SPLIT UNIT GT 150 ML
|
Facility
|
IP
|
$354.00
|
|
|
Service Code
|
CPT P9011
|
| Hospital Charge Code |
900904533
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$70.80 |
| Max. Negotiated Rate |
$318.60 |
| Rate for Payer: Cash Price |
$159.30
|
| Rate for Payer: Central Health Plan Commercial |
$283.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$141.60
|
| Rate for Payer: Galaxy Health WC |
$300.90
|
| Rate for Payer: Global Benefits Group Commercial |
$212.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$318.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$236.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$134.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.80
|
| Rate for Payer: Multiplan Commercial |
$265.50
|
| Rate for Payer: Networks By Design Commercial |
$230.10
|
| Rate for Payer: Prime Health Services Commercial |
$300.90
|
|
|
HC FIBRIN DEGRAD SPLIT PRODUCTS
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
CPT 85362
|
| Hospital Charge Code |
900910069
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.40 |
| Max. Negotiated Rate |
$61.05 |
| Rate for Payer: Adventist Health Medi-Cal |
$6.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$48.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.34
|
| Rate for Payer: Alpha Care Medical Group 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 |
$61.05
|
| Rate for Payer: Blue Distinction Transplant |
$16.20
|
| Rate for Payer: Blue Shield of California Commercial |
$16.69
|
| Rate for Payer: Blue Shield of California EPN |
$13.12
|
| Rate for Payer: Caremore Medicare Advantage |
$6.89
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Central Health Plan Commercial |
$21.60
|
| Rate for Payer: Cigna of CA HMO |
$17.28
|
| Rate for Payer: Cigna of CA PPO |
$19.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.34
|
| Rate for Payer: Dignity Health Media |
$6.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.30
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6.89
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.89
|
| Rate for Payer: Galaxy Health WC |
$22.95
|
| Rate for Payer: Global Benefits Group Commercial |
$16.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$24.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$20.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11.37
|
| 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 |
$18.01
|
| 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 |
$5.40
|
| 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 |
$20.25
|
| Rate for Payer: Networks By Design Commercial |
$17.55
|
| Rate for Payer: Prime Health Services Commercial |
$22.95
|
| 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 |
$16.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.20
|
| 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: 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
|
$276.00
|
|
|
Service Code
|
CPT 85362
|
| Hospital Charge Code |
900910069
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$55.20 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Central Health Plan Commercial |
$220.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$110.40
|
| Rate for Payer: Galaxy Health WC |
$234.60
|
| Rate for Payer: Global Benefits Group Commercial |
$165.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$248.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$184.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$105.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.20
|
| Rate for Payer: Multiplan Commercial |
$207.00
|
| Rate for Payer: Networks By Design Commercial |
$179.40
|
| Rate for Payer: Prime Health Services Commercial |
$234.60
|
|
|
HC FIBRINOGEN ASSAY
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
CPT 85384
|
| Hospital Charge Code |
900910013
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.40 |
| Max. Negotiated Rate |
$74.91 |
| Rate for Payer: Adventist Health Medi-Cal |
$9.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$62.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.58
|
| Rate for Payer: Alpha Care Medical Group 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 |
$74.91
|
| Rate for Payer: Blue Distinction Transplant |
$19.20
|
| Rate for Payer: Blue Shield of California Commercial |
$19.78
|
| Rate for Payer: Blue Shield of California EPN |
$15.55
|
| Rate for Payer: Caremore Medicare Advantage |
$9.72
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Central Health Plan Commercial |
$25.60
|
| Rate for Payer: Cigna of CA HMO |
$20.48
|
| Rate for Payer: Cigna of CA PPO |
$23.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.58
|
| Rate for Payer: Dignity Health Media |
$9.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.12
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$9.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.72
|
| Rate for Payer: Galaxy Health WC |
$27.20
|
| Rate for Payer: Global Benefits Group Commercial |
$19.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$24.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$16.04
|
| 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 |
$21.34
|
| 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 |
$6.40
|
| 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 |
$24.00
|
| Rate for Payer: Networks By Design Commercial |
$20.80
|
| Rate for Payer: Prime Health Services Commercial |
$27.20
|
| 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 |
$19.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.20
|
| 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: 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 FIBRINOGEN ASSAY
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
CPT 85384
|
| Hospital Charge Code |
900910013
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$63.00 |
| Max. Negotiated Rate |
$283.50 |
| Rate for Payer: Cash Price |
$141.75
|
| Rate for Payer: Central Health Plan Commercial |
$252.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.00
|
| Rate for Payer: Galaxy Health WC |
$267.75
|
| Rate for Payer: Global Benefits Group Commercial |
$189.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$283.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$210.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.00
|
| Rate for Payer: Multiplan Commercial |
$236.25
|
| Rate for Payer: Networks By Design Commercial |
$204.75
|
| Rate for Payer: Prime Health Services Commercial |
$267.75
|
|
|
HC FINE NDL ASP WO IMG EA ADD LSN
|
Facility
|
OP
|
$583.00
|
|
|
Service Code
|
CPT 10004
|
| Hospital Charge Code |
903810004
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$85.60 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$495.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$320.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$320.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$349.80
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$262.35
|
| Rate for Payer: Cash Price |
$262.35
|
| Rate for Payer: Cash Price |
$262.35
|
| Rate for Payer: Central Health Plan Commercial |
$466.40
|
| Rate for Payer: Cigna of CA PPO |
$431.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$495.55
|
| Rate for Payer: Dignity Health Media |
$495.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$495.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$233.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$233.20
|
| Rate for Payer: Galaxy Health WC |
$495.55
|
| Rate for Payer: Global Benefits Group Commercial |
$349.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$524.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$437.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$204.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$388.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.60
|
| Rate for Payer: Multiplan Commercial |
$437.25
|
| Rate for Payer: Networks By Design Commercial |
$378.95
|
| Rate for Payer: Prime Health Services Commercial |
$495.55
|
| Rate for Payer: Riverside University Health System MISP |
$233.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$349.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$495.55
|
| Rate for Payer: Vantage Medical Group Senior |
$495.55
|
|
