|
HC MERO ETEST
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
900913009
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Central Health Plan Commercial |
$12.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6.00
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
|
|
HC MERO ETEST
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
900913009
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$22.81 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.75
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$16.41
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$16.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.81
|
| Rate for Payer: Blue Shield of California Commercial |
$9.45
|
| Rate for Payer: Blue Shield of California Commercial |
$6.30
|
| Rate for Payer: Blue Shield of California EPN |
$5.96
|
| Rate for Payer: Blue Shield of California EPN |
$3.97
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Central Health Plan Commercial |
$8.00
|
| Rate for Payer: Central Health Plan Commercial |
$12.00
|
| Rate for Payer: Cigna of CA HMO |
$9.60
|
| Rate for Payer: Cigna of CA HMO |
$6.40
|
| Rate for Payer: Cigna of CA PPO |
$11.10
|
| Rate for Payer: Cigna of CA PPO |
$7.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.84
|
| Rate for Payer: EPIC Health Plan Senior |
$5.22
|
| Rate for Payer: EPIC Health Plan Senior |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Galaxy Health WC |
$8.50
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.79
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.37
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: Multiplan Commercial |
$7.50
|
| Rate for Payer: Networks By Design Commercial |
$6.50
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.75
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
| Rate for Payer: Prime Health Services Commercial |
$8.50
|
| Rate for Payer: Prime Health Services Medicare |
$5.04
|
| Rate for Payer: Prime Health Services Medicare |
$5.04
|
| Rate for Payer: Riverside University Health System MISP |
$5.22
|
| Rate for Payer: Riverside University Health System MISP |
$5.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.85
|
| Rate for Payer: United Healthcare All Other HMO |
$3.85
|
| Rate for Payer: United Healthcare All Other HMO |
$3.85
|
| Rate for Payer: United Healthcare HMO Rider |
$3.85
|
| Rate for Payer: United Healthcare HMO Rider |
$3.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.85
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.75
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Vantage Medical Group Senior |
$4.75
|
| Rate for Payer: Vantage Medical Group Senior |
$4.75
|
|
|
HC METANEPHRINES FRACTIONATED UR
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
900910288
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Adventist Health Commercial |
$14.00
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Central Health Plan Commercial |
$56.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.00
|
| Rate for Payer: EPIC Health Plan Senior |
$28.00
|
| Rate for Payer: Galaxy Health WC |
$59.50
|
| Rate for Payer: Global Benefits Group Commercial |
$42.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$44.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.00
|
| Rate for Payer: Multiplan Commercial |
$52.50
|
| Rate for Payer: Networks By Design Commercial |
$45.50
|
| Rate for Payer: Prime Health Services Commercial |
$59.50
|
|
|
HC METANEPHRINES FRACTIONATED UR
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
900910288
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$171.38 |
| Rate for Payer: Adventist Health Commercial |
$13.60
|
| Rate for Payer: Adventist Health Commercial |
$14.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$16.94
|
| Rate for Payer: Adventist Health Medi-Cal |
$16.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$124.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$124.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$123.28
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$123.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$171.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$171.38
|
| Rate for Payer: Blue Shield of California Commercial |
$44.10
|
| Rate for Payer: Blue Shield of California Commercial |
$42.84
|
| Rate for Payer: Blue Shield of California EPN |
$27.79
|
| Rate for Payer: Blue Shield of California EPN |
$27.00
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Central Health Plan Commercial |
$54.40
|
| Rate for Payer: Central Health Plan Commercial |
$56.00
|
| Rate for Payer: Cigna of CA HMO |
$44.80
|
| Rate for Payer: Cigna of CA HMO |
$43.52
|
| Rate for Payer: Cigna of CA PPO |
$51.80
|
| Rate for Payer: Cigna of CA PPO |
$50.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$47.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.95
|
| Rate for Payer: EPIC Health Plan Senior |
$18.63
|
| Rate for Payer: EPIC Health Plan Senior |
$18.63
|
| Rate for Payer: Galaxy Health WC |
$59.50
|
| Rate for Payer: Galaxy Health WC |
$57.80
|
| Rate for Payer: Global Benefits Group Commercial |
$42.00
|
| Rate for Payer: Global Benefits Group Commercial |
$40.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$61.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.78
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$43.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$44.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22.70
|
| Rate for Payer: Multiplan Commercial |
$52.50
|
| Rate for Payer: Multiplan Commercial |
$51.00
|
| Rate for Payer: Networks By Design Commercial |
$44.20
|
| Rate for Payer: Networks By Design Commercial |
$45.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16.94
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16.94
|
| Rate for Payer: Prime Health Services Commercial |
$59.50
|
| Rate for Payer: Prime Health Services Commercial |
$57.80
|
| Rate for Payer: Prime Health Services Medicare |
$17.96
|
| Rate for Payer: Prime Health Services Medicare |
$17.96
|
| Rate for Payer: Riverside University Health System MISP |
$18.63
|
| Rate for Payer: Riverside University Health System MISP |
$18.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$40.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$40.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.72
|
| Rate for Payer: United Healthcare All Other HMO |
$13.72
|
| Rate for Payer: United Healthcare All Other HMO |
$13.72
|
| Rate for Payer: United Healthcare HMO Rider |
$13.72
|
| Rate for Payer: United Healthcare HMO Rider |
$13.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.72
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.94
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.63
|
| Rate for Payer: Vantage Medical Group Senior |
$16.94
|
| Rate for Payer: Vantage Medical Group Senior |
$16.94
|
|
|
HC METANEPHRINE URINE 24 HOURS
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
900912209
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$171.38 |
| Rate for Payer: Adventist Health Commercial |
$13.00
|
| Rate for Payer: Adventist Health Commercial |
$14.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$16.94
|
| Rate for Payer: Adventist Health Medi-Cal |
$16.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$124.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$124.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$123.28
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$123.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$171.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$171.38
|
| Rate for Payer: Blue Shield of California Commercial |
$44.10
|
| Rate for Payer: Blue Shield of California Commercial |
$40.95
|
| Rate for Payer: Blue Shield of California EPN |
$27.79
|
| Rate for Payer: Blue Shield of California EPN |
$25.80
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Central Health Plan Commercial |
$52.00
|
| Rate for Payer: Central Health Plan Commercial |
$56.00
|
| Rate for Payer: Cigna of CA HMO |
$44.80
|
| Rate for Payer: Cigna of CA HMO |
$41.60
|
| Rate for Payer: Cigna of CA PPO |
$51.80
|
| Rate for Payer: Cigna of CA PPO |
$48.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$45.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.95
|
| Rate for Payer: EPIC Health Plan Senior |
$18.63
|
| Rate for Payer: EPIC Health Plan Senior |
$18.63
|
| Rate for Payer: Galaxy Health WC |
$59.50
|
| Rate for Payer: Galaxy Health WC |
$55.25
|
| Rate for Payer: Global Benefits Group Commercial |
$42.00
|
| Rate for Payer: Global Benefits Group Commercial |
$39.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$58.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.78
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$41.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$44.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22.70
|
| Rate for Payer: Multiplan Commercial |
$52.50
|
| Rate for Payer: Multiplan Commercial |
$48.75
|
| Rate for Payer: Networks By Design Commercial |
$42.25
|
| Rate for Payer: Networks By Design Commercial |
$45.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16.94
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16.94
|
| Rate for Payer: Prime Health Services Commercial |
$59.50
|
| Rate for Payer: Prime Health Services Commercial |
$55.25
|
| Rate for Payer: Prime Health Services Medicare |
$17.96
|
| Rate for Payer: Prime Health Services Medicare |
$17.96
|
| Rate for Payer: Riverside University Health System MISP |
$18.63
|
| Rate for Payer: Riverside University Health System MISP |
$18.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.72
|
| Rate for Payer: United Healthcare All Other HMO |
$13.72
|
| Rate for Payer: United Healthcare All Other HMO |
$13.72
|
| Rate for Payer: United Healthcare HMO Rider |
$13.72
|
| Rate for Payer: United Healthcare HMO Rider |
$13.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.72
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.94
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.63
|
| Rate for Payer: Vantage Medical Group Senior |
$16.94
|
| Rate for Payer: Vantage Medical Group Senior |
$16.94
|
|
|
HC METANEPHRINE URINE 24 HOURS
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
900912209
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Adventist Health Commercial |
$14.00
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Central Health Plan Commercial |
$56.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.00
|
| Rate for Payer: EPIC Health Plan Senior |
$28.00
|
| Rate for Payer: Galaxy Health WC |
$59.50
|
| Rate for Payer: Global Benefits Group Commercial |
$42.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$44.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.00
|
| Rate for Payer: Multiplan Commercial |
$52.50
|
| Rate for Payer: Networks By Design Commercial |
$45.50
|
| Rate for Payer: Prime Health Services Commercial |
$59.50
|
|
|
HC METANEPHRINE URINE RANDOM
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
900912208
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$171.38 |
| Rate for Payer: Adventist Health Commercial |
$13.00
|
| Rate for Payer: Adventist Health Commercial |
$14.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$16.94
|
| Rate for Payer: Adventist Health Medi-Cal |
$16.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$124.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$124.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$123.28
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$123.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$171.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$171.38
|
| Rate for Payer: Blue Shield of California Commercial |
$44.10
|
| Rate for Payer: Blue Shield of California Commercial |
$40.95
|
| Rate for Payer: Blue Shield of California EPN |
$27.79
|
| Rate for Payer: Blue Shield of California EPN |
$25.80
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Central Health Plan Commercial |
$52.00
|
| Rate for Payer: Central Health Plan Commercial |
$56.00
|
| Rate for Payer: Cigna of CA HMO |
$44.80
|
| Rate for Payer: Cigna of CA HMO |
$41.60
|
| Rate for Payer: Cigna of CA PPO |
$51.80
|
| Rate for Payer: Cigna of CA PPO |
$48.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$45.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.95
|
| Rate for Payer: EPIC Health Plan Senior |
$18.63
|
| Rate for Payer: EPIC Health Plan Senior |
$18.63
|
| Rate for Payer: Galaxy Health WC |
$59.50
|
| Rate for Payer: Galaxy Health WC |
$55.25
|
| Rate for Payer: Global Benefits Group Commercial |
$42.00
|
| Rate for Payer: Global Benefits Group Commercial |
$39.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$58.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.78
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$41.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$44.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22.70
|
| Rate for Payer: Multiplan Commercial |
$52.50
|
| Rate for Payer: Multiplan Commercial |
$48.75
|
| Rate for Payer: Networks By Design Commercial |
$42.25
|
| Rate for Payer: Networks By Design Commercial |
$45.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16.94
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16.94
|
| Rate for Payer: Prime Health Services Commercial |
$59.50
|
| Rate for Payer: Prime Health Services Commercial |
$55.25
|
| Rate for Payer: Prime Health Services Medicare |
$17.96
|
| Rate for Payer: Prime Health Services Medicare |
$17.96
|
| Rate for Payer: Riverside University Health System MISP |
$18.63
|
| Rate for Payer: Riverside University Health System MISP |
$18.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.72
|
| Rate for Payer: United Healthcare All Other HMO |
$13.72
|
| Rate for Payer: United Healthcare All Other HMO |
$13.72
|
| Rate for Payer: United Healthcare HMO Rider |
$13.72
|
| Rate for Payer: United Healthcare HMO Rider |
$13.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.72
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.94
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.63
|
| Rate for Payer: Vantage Medical Group Senior |
$16.94
|
| Rate for Payer: Vantage Medical Group Senior |
$16.94
|
|
|
HC METANEPHRINE URINE RANDOM
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
900912208
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Adventist Health Commercial |
$14.00
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Central Health Plan Commercial |
$56.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.00
|
| Rate for Payer: EPIC Health Plan Senior |
$28.00
|
| Rate for Payer: Galaxy Health WC |
$59.50
|
| Rate for Payer: Global Benefits Group Commercial |
$42.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$44.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.00
|
| Rate for Payer: Multiplan Commercial |
$52.50
|
| Rate for Payer: Networks By Design Commercial |
$45.50
|
| Rate for Payer: Prime Health Services Commercial |
$59.50
|
|
|
HC METATARSAL DISLOCAT TOE W/ANES
|
Facility
|
IP
|
$6,912.00
|
|
|
Service Code
|
CPT 28635
|
| Hospital Charge Code |
902890366
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$1,382.40 |
| Max. Negotiated Rate |
$6,220.80 |
| Rate for Payer: Adventist Health Commercial |
$1,382.40
|
| Rate for Payer: Cash Price |
$3,110.40
|
| Rate for Payer: Central Health Plan Commercial |
$5,529.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,838.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,764.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,764.80
|
| Rate for Payer: Galaxy Health WC |
$5,875.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,147.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,220.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,389.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,078.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,382.40
|
| Rate for Payer: Multiplan Commercial |
$5,184.00
|
| Rate for Payer: Networks By Design Commercial |
$4,492.80
|
| Rate for Payer: Prime Health Services Commercial |
$5,875.20
|
|
|
HC METATARSAL DISLOCAT TOE W/ANES
|
Facility
|
OP
|
$6,912.00
|
|
|
Service Code
|
CPT 28635
|
| Hospital Charge Code |
902890366
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$160.57 |
| Max. Negotiated Rate |
$6,220.80 |
| Rate for Payer: Adventist Health Commercial |
$2,833.92
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$769.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,068.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,240.00
|
| Rate for Payer: Cash Price |
$3,110.40
|
| Rate for Payer: Cash Price |
$3,110.40
|
| Rate for Payer: Cash Price |
$3,110.40
|
| Rate for Payer: Cash Price |
$3,110.40
|
| Rate for Payer: Central Health Plan Commercial |
$5,529.60
|
| Rate for Payer: Cigna of CA HMO |
$4,423.68
|
| Rate for Payer: Cigna of CA PPO |
$5,114.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,274.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,068.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,838.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,412.45
|
| Rate for Payer: EPIC Health Plan Senior |
$2,274.97
|
| Rate for Payer: Galaxy Health WC |
$5,875.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,147.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,220.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,391.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,068.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,389.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$160.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,223.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,382.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,771.32
|
| Rate for Payer: Multiplan Commercial |
$5,184.00
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$4,492.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,068.15
|
| Rate for Payer: Preferred Health Network WC |
$3,306.12
|
| Rate for Payer: Prime Health Services Commercial |
$5,875.20
|
| Rate for Payer: Prime Health Services Medicare |
$2,192.24
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Riverside University Health System MISP |
$2,274.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,147.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,147.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,068.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Vantage Medical Group Senior |
$2,068.15
|
|
|
HC METATRSAL BAR WEDGE, ROCKER
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
CPT L3400
|
| Hospital Charge Code |
915353400
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$36.90 |
| Rate for Payer: Adventist Health Commercial |
$8.20
|
| Rate for Payer: Blue Shield of California Commercial |
$32.88
|
| Rate for Payer: Blue Shield of California EPN |
$20.66
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Central Health Plan Commercial |
$32.80
|
| Rate for Payer: Cigna of CA HMO |
$28.70
|
| Rate for Payer: Cigna of CA PPO |
$28.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.40
|
| Rate for Payer: EPIC Health Plan Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$26.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.19
|
| 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: United Healthcare All Other Commercial |
$15.39
|
| Rate for Payer: United Healthcare All Other HMO |
$14.98
|
| Rate for Payer: United Healthcare HMO Rider |
$14.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.43
|
|
|
HC METATRSAL BAR WEDGE, ROCKER
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
CPT L3400
|
| Hospital Charge Code |
905353400
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$10.61 |
| Max. Negotiated Rate |
$36.90 |
| Rate for Payer: Adventist Health Commercial |
$16.81
|
| 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 |
$30.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.85
|
| Rate for Payer: Blue Shield of California Commercial |
$32.88
|
| Rate for Payer: Blue Shield of California EPN |
$20.66
|
| 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 |
$28.70
|
| Rate for Payer: Cigna of CA PPO |
$28.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$34.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.40
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Inland Empire Health Plan (IEHP) medi-cal |
$10.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$28.70
|
| Rate for Payer: Multiplan Commercial |
$30.75
|
| Rate for Payer: Networks By Design Commercial |
$20.50
|
| 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 |
$15.39
|
| Rate for Payer: United Healthcare All Other HMO |
$14.98
|
| Rate for Payer: United Healthcare HMO Rider |
$14.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.85
|
| Rate for Payer: Vantage Medical Group Senior |
$34.85
|
|
|
HC METATRSAL BAR WEDGE, ROCKER
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
CPT L3400
|
| Hospital Charge Code |
905353400
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$36.90 |
| Rate for Payer: Adventist Health Commercial |
$8.20
|
| Rate for Payer: Blue Shield of California Commercial |
$32.88
|
| Rate for Payer: Blue Shield of California EPN |
$20.66
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Central Health Plan Commercial |
$32.80
|
| Rate for Payer: Cigna of CA HMO |
$28.70
|
| Rate for Payer: Cigna of CA PPO |
$28.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.40
|
| Rate for Payer: EPIC Health Plan Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$26.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.19
|
| 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: United Healthcare All Other Commercial |
$15.39
|
| Rate for Payer: United Healthcare All Other HMO |
$14.98
|
| Rate for Payer: United Healthcare HMO Rider |
$14.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.43
|
|
|
HC METATRSAL BAR WEDGE, ROCKER
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
CPT L3400
|
| Hospital Charge Code |
915353400
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$10.61 |
| Max. Negotiated Rate |
$36.90 |
| Rate for Payer: Adventist Health Commercial |
$16.81
|
| 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 |
$30.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.85
|
| Rate for Payer: Blue Shield of California Commercial |
$32.88
|
| Rate for Payer: Blue Shield of California EPN |
$20.66
|
| 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 |
$28.70
|
| Rate for Payer: Cigna of CA PPO |
$28.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$34.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.40
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Inland Empire Health Plan (IEHP) medi-cal |
$10.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$28.70
|
| Rate for Payer: Multiplan Commercial |
$30.75
|
| Rate for Payer: Networks By Design Commercial |
$20.50
|
| 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 |
$15.39
|
| Rate for Payer: United Healthcare All Other HMO |
$14.98
|
| Rate for Payer: United Healthcare HMO Rider |
$14.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.85
|
| Rate for Payer: Vantage Medical Group Senior |
$34.85
|
|
|
HC MET BAR WEDGE BETWEEN SOLE
|
Facility
|
IP
|
$182.00
|
|
|
Service Code
|
CPT L3410
|
| Hospital Charge Code |
905353410
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$163.80 |
| Rate for Payer: Adventist Health Commercial |
$36.40
|
| Rate for Payer: Blue Shield of California Commercial |
$145.96
|
| Rate for Payer: Blue Shield of California EPN |
$91.73
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Central Health Plan Commercial |
$145.60
|
| Rate for Payer: Cigna of CA HMO |
$127.40
|
| Rate for Payer: Cigna of CA PPO |
$127.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$127.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.80
|
| Rate for Payer: EPIC Health Plan Senior |
$72.80
|
| Rate for Payer: Galaxy Health WC |
$154.70
|
| Rate for Payer: Global Benefits Group Commercial |
$109.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$163.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$115.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$107.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.40
|
| Rate for Payer: Multiplan Commercial |
$136.50
|
| Rate for Payer: Networks By Design Commercial |
$118.30
|
| Rate for Payer: Prime Health Services Commercial |
$154.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$68.30
|
| Rate for Payer: United Healthcare All Other HMO |
$66.48
|
| Rate for Payer: United Healthcare HMO Rider |
$65.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.60
|
|
|
HC MET BAR WEDGE BETWEEN SOLE
|
Facility
|
IP
|
$182.00
|
|
|
Service Code
|
CPT L3410
|
| Hospital Charge Code |
915353410
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$163.80 |
| Rate for Payer: Adventist Health Commercial |
$36.40
|
| Rate for Payer: Blue Shield of California Commercial |
$145.96
|
| Rate for Payer: Blue Shield of California EPN |
$91.73
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Central Health Plan Commercial |
$145.60
|
| Rate for Payer: Cigna of CA HMO |
$127.40
|
| Rate for Payer: Cigna of CA PPO |
$127.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$127.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.80
|
| Rate for Payer: EPIC Health Plan Senior |
$72.80
|
| Rate for Payer: Galaxy Health WC |
$154.70
|
| Rate for Payer: Global Benefits Group Commercial |
$109.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$163.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$115.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$107.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.40
|
| Rate for Payer: Multiplan Commercial |
$136.50
|
| Rate for Payer: Networks By Design Commercial |
$118.30
|
| Rate for Payer: Prime Health Services Commercial |
$154.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$68.30
|
| Rate for Payer: United Healthcare All Other HMO |
$66.48
|
| Rate for Payer: United Healthcare HMO Rider |
$65.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.60
|
|
|
HC MET BAR WEDGE BETWEEN SOLE
|
Facility
|
OP
|
$182.00
|
|
|
Service Code
|
CPT L3410
|
| Hospital Charge Code |
915353410
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$163.80 |
| Rate for Payer: Adventist Health Commercial |
$74.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$154.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$100.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$136.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$105.87
|
| Rate for Payer: Blue Shield of California Commercial |
$145.96
|
| Rate for Payer: Blue Shield of California EPN |
$91.73
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Central Health Plan Commercial |
$145.60
|
| Rate for Payer: Cigna of CA HMO |
$127.40
|
| Rate for Payer: Cigna of CA PPO |
$127.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$154.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$154.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$154.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$127.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.80
|
| Rate for Payer: EPIC Health Plan Senior |
$72.80
|
| Rate for Payer: Galaxy Health WC |
$154.70
|
| Rate for Payer: Global Benefits Group Commercial |
$109.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$163.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$39.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$115.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$43.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$107.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$127.40
|
| Rate for Payer: Multiplan Commercial |
$136.50
|
| Rate for Payer: Networks By Design Commercial |
$91.00
|
| Rate for Payer: Prime Health Services Commercial |
$154.70
|
| Rate for Payer: Riverside University Health System MISP |
$72.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$109.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$109.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$68.30
|
| Rate for Payer: United Healthcare All Other HMO |
$66.48
|
| Rate for Payer: United Healthcare HMO Rider |
$65.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$154.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$154.70
|
| Rate for Payer: Vantage Medical Group Senior |
$154.70
|
|
|
HC MET BAR WEDGE BETWEEN SOLE
|
Facility
|
OP
|
$182.00
|
|
|
Service Code
|
CPT L3410
|
| Hospital Charge Code |
905353410
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$163.80 |
| Rate for Payer: Adventist Health Commercial |
$74.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$154.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$100.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$136.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$105.87
|
| Rate for Payer: Blue Shield of California Commercial |
$145.96
|
| Rate for Payer: Blue Shield of California EPN |
$91.73
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Central Health Plan Commercial |
$145.60
|
| Rate for Payer: Cigna of CA HMO |
$127.40
|
| Rate for Payer: Cigna of CA PPO |
$127.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$154.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$154.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$154.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$127.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.80
|
| Rate for Payer: EPIC Health Plan Senior |
$72.80
|
| Rate for Payer: Galaxy Health WC |
$154.70
|
| Rate for Payer: Global Benefits Group Commercial |
$109.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$163.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$39.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$115.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$43.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$107.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$127.40
|
| Rate for Payer: Multiplan Commercial |
$136.50
|
| Rate for Payer: Networks By Design Commercial |
$91.00
|
| Rate for Payer: Prime Health Services Commercial |
$154.70
|
| Rate for Payer: Riverside University Health System MISP |
$72.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$109.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$109.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$68.30
|
| Rate for Payer: United Healthcare All Other HMO |
$66.48
|
| Rate for Payer: United Healthcare HMO Rider |
$65.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$154.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$154.70
|
| Rate for Payer: Vantage Medical Group Senior |
$154.70
|
|
|
HC METHOTREXATE
|
Facility
|
IP
|
$223.00
|
|
|
Service Code
|
CPT 80204
|
| Hospital Charge Code |
900910937
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.60 |
| Max. Negotiated Rate |
$200.70 |
| Rate for Payer: Adventist Health Commercial |
$44.60
|
| Rate for Payer: Cash Price |
$100.35
|
| Rate for Payer: Central Health Plan Commercial |
$178.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$156.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.20
|
| Rate for Payer: EPIC Health Plan Senior |
$89.20
|
| Rate for Payer: Galaxy Health WC |
$189.55
|
| Rate for Payer: Global Benefits Group Commercial |
$133.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$200.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$141.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$131.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.60
|
| Rate for Payer: Multiplan Commercial |
$167.25
|
| Rate for Payer: Networks By Design Commercial |
$144.95
|
| Rate for Payer: Prime Health Services Commercial |
$189.55
|
|
|
HC METHOTREXATE
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 80204
|
| Hospital Charge Code |
900910937
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$201.13 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Adventist Health Commercial |
$44.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$38.57
|
| Rate for Payer: Adventist Health Medi-Cal |
$38.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$201.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$201.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$57.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$57.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$42.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$42.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$38.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$38.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$99.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$99.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$138.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$138.22
|
| Rate for Payer: Blue Shield of California Commercial |
$140.49
|
| Rate for Payer: Blue Shield of California Commercial |
$75.60
|
| Rate for Payer: Blue Shield of California EPN |
$88.53
|
| Rate for Payer: Blue Shield of California EPN |
$47.64
|
| Rate for Payer: Cash Price |
$100.35
|
| Rate for Payer: Cash Price |
$100.35
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Central Health Plan Commercial |
$96.00
|
| Rate for Payer: Central Health Plan Commercial |
$178.40
|
| Rate for Payer: Cigna of CA HMO |
$142.72
|
| Rate for Payer: Cigna of CA HMO |
$76.80
|
| Rate for Payer: Cigna of CA PPO |
$165.02
|
| Rate for Payer: Cigna of CA PPO |
$88.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$57.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$57.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$38.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$38.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$84.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$156.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.64
|
| Rate for Payer: EPIC Health Plan Senior |
$42.43
|
| Rate for Payer: EPIC Health Plan Senior |
$42.43
|
| Rate for Payer: Galaxy Health WC |
$189.55
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$133.80
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$200.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$63.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$63.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$53.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$53.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$38.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$38.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$76.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$141.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$58.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$58.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$54.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$54.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$51.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$51.68
|
| Rate for Payer: Multiplan Commercial |
$167.25
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Networks By Design Commercial |
$78.00
|
| Rate for Payer: Networks By Design Commercial |
$144.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$38.57
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$38.57
|
| Rate for Payer: Prime Health Services Commercial |
$189.55
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: Prime Health Services Medicare |
$40.88
|
| Rate for Payer: Prime Health Services Medicare |
$40.88
|
| Rate for Payer: Riverside University Health System MISP |
$42.43
|
| Rate for Payer: Riverside University Health System MISP |
$42.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$133.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$133.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.24
|
| Rate for Payer: United Healthcare All Other HMO |
$31.24
|
| Rate for Payer: United Healthcare All Other HMO |
$31.24
|
| Rate for Payer: United Healthcare HMO Rider |
$31.24
|
| Rate for Payer: United Healthcare HMO Rider |
$31.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$38.57
|
| Rate for Payer: Upland Medical Group Pediatric |
$38.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$57.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$57.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.43
|
| Rate for Payer: Vantage Medical Group Senior |
$38.57
|
| Rate for Payer: Vantage Medical Group Senior |
$38.57
|
|
|
HC MIAMI J REPLCMNT PAD SHORT
|
Facility
|
IP
|
$135.28
|
|
|
Service Code
|
CPT L9900
|
| Hospital Charge Code |
901605410
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$27.06 |
| Max. Negotiated Rate |
$121.75 |
| Rate for Payer: Adventist Health Commercial |
$27.06
|
| Rate for Payer: Blue Shield of California Commercial |
$108.49
|
| Rate for Payer: Blue Shield of California EPN |
$68.18
|
| Rate for Payer: Cash Price |
$60.88
|
| Rate for Payer: Central Health Plan Commercial |
$108.22
|
| Rate for Payer: Cigna of CA HMO |
$94.70
|
| Rate for Payer: Cigna of CA PPO |
$94.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$94.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.11
|
| Rate for Payer: EPIC Health Plan Senior |
$54.11
|
| Rate for Payer: Galaxy Health WC |
$114.99
|
| Rate for Payer: Global Benefits Group Commercial |
$81.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$121.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$85.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$79.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.06
|
| Rate for Payer: Multiplan Commercial |
$101.46
|
| Rate for Payer: Networks By Design Commercial |
$87.93
|
| Rate for Payer: Prime Health Services Commercial |
$114.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.77
|
| Rate for Payer: United Healthcare All Other HMO |
$49.42
|
| Rate for Payer: United Healthcare HMO Rider |
$48.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$44.30
|
|
|
HC MIAMI J REPLCMNT PAD SHORT
|
Facility
|
OP
|
$135.28
|
|
|
Service Code
|
CPT L9900
|
| Hospital Charge Code |
901605410
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$44.30 |
| Max. Negotiated Rate |
$121.75 |
| Rate for Payer: Adventist Health Commercial |
$55.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$114.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$101.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$78.69
|
| Rate for Payer: Blue Shield of California Commercial |
$108.49
|
| Rate for Payer: Blue Shield of California EPN |
$68.18
|
| Rate for Payer: Cash Price |
$60.88
|
| Rate for Payer: Central Health Plan Commercial |
$108.22
|
| Rate for Payer: Cigna of CA HMO |
$94.70
|
| Rate for Payer: Cigna of CA PPO |
$94.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$114.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$114.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$94.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.11
|
| Rate for Payer: EPIC Health Plan Senior |
$54.11
|
| Rate for Payer: Galaxy Health WC |
$114.99
|
| Rate for Payer: Global Benefits Group Commercial |
$81.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$121.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$85.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$79.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$94.70
|
| Rate for Payer: Multiplan Commercial |
$101.46
|
| Rate for Payer: Networks By Design Commercial |
$67.64
|
| Rate for Payer: Prime Health Services Commercial |
$114.99
|
| Rate for Payer: Riverside University Health System MISP |
$54.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.77
|
| Rate for Payer: United Healthcare All Other HMO |
$49.42
|
| Rate for Payer: United Healthcare HMO Rider |
$48.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$44.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$114.99
|
| Rate for Payer: Vantage Medical Group Senior |
$114.99
|
|
|
HC MIAMI J REPLCMNT PAD STOUT
|
Facility
|
OP
|
$110.28
|
|
|
Service Code
|
CPT L9900
|
| Hospital Charge Code |
901605411
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$36.12 |
| Max. Negotiated Rate |
$99.25 |
| Rate for Payer: Adventist Health Commercial |
$45.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$60.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$82.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$64.15
|
| Rate for Payer: Blue Shield of California Commercial |
$88.44
|
| Rate for Payer: Blue Shield of California EPN |
$55.58
|
| Rate for Payer: Cash Price |
$49.63
|
| Rate for Payer: Central Health Plan Commercial |
$88.22
|
| Rate for Payer: Cigna of CA HMO |
$77.20
|
| Rate for Payer: Cigna of CA PPO |
$77.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$93.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$93.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$77.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.11
|
| Rate for Payer: EPIC Health Plan Senior |
$44.11
|
| Rate for Payer: Galaxy Health WC |
$93.74
|
| Rate for Payer: Global Benefits Group Commercial |
$66.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$70.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$65.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$77.20
|
| Rate for Payer: Multiplan Commercial |
$82.71
|
| Rate for Payer: Networks By Design Commercial |
$55.14
|
| Rate for Payer: Prime Health Services Commercial |
$93.74
|
| Rate for Payer: Riverside University Health System MISP |
$44.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$66.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.39
|
| Rate for Payer: United Healthcare All Other HMO |
$40.29
|
| Rate for Payer: United Healthcare HMO Rider |
$39.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$93.74
|
| Rate for Payer: Vantage Medical Group Senior |
$93.74
|
|
|
HC MIAMI J REPLCMNT PAD STOUT
|
Facility
|
IP
|
$110.28
|
|
|
Service Code
|
CPT L9900
|
| Hospital Charge Code |
901605411
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$22.06 |
| Max. Negotiated Rate |
$99.25 |
| Rate for Payer: Adventist Health Commercial |
$22.06
|
| Rate for Payer: Blue Shield of California Commercial |
$88.44
|
| Rate for Payer: Blue Shield of California EPN |
$55.58
|
| Rate for Payer: Cash Price |
$49.63
|
| Rate for Payer: Central Health Plan Commercial |
$88.22
|
| Rate for Payer: Cigna of CA HMO |
$77.20
|
| Rate for Payer: Cigna of CA PPO |
$77.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$77.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.11
|
| Rate for Payer: EPIC Health Plan Senior |
$44.11
|
| Rate for Payer: Galaxy Health WC |
$93.74
|
| Rate for Payer: Global Benefits Group Commercial |
$66.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$70.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$65.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.06
|
| Rate for Payer: Multiplan Commercial |
$82.71
|
| Rate for Payer: Networks By Design Commercial |
$71.68
|
| Rate for Payer: Prime Health Services Commercial |
$93.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.39
|
| Rate for Payer: United Healthcare All Other HMO |
$40.29
|
| Rate for Payer: United Healthcare HMO Rider |
$39.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.12
|
|
|
HC MIAMI JR REPLCMNT PAD 0-6MO
|
Facility
|
OP
|
$110.28
|
|
|
Service Code
|
CPT L9900
|
| Hospital Charge Code |
901605412
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$36.12 |
| Max. Negotiated Rate |
$99.25 |
| Rate for Payer: Adventist Health Commercial |
$45.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$60.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$82.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$64.15
|
| Rate for Payer: Blue Shield of California Commercial |
$88.44
|
| Rate for Payer: Blue Shield of California EPN |
$55.58
|
| Rate for Payer: Cash Price |
$49.63
|
| Rate for Payer: Central Health Plan Commercial |
$88.22
|
| Rate for Payer: Cigna of CA HMO |
$77.20
|
| Rate for Payer: Cigna of CA PPO |
$77.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$93.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$93.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$77.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.11
|
| Rate for Payer: EPIC Health Plan Senior |
$44.11
|
| Rate for Payer: Galaxy Health WC |
$93.74
|
| Rate for Payer: Global Benefits Group Commercial |
$66.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$70.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$65.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$77.20
|
| Rate for Payer: Multiplan Commercial |
$82.71
|
| Rate for Payer: Networks By Design Commercial |
$55.14
|
| Rate for Payer: Prime Health Services Commercial |
$93.74
|
| Rate for Payer: Riverside University Health System MISP |
$44.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$66.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.39
|
| Rate for Payer: United Healthcare All Other HMO |
$40.29
|
| Rate for Payer: United Healthcare HMO Rider |
$39.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$93.74
|
| Rate for Payer: Vantage Medical Group Senior |
$93.74
|
|
