|
HC POS COMBO 43 PANEL ID
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900912490
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$8.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$58.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$71.63
|
| Rate for Payer: Blue Distinction Transplant |
$13.20
|
| Rate for Payer: Blue Shield of California Commercial |
$13.60
|
| Rate for Payer: Blue Shield of California EPN |
$10.69
|
| Rate for Payer: Caremore Medicare Advantage |
$8.08
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Central Health Plan Commercial |
$17.60
|
| Rate for Payer: Cigna of CA HMO |
$14.08
|
| Rate for Payer: Cigna of CA PPO |
$16.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: Dignity Health Media |
$8.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.08
|
| Rate for Payer: Galaxy Health WC |
$18.70
|
| Rate for Payer: Global Benefits Group Commercial |
$13.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$16.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.08
|
| Rate for Payer: InnovAge PACE Commercial |
$12.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.83
|
| Rate for Payer: Multiplan Commercial |
$16.50
|
| Rate for Payer: Networks By Design Commercial |
$14.30
|
| Rate for Payer: Prime Health Services Commercial |
$18.70
|
| Rate for Payer: Prime Health Services Medicare |
$8.56
|
| Rate for Payer: Riverside University Health System MISP |
$8.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.54
|
| Rate for Payer: United Healthcare All Other HMO |
$6.54
|
| Rate for Payer: United Healthcare HMO Rider |
$6.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
HC POSITIONING GEL-E DONUT MED
|
Facility
|
IP
|
$65.27
|
|
| Hospital Charge Code |
901604725
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.05 |
| Max. Negotiated Rate |
$58.74 |
| Rate for Payer: Cash Price |
$29.37
|
| Rate for Payer: Central Health Plan Commercial |
$52.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.11
|
| Rate for Payer: Galaxy Health WC |
$55.48
|
| Rate for Payer: Global Benefits Group Commercial |
$39.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$58.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.05
|
| Rate for Payer: Multiplan Commercial |
$48.95
|
| Rate for Payer: Networks By Design Commercial |
$42.43
|
| Rate for Payer: Prime Health Services Commercial |
$55.48
|
|
|
HC POSITIONING GEL-E DONUT MED
|
Facility
|
OP
|
$65.27
|
|
| Hospital Charge Code |
901604725
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.05 |
| Max. Negotiated Rate |
$58.74 |
| Rate for Payer: Aetna of CA HMO/PPO |
$39.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$35.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.56
|
| Rate for Payer: Blue Distinction Transplant |
$39.16
|
| Rate for Payer: Blue Shield of California Commercial |
$41.05
|
| Rate for Payer: Blue Shield of California EPN |
$31.92
|
| Rate for Payer: Cash Price |
$29.37
|
| Rate for Payer: Central Health Plan Commercial |
$52.22
|
| Rate for Payer: Cigna of CA HMO |
$41.77
|
| Rate for Payer: Cigna of CA PPO |
$48.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.48
|
| Rate for Payer: Dignity Health Media |
$55.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$55.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$26.11
|
| Rate for Payer: Galaxy Health WC |
$55.48
|
| Rate for Payer: Global Benefits Group Commercial |
$39.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$58.74
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$48.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.05
|
| Rate for Payer: Multiplan Commercial |
$48.95
|
| Rate for Payer: Networks By Design Commercial |
$42.43
|
| Rate for Payer: Prime Health Services Commercial |
$55.48
|
| Rate for Payer: Riverside University Health System MISP |
$26.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.64
|
| Rate for Payer: United Healthcare All Other HMO |
$32.64
|
| Rate for Payer: United Healthcare HMO Rider |
$32.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$55.48
|
| Rate for Payer: Vantage Medical Group Senior |
$55.48
|
|
|
HC POSITIONING GEL-E DONUT SMALL
|
Facility
|
OP
|
$65.27
|
|
| Hospital Charge Code |
901604727
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.05 |
| Max. Negotiated Rate |
$58.74 |
| Rate for Payer: Aetna of CA HMO/PPO |
$39.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$35.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.56
|
| Rate for Payer: Blue Distinction Transplant |
$39.16
|
| Rate for Payer: Blue Shield of California Commercial |
$41.05
|
| Rate for Payer: Blue Shield of California EPN |
$31.92
|
| Rate for Payer: Cash Price |
$29.37
|
| Rate for Payer: Central Health Plan Commercial |
$52.22
|
| Rate for Payer: Cigna of CA HMO |
$41.77
|
| Rate for Payer: Cigna of CA PPO |
$48.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.48
|
| Rate for Payer: Dignity Health Media |
$55.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$55.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$26.11
|
| Rate for Payer: Galaxy Health WC |
$55.48
|
| Rate for Payer: Global Benefits Group Commercial |
$39.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$58.74
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$48.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.05
|
| Rate for Payer: Multiplan Commercial |
$48.95
|
| Rate for Payer: Networks By Design Commercial |
$42.43
|
| Rate for Payer: Prime Health Services Commercial |
$55.48
|
| Rate for Payer: Riverside University Health System MISP |
$26.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.64
|
| Rate for Payer: United Healthcare All Other HMO |
$32.64
|
| Rate for Payer: United Healthcare HMO Rider |
$32.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$55.48
|
| Rate for Payer: Vantage Medical Group Senior |
$55.48
|
|
|
HC POSITIONING GEL-E DONUT SMALL
|
Facility
|
IP
|
$65.27
|
|
| Hospital Charge Code |
901604727
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.05 |
| Max. Negotiated Rate |
$58.74 |
| Rate for Payer: Cash Price |
$29.37
|
| Rate for Payer: Central Health Plan Commercial |
$52.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.11
|
| Rate for Payer: Galaxy Health WC |
$55.48
|
| Rate for Payer: Global Benefits Group Commercial |
$39.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$58.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.05
|
| Rate for Payer: Multiplan Commercial |
$48.95
|
| Rate for Payer: Networks By Design Commercial |
$42.43
|
| Rate for Payer: Prime Health Services Commercial |
$55.48
|
|
|
HC POSITIONING GEL-E DONUT X-SM
|
Facility
|
OP
|
$63.55
|
|
| Hospital Charge Code |
901698581
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.71 |
| Max. Negotiated Rate |
$57.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$38.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$54.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$34.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$30.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.55
|
| Rate for Payer: Blue Distinction Transplant |
$38.13
|
| Rate for Payer: Blue Shield of California Commercial |
$39.97
|
| Rate for Payer: Blue Shield of California EPN |
$31.08
|
| Rate for Payer: Cash Price |
$28.60
|
| Rate for Payer: Central Health Plan Commercial |
$50.84
|
| Rate for Payer: Cigna of CA HMO |
$40.67
|
| Rate for Payer: Cigna of CA PPO |
$47.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$54.02
|
| Rate for Payer: Dignity Health Media |
$54.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$54.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$25.42
|
| Rate for Payer: Galaxy Health WC |
$54.02
|
| Rate for Payer: Global Benefits Group Commercial |
$38.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$57.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$47.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.71
|
| Rate for Payer: Multiplan Commercial |
$47.66
|
| Rate for Payer: Networks By Design Commercial |
$41.31
|
| Rate for Payer: Prime Health Services Commercial |
$54.02
|
| Rate for Payer: Riverside University Health System MISP |
$25.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$38.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$38.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.78
|
| Rate for Payer: United Healthcare All Other HMO |
$31.78
|
| Rate for Payer: United Healthcare HMO Rider |
$31.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$54.02
|
| Rate for Payer: Vantage Medical Group Senior |
$54.02
|
|
|
HC POSITIONING GEL-E DONUT X-SM
|
Facility
|
IP
|
$63.55
|
|
| Hospital Charge Code |
901698581
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.71 |
| Max. Negotiated Rate |
$57.20 |
| Rate for Payer: Cash Price |
$28.60
|
| Rate for Payer: Central Health Plan Commercial |
$50.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.42
|
| Rate for Payer: Galaxy Health WC |
$54.02
|
| Rate for Payer: Global Benefits Group Commercial |
$38.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$57.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.71
|
| Rate for Payer: Multiplan Commercial |
$47.66
|
| Rate for Payer: Networks By Design Commercial |
$41.31
|
| Rate for Payer: Prime Health Services Commercial |
$54.02
|
|
|
HC POST FLUIDIZED ZFLO MED
|
Facility
|
OP
|
$689.68
|
|
| Hospital Charge Code |
901605553
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$137.94 |
| Max. Negotiated Rate |
$620.71 |
| Rate for Payer: Aetna of CA HMO/PPO |
$418.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$586.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$379.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$379.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$333.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$407.46
|
| Rate for Payer: Blue Distinction Transplant |
$413.81
|
| Rate for Payer: Blue Shield of California Commercial |
$433.81
|
| Rate for Payer: Blue Shield of California EPN |
$337.25
|
| Rate for Payer: Cash Price |
$310.36
|
| Rate for Payer: Central Health Plan Commercial |
$551.74
|
| Rate for Payer: Cigna of CA HMO |
$441.40
|
| Rate for Payer: Cigna of CA PPO |
$510.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$586.23
|
| Rate for Payer: Dignity Health Media |
$586.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$586.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$275.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$275.87
|
| Rate for Payer: Galaxy Health WC |
$586.23
|
| Rate for Payer: Global Benefits Group Commercial |
$413.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$620.71
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$517.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$241.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$460.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$262.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$137.94
|
| Rate for Payer: Multiplan Commercial |
$517.26
|
| Rate for Payer: Networks By Design Commercial |
$448.29
|
| Rate for Payer: Prime Health Services Commercial |
$586.23
|
| Rate for Payer: Riverside University Health System MISP |
$275.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$413.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$413.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$344.84
|
| Rate for Payer: United Healthcare All Other HMO |
$344.84
|
| Rate for Payer: United Healthcare HMO Rider |
$344.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$344.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$586.23
|
| Rate for Payer: Vantage Medical Group Senior |
$586.23
|
|
|
HC POST FLUIDIZED ZFLO MED
|
Facility
|
IP
|
$689.68
|
|
| Hospital Charge Code |
901605553
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$137.94 |
| Max. Negotiated Rate |
$620.71 |
| Rate for Payer: Cash Price |
$310.36
|
| Rate for Payer: Central Health Plan Commercial |
$551.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$275.87
|
| Rate for Payer: Galaxy Health WC |
$586.23
|
| Rate for Payer: Global Benefits Group Commercial |
$413.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$620.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$460.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$262.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$137.94
|
| Rate for Payer: Multiplan Commercial |
$517.26
|
| Rate for Payer: Networks By Design Commercial |
$448.29
|
| Rate for Payer: Prime Health Services Commercial |
$586.23
|
|
|
HC POST PARTUM PERINEAL LAC RPR
|
Facility
|
IP
|
$7,247.00
|
|
|
Service Code
|
CPT 56810
|
| Hospital Charge Code |
902400754
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,449.40 |
| Max. Negotiated Rate |
$6,522.30 |
| Rate for Payer: Cash Price |
$3,261.15
|
| Rate for Payer: Central Health Plan Commercial |
$5,797.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,898.80
|
| Rate for Payer: Galaxy Health WC |
$6,159.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4,348.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,522.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,833.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,761.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,449.40
|
| Rate for Payer: Multiplan Commercial |
$5,435.25
|
| Rate for Payer: Networks By Design Commercial |
$4,710.55
|
| Rate for Payer: Prime Health Services Commercial |
$6,159.95
|
|
|
HC POST PARTUM PERINEAL LAC RPR
|
Facility
|
OP
|
$7,247.00
|
|
|
Service Code
|
CPT 56810
|
| Hospital Charge Code |
902400754
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$471.73 |
| Max. Negotiated Rate |
$11,071.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,906.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,071.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,906.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,017.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,348.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4,558.36
|
| Rate for Payer: Blue Shield of California EPN |
$3,543.78
|
| Rate for Payer: Caremore Medicare Advantage |
$3,906.18
|
| Rate for Payer: Cash Price |
$3,261.15
|
| Rate for Payer: Cash Price |
$3,261.15
|
| Rate for Payer: Cash Price |
$3,261.15
|
| Rate for Payer: Central Health Plan Commercial |
$5,797.60
|
| Rate for Payer: Cigna of CA HMO |
$4,638.08
|
| Rate for Payer: Cigna of CA PPO |
$5,362.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Dignity Health Media |
$3,906.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,296.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,273.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,906.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,906.18
|
| Rate for Payer: Galaxy Health WC |
$6,159.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4,348.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,522.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,435.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,406.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,445.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,906.18
|
| Rate for Payer: InnovAge PACE Commercial |
$5,859.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,833.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$471.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,906.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,449.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,234.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,234.28
|
| Rate for Payer: Multiplan Commercial |
$5,435.25
|
| Rate for Payer: Networks By Design Commercial |
$4,710.55
|
| Rate for Payer: Prime Health Services Commercial |
$6,159.95
|
| Rate for Payer: Prime Health Services Medicare |
$4,140.55
|
| Rate for Payer: Riverside University Health System MISP |
$4,296.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,348.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,348.20
|
| 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 |
$5,859.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,906.18
|
|
|
HC POST TRANSFUSION INVESTIGATION
|
Facility
|
OP
|
$304.00
|
|
|
Service Code
|
CPT 86078
|
| Hospital Charge Code |
900904761
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$60.80 |
| Max. Negotiated Rate |
$642.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$213.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$256.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$320.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$234.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$213.41
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$232.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$179.60
|
| Rate for Payer: Blue Distinction Transplant |
$182.40
|
| Rate for Payer: Blue Shield of California Commercial |
$191.22
|
| Rate for Payer: Blue Shield of California EPN |
$148.66
|
| Rate for Payer: Caremore Medicare Advantage |
$213.41
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Central Health Plan Commercial |
$243.20
|
| Rate for Payer: Cigna of CA HMO |
$194.56
|
| Rate for Payer: Cigna of CA PPO |
$224.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$320.12
|
| Rate for Payer: Dignity Health Media |
$213.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$234.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$288.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$213.41
|
| Rate for Payer: EPIC Health Plan Transplant |
$213.41
|
| Rate for Payer: Galaxy Health WC |
$258.40
|
| Rate for Payer: Global Benefits Group Commercial |
$182.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$273.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$228.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$349.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$352.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$213.41
|
| Rate for Payer: InnovAge PACE Commercial |
$320.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$202.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$213.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$285.97
|
| Rate for Payer: Multiplan Commercial |
$228.00
|
| Rate for Payer: Networks By Design Commercial |
$197.60
|
| Rate for Payer: Prime Health Services Commercial |
$258.40
|
| Rate for Payer: Prime Health Services Medicare |
$226.21
|
| Rate for Payer: Riverside University Health System MISP |
$234.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$182.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$182.40
|
| 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 |
$320.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$234.75
|
| Rate for Payer: Vantage Medical Group Senior |
$213.41
|
|
|
HC POST TRANSFUSION INVESTIGATION
|
Facility
|
IP
|
$304.00
|
|
|
Service Code
|
CPT 86078
|
| Hospital Charge Code |
900904761
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$60.80 |
| Max. Negotiated Rate |
$273.60 |
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Central Health Plan Commercial |
$243.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.60
|
| Rate for Payer: Galaxy Health WC |
$258.40
|
| Rate for Payer: Global Benefits Group Commercial |
$182.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$273.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$202.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.80
|
| Rate for Payer: Multiplan Commercial |
$228.00
|
| Rate for Payer: Networks By Design Commercial |
$197.60
|
| Rate for Payer: Prime Health Services Commercial |
$258.40
|
|
|
HC POTASSIUM
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
900910488
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.80 |
| Max. Negotiated Rate |
$80.10 |
| Rate for Payer: Cash Price |
$40.05
|
| Rate for Payer: Central Health Plan Commercial |
$71.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.60
|
| Rate for Payer: Galaxy Health WC |
$75.65
|
| Rate for Payer: Global Benefits Group Commercial |
$53.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$80.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$59.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.80
|
| Rate for Payer: Multiplan Commercial |
$66.75
|
| Rate for Payer: Networks By Design Commercial |
$57.85
|
| Rate for Payer: Prime Health Services Commercial |
$75.65
|
|
|
HC POTASSIUM
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
900910266
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.80 |
| Max. Negotiated Rate |
$80.10 |
| Rate for Payer: Cash Price |
$40.05
|
| Rate for Payer: Central Health Plan Commercial |
$71.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.60
|
| Rate for Payer: Galaxy Health WC |
$75.65
|
| Rate for Payer: Global Benefits Group Commercial |
$53.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$80.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$59.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.80
|
| Rate for Payer: Multiplan Commercial |
$66.75
|
| Rate for Payer: Networks By Design Commercial |
$57.85
|
| Rate for Payer: Prime Health Services Commercial |
$75.65
|
|
|
HC POTASSIUM
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
900910266
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$41.16 |
| Rate for Payer: Adventist Health Medi-Cal |
$4.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$33.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.76
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$33.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.16
|
| Rate for Payer: Blue Distinction Transplant |
$9.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9.27
|
| Rate for Payer: Blue Shield of California EPN |
$7.29
|
| Rate for Payer: Caremore Medicare Advantage |
$4.76
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Central Health Plan Commercial |
$12.00
|
| Rate for Payer: Cigna of CA HMO |
$9.60
|
| Rate for Payer: Cigna of CA PPO |
$11.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.14
|
| Rate for Payer: Dignity Health Media |
$4.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.76
|
| 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: Health Plan of Nevada (Sierra) Other |
$11.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.76
|
| Rate for Payer: InnovAge PACE Commercial |
$7.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.38
|
| 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
|
| Rate for Payer: Prime Health Services Medicare |
$5.05
|
| Rate for Payer: Riverside University Health System MISP |
$5.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.00
|
| 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 HMO Rider |
$3.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.24
|
| Rate for Payer: Vantage Medical Group Senior |
$4.76
|
|
|
HC POTASSIUM
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
900910488
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$41.16 |
| Rate for Payer: Adventist Health Medi-Cal |
$4.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$33.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.76
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$33.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.16
|
| Rate for Payer: Blue Distinction Transplant |
$9.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9.27
|
| Rate for Payer: Blue Shield of California EPN |
$7.29
|
| Rate for Payer: Caremore Medicare Advantage |
$4.76
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Central Health Plan Commercial |
$12.00
|
| Rate for Payer: Cigna of CA HMO |
$9.60
|
| Rate for Payer: Cigna of CA PPO |
$11.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.14
|
| Rate for Payer: Dignity Health Media |
$4.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.76
|
| 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: Health Plan of Nevada (Sierra) Other |
$11.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.76
|
| Rate for Payer: InnovAge PACE Commercial |
$7.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.38
|
| 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
|
| Rate for Payer: Prime Health Services Medicare |
$5.05
|
| Rate for Payer: Riverside University Health System MISP |
$5.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.00
|
| 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 HMO Rider |
$3.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.24
|
| Rate for Payer: Vantage Medical Group Senior |
$4.76
|
|
|
HC POTASSIUM BODY FLUID
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
900912245
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
|
|
HC POTASSIUM BODY FLUID
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
900912245
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$10.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.04
|
| Rate for Payer: Blue Distinction Transplant |
$10.20
|
| Rate for Payer: Blue Shield of California Commercial |
$10.51
|
| Rate for Payer: Blue Shield of California EPN |
$8.26
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Central Health Plan Commercial |
$13.60
|
| Rate for Payer: Cigna of CA HMO |
$10.88
|
| Rate for Payer: Cigna of CA PPO |
$12.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.45
|
| Rate for Payer: Dignity Health Media |
$14.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.80
|
| Rate for Payer: Galaxy Health WC |
$14.45
|
| Rate for Payer: Global Benefits Group Commercial |
$10.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.40
|
| Rate for Payer: Multiplan Commercial |
$12.75
|
| Rate for Payer: Networks By Design Commercial |
$11.05
|
| Rate for Payer: Prime Health Services Commercial |
$14.45
|
| Rate for Payer: Riverside University Health System MISP |
$6.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.50
|
| Rate for Payer: United Healthcare All Other HMO |
$8.50
|
| Rate for Payer: United Healthcare HMO Rider |
$8.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.45
|
| Rate for Payer: Vantage Medical Group Senior |
$14.45
|
|
|
HC POTASSIUM POC
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
900912117
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
|
|
HC POTASSIUM POC
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
900912117
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$4.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$33.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.76
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$33.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.16
|
| Rate for Payer: Blue Distinction Transplant |
$49.20
|
| Rate for Payer: Blue Shield of California Commercial |
$50.68
|
| Rate for Payer: Blue Shield of California EPN |
$39.85
|
| Rate for Payer: Caremore Medicare Advantage |
$4.76
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.14
|
| Rate for Payer: Dignity Health Media |
$4.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.76
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$61.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.76
|
| Rate for Payer: InnovAge PACE Commercial |
$7.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.38
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Prime Health Services Medicare |
$5.05
|
| Rate for Payer: Riverside University Health System MISP |
$5.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| 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 HMO Rider |
$3.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.24
|
| Rate for Payer: Vantage Medical Group Senior |
$4.76
|
|
|
HC POTASSIUM STOOL
|
Facility
|
IP
|
$179.00
|
|
|
Service Code
|
CPT 84133
|
| Hospital Charge Code |
900910416
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.80 |
| Max. Negotiated Rate |
$161.10 |
| Rate for Payer: Cash Price |
$80.55
|
| Rate for Payer: Central Health Plan Commercial |
$143.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.60
|
| Rate for Payer: Galaxy Health WC |
$152.15
|
| Rate for Payer: Global Benefits Group Commercial |
$107.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$161.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$119.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.80
|
| Rate for Payer: Multiplan Commercial |
$134.25
|
| Rate for Payer: Networks By Design Commercial |
$116.35
|
| Rate for Payer: Prime Health Services Commercial |
$152.15
|
|
|
HC POTASSIUM STOOL
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
CPT 84133
|
| Hospital Charge Code |
900910416
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$38.17 |
| Rate for Payer: Adventist Health Medi-Cal |
$4.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.17
|
| Rate for Payer: Blue Distinction Transplant |
$9.60
|
| Rate for Payer: Blue Shield of California Commercial |
$9.89
|
| Rate for Payer: Blue Shield of California EPN |
$7.78
|
| Rate for Payer: Caremore Medicare Advantage |
$4.73
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Central Health Plan Commercial |
$12.80
|
| Rate for Payer: Cigna of CA HMO |
$10.24
|
| Rate for Payer: Cigna of CA PPO |
$11.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.10
|
| Rate for Payer: Dignity Health Media |
$4.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.39
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4.73
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.73
|
| Rate for Payer: Galaxy Health WC |
$13.60
|
| Rate for Payer: Global Benefits Group Commercial |
$9.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.73
|
| Rate for Payer: InnovAge PACE Commercial |
$7.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.34
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: Networks By Design Commercial |
$10.40
|
| Rate for Payer: Prime Health Services Commercial |
$13.60
|
| Rate for Payer: Prime Health Services Medicare |
$5.01
|
| Rate for Payer: Riverside University Health System MISP |
$5.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.83
|
| Rate for Payer: United Healthcare All Other HMO |
$3.83
|
| Rate for Payer: United Healthcare HMO Rider |
$3.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.20
|
| Rate for Payer: Vantage Medical Group Senior |
$4.73
|
|
|
HC POTASSIUM URINE
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 84133
|
| Hospital Charge Code |
900910267
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$38.17 |
| Rate for Payer: Adventist Health Medi-Cal |
$4.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.17
|
| Rate for Payer: Blue Distinction Transplant |
$9.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9.27
|
| Rate for Payer: Blue Shield of California EPN |
$7.29
|
| Rate for Payer: Caremore Medicare Advantage |
$4.73
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Central Health Plan Commercial |
$12.00
|
| Rate for Payer: Cigna of CA HMO |
$9.60
|
| Rate for Payer: Cigna of CA PPO |
$11.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.10
|
| Rate for Payer: Dignity Health Media |
$4.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.39
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4.73
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.73
|
| 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: Health Plan of Nevada (Sierra) Other |
$11.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.73
|
| Rate for Payer: InnovAge PACE Commercial |
$7.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.34
|
| 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
|
| Rate for Payer: Prime Health Services Medicare |
$5.01
|
| Rate for Payer: Riverside University Health System MISP |
$5.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.83
|
| Rate for Payer: United Healthcare All Other HMO |
$3.83
|
| Rate for Payer: United Healthcare HMO Rider |
$3.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.20
|
| Rate for Payer: Vantage Medical Group Senior |
$4.73
|
|
|
HC POTASSIUM URINE
|
Facility
|
IP
|
$106.00
|
|
|
Service Code
|
CPT 84133
|
| Hospital Charge Code |
900910267
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.20 |
| Max. Negotiated Rate |
$95.40 |
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Central Health Plan Commercial |
$84.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.40
|
| Rate for Payer: Galaxy Health WC |
$90.10
|
| Rate for Payer: Global Benefits Group Commercial |
$63.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$95.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.20
|
| Rate for Payer: Multiplan Commercial |
$79.50
|
| Rate for Payer: Networks By Design Commercial |
$68.90
|
| Rate for Payer: Prime Health Services Commercial |
$90.10
|
|
