|
HC SOCC FANCONI COMPLEM ASSAY
|
Facility
|
OP
|
$1,699.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914675
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$339.80 |
| Max. Negotiated Rate |
$1,529.10 |
| Rate for Payer: Adventist Health Commercial |
$339.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,031.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,444.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$934.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,274.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$822.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$997.82
|
| Rate for Payer: Blue Shield of California Commercial |
$1,031.29
|
| Rate for Payer: Blue Shield of California EPN |
$674.50
|
| Rate for Payer: Cash Price |
$934.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,359.20
|
| Rate for Payer: Cigna of CA HMO |
$1,087.36
|
| Rate for Payer: Cigna of CA PPO |
$1,257.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,444.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,444.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,444.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$679.60
|
| Rate for Payer: EPIC Health Plan Senior |
$679.60
|
| Rate for Payer: Galaxy Health WC |
$1,444.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,019.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,529.10
|
| Rate for Payer: InnovAge PACE Commercial |
$849.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,133.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,051.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,189.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,189.30
|
| Rate for Payer: Multiplan Commercial |
$1,274.25
|
| Rate for Payer: Networks By Design Commercial |
$1,104.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,444.15
|
| Rate for Payer: Riverside University Health System MISP |
$679.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,019.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,019.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$849.50
|
| Rate for Payer: United Healthcare All Other HMO |
$849.50
|
| Rate for Payer: United Healthcare HMO Rider |
$849.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$849.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,444.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,444.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,444.15
|
|
|
HC SOCC FANCONI COMPLEM ASSAY
|
Facility
|
IP
|
$1,699.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914675
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$339.80 |
| Max. Negotiated Rate |
$1,529.10 |
| Rate for Payer: Adventist Health Commercial |
$339.80
|
| Rate for Payer: Cash Price |
$934.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,359.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$679.60
|
| Rate for Payer: EPIC Health Plan Senior |
$679.60
|
| Rate for Payer: Galaxy Health WC |
$1,444.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,019.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,529.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,133.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$647.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,051.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.80
|
| Rate for Payer: Multiplan Commercial |
$1,274.25
|
| Rate for Payer: Networks By Design Commercial |
$1,104.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,444.15
|
|
|
HC SOCDX ALLOSURE COLLECTION
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 99001
|
| Hospital Charge Code |
900915321
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.33 |
| Max. Negotiated Rate |
$71.36 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$71.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.48
|
| Rate for Payer: Blue Shield of California Commercial |
$18.21
|
| Rate for Payer: Blue Shield of California EPN |
$11.91
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Central Health Plan Commercial |
$24.00
|
| Rate for Payer: Cigna of CA HMO |
$19.20
|
| Rate for Payer: Cigna of CA PPO |
$22.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.00
|
| Rate for Payer: InnovAge PACE Commercial |
$15.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.00
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
| Rate for Payer: Riverside University Health System MISP |
$12.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.33
|
| Rate for Payer: United Healthcare All Other HMO |
$5.33
|
| Rate for Payer: United Healthcare HMO Rider |
$5.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.50
|
| Rate for Payer: Vantage Medical Group Senior |
$25.50
|
|
|
HC SOCDX ALLOSURE COLLECTION
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 99001
|
| Hospital Charge Code |
900915321
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Central Health Plan Commercial |
$24.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
|
|
HC SOCIDEM PDC 82657
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
900915254
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$17.95 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$22.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$91.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$130.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.55
|
| Rate for Payer: Blue Shield of California Commercial |
$91.05
|
| Rate for Payer: Blue Shield of California EPN |
$59.55
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Central Health Plan Commercial |
$120.00
|
| Rate for Payer: Cigna of CA HMO |
$96.00
|
| Rate for Payer: Cigna of CA PPO |
$111.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.93
|
| Rate for Payer: EPIC Health Plan Senior |
$22.17
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$135.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$36.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$30.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.17
|
| Rate for Payer: InnovAge PACE Commercial |
$33.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$100.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.71
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
| Rate for Payer: Networks By Design Commercial |
$97.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$22.17
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
| Rate for Payer: Prime Health Services Medicare |
$23.50
|
| Rate for Payer: Riverside University Health System MISP |
$24.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$90.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$90.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.95
|
| Rate for Payer: United Healthcare All Other HMO |
$17.95
|
| Rate for Payer: United Healthcare HMO Rider |
$17.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.95
|
| Rate for Payer: Upland Medical Group Pediatric |
$22.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22.17
|
|
|
HC SOCIDEM PDC 82657
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
900915254
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Central Health Plan Commercial |
$120.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.00
|
| Rate for Payer: EPIC Health Plan Senior |
$60.00
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$135.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$100.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$92.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
| Rate for Payer: Networks By Design Commercial |
$97.50
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
|
|
HC SOCIDEM PDC 82658
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
CPT 82658
|
| Hospital Charge Code |
900915255
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Central Health Plan Commercial |
$120.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.00
|
| Rate for Payer: EPIC Health Plan Senior |
$60.00
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$135.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$100.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$92.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
| Rate for Payer: Networks By Design Commercial |
$97.50
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
|
|
HC SOCIDEM PDC 82658
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT 82658
|
| Hospital Charge Code |
900915255
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$26.55 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$44.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$91.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$66.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$48.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$44.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$130.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.55
|
| Rate for Payer: Blue Shield of California Commercial |
$91.05
|
| Rate for Payer: Blue Shield of California EPN |
$59.55
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Central Health Plan Commercial |
$120.00
|
| Rate for Payer: Cigna of CA HMO |
$96.00
|
| Rate for Payer: Cigna of CA PPO |
$111.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$66.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$48.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$44.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.44
|
| Rate for Payer: EPIC Health Plan Senior |
$44.03
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$135.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$72.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$33.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$44.03
|
| Rate for Payer: InnovAge PACE Commercial |
$66.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$100.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$44.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$59.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$59.00
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
| Rate for Payer: Networks By Design Commercial |
$97.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$44.03
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
| Rate for Payer: Prime Health Services Medicare |
$46.67
|
| Rate for Payer: Riverside University Health System MISP |
$48.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$90.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$90.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.67
|
| Rate for Payer: United Healthcare All Other HMO |
$35.67
|
| Rate for Payer: United Healthcare HMO Rider |
$35.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.67
|
| Rate for Payer: Upland Medical Group Pediatric |
$44.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$66.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48.43
|
| Rate for Payer: Vantage Medical Group Senior |
$44.03
|
|
|
HC SOCIDEM PDC 84157
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
900915256
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.24 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$91.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$26.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.43
|
| Rate for Payer: Blue Shield of California Commercial |
$91.05
|
| Rate for Payer: Blue Shield of California EPN |
$59.55
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Central Health Plan Commercial |
$120.00
|
| Rate for Payer: Cigna of CA HMO |
$96.00
|
| Rate for Payer: Cigna of CA PPO |
$111.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4.00
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$135.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.00
|
| Rate for Payer: InnovAge PACE Commercial |
$6.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$100.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.36
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
| Rate for Payer: Networks By Design Commercial |
$97.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.00
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
| Rate for Payer: Prime Health Services Medicare |
$4.24
|
| Rate for Payer: Riverside University Health System MISP |
$4.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$90.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$90.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.24
|
| Rate for Payer: United Healthcare All Other HMO |
$3.24
|
| Rate for Payer: United Healthcare HMO Rider |
$3.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.40
|
| Rate for Payer: Vantage Medical Group Senior |
$4.00
|
|
|
HC SOCIDEM PDC 84157
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
900915256
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Central Health Plan Commercial |
$120.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.00
|
| Rate for Payer: EPIC Health Plan Senior |
$60.00
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$135.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$100.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$92.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
| Rate for Payer: Networks By Design Commercial |
$97.50
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
|
|
HC SOCIDEM PDC 84999
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
900915253
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Central Health Plan Commercial |
$96.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Senior |
$48.00
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$74.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Networks By Design Commercial |
$78.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
|
|
HC SOCIDEM PDC 84999
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
900915253
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$72.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$102.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$58.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.48
|
| Rate for Payer: Blue Shield of California Commercial |
$72.84
|
| Rate for Payer: Blue Shield of California EPN |
$47.64
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Central Health Plan Commercial |
$96.00
|
| Rate for Payer: Cigna of CA HMO |
$76.80
|
| Rate for Payer: Cigna of CA PPO |
$88.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$102.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$102.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Senior |
$48.00
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.00
|
| Rate for Payer: InnovAge PACE Commercial |
$60.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$74.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Networks By Design Commercial |
$78.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: Riverside University Health System MISP |
$48.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.00
|
| Rate for Payer: United Healthcare All Other HMO |
$60.00
|
| Rate for Payer: United Healthcare HMO Rider |
$60.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$60.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$102.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$102.00
|
| Rate for Payer: Vantage Medical Group Senior |
$102.00
|
|
|
HC SOCINN 558 PRF1 GENE
|
Facility
|
OP
|
$2,371.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914743
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$474.20 |
| Max. Negotiated Rate |
$2,133.90 |
| Rate for Payer: Adventist Health Commercial |
$474.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,439.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,015.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,304.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,778.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,148.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,392.49
|
| Rate for Payer: Blue Shield of California Commercial |
$1,439.20
|
| Rate for Payer: Blue Shield of California EPN |
$941.29
|
| Rate for Payer: Cash Price |
$1,304.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,896.80
|
| Rate for Payer: Cigna of CA HMO |
$1,517.44
|
| Rate for Payer: Cigna of CA PPO |
$1,754.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,015.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,015.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,015.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$948.40
|
| Rate for Payer: EPIC Health Plan Senior |
$948.40
|
| Rate for Payer: Galaxy Health WC |
$2,015.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,422.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,133.90
|
| Rate for Payer: InnovAge PACE Commercial |
$1,185.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,581.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,467.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$474.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,659.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,659.70
|
| Rate for Payer: Multiplan Commercial |
$1,778.25
|
| Rate for Payer: Networks By Design Commercial |
$1,541.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,015.35
|
| Rate for Payer: Riverside University Health System MISP |
$948.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,422.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,422.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,185.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,185.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,185.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,185.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,015.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,015.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,015.35
|
|
|
HC SOCINN 558 PRF1 GENE
|
Facility
|
IP
|
$2,371.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914743
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$474.20 |
| Max. Negotiated Rate |
$2,133.90 |
| Rate for Payer: Adventist Health Commercial |
$474.20
|
| Rate for Payer: Cash Price |
$1,304.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,896.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$948.40
|
| Rate for Payer: EPIC Health Plan Senior |
$948.40
|
| Rate for Payer: Galaxy Health WC |
$2,015.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,422.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,133.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,581.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$903.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,467.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$474.20
|
| Rate for Payer: Multiplan Commercial |
$1,778.25
|
| Rate for Payer: Networks By Design Commercial |
$1,541.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,015.35
|
|
|
HC SOCKET INSERT W LOCK MECH
|
Facility
|
OP
|
$1,133.00
|
|
|
Service Code
|
CPT L5673
|
| Hospital Charge Code |
915340556
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$371.06 |
| Max. Negotiated Rate |
$1,019.70 |
| Rate for Payer: Adventist Health Commercial |
$464.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$963.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$623.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$849.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$665.41
|
| Rate for Payer: Blue Shield of California Commercial |
$875.81
|
| Rate for Payer: Blue Shield of California EPN |
$571.03
|
| Rate for Payer: Cash Price |
$623.15
|
| Rate for Payer: Cash Price |
$623.15
|
| Rate for Payer: Central Health Plan Commercial |
$906.40
|
| Rate for Payer: Cigna of CA HMO |
$793.10
|
| Rate for Payer: Cigna of CA PPO |
$793.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$963.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$963.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$963.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$453.20
|
| Rate for Payer: EPIC Health Plan Senior |
$453.20
|
| Rate for Payer: Galaxy Health WC |
$963.05
|
| Rate for Payer: Global Benefits Group Commercial |
$679.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,019.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$864.70
|
| Rate for Payer: InnovAge PACE Commercial |
$566.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$755.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$955.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$701.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$464.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$793.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$793.10
|
| Rate for Payer: Multiplan Commercial |
$849.75
|
| Rate for Payer: Networks By Design Commercial |
$566.50
|
| Rate for Payer: Prime Health Services Commercial |
$963.05
|
| Rate for Payer: Riverside University Health System MISP |
$453.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$679.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$679.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$425.21
|
| Rate for Payer: United Healthcare All Other HMO |
$413.88
|
| Rate for Payer: United Healthcare HMO Rider |
$404.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$371.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$963.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$963.05
|
| Rate for Payer: Vantage Medical Group Senior |
$963.05
|
|
|
HC SOCKET INSERT W LOCK MECH
|
Facility
|
IP
|
$1,133.00
|
|
|
Service Code
|
CPT L5673
|
| Hospital Charge Code |
915340556
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$226.60 |
| Max. Negotiated Rate |
$1,019.70 |
| Rate for Payer: Adventist Health Commercial |
$226.60
|
| Rate for Payer: Blue Shield of California Commercial |
$875.81
|
| Rate for Payer: Blue Shield of California EPN |
$571.03
|
| Rate for Payer: Cash Price |
$623.15
|
| Rate for Payer: Central Health Plan Commercial |
$906.40
|
| Rate for Payer: Cigna of CA HMO |
$793.10
|
| Rate for Payer: Cigna of CA PPO |
$793.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$453.20
|
| Rate for Payer: EPIC Health Plan Senior |
$453.20
|
| Rate for Payer: Galaxy Health WC |
$963.05
|
| Rate for Payer: Global Benefits Group Commercial |
$679.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,019.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$755.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$431.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$701.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.60
|
| Rate for Payer: Multiplan Commercial |
$849.75
|
| Rate for Payer: Networks By Design Commercial |
$736.45
|
| Rate for Payer: Prime Health Services Commercial |
$963.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$425.21
|
| Rate for Payer: United Healthcare All Other HMO |
$413.88
|
| Rate for Payer: United Healthcare HMO Rider |
$404.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$371.06
|
|
|
HC SOCKET INSERT W/O LOCK MECH
|
Facility
|
IP
|
$1,133.00
|
|
|
Service Code
|
CPT L5679
|
| Hospital Charge Code |
915340557
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$226.60 |
| Max. Negotiated Rate |
$1,019.70 |
| Rate for Payer: Adventist Health Commercial |
$226.60
|
| Rate for Payer: Blue Shield of California Commercial |
$875.81
|
| Rate for Payer: Blue Shield of California EPN |
$571.03
|
| Rate for Payer: Cash Price |
$623.15
|
| Rate for Payer: Central Health Plan Commercial |
$906.40
|
| Rate for Payer: Cigna of CA HMO |
$793.10
|
| Rate for Payer: Cigna of CA PPO |
$793.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$453.20
|
| Rate for Payer: EPIC Health Plan Senior |
$453.20
|
| Rate for Payer: Galaxy Health WC |
$963.05
|
| Rate for Payer: Global Benefits Group Commercial |
$679.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,019.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$755.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$431.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$701.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.60
|
| Rate for Payer: Multiplan Commercial |
$849.75
|
| Rate for Payer: Networks By Design Commercial |
$736.45
|
| Rate for Payer: Prime Health Services Commercial |
$963.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$425.21
|
| Rate for Payer: United Healthcare All Other HMO |
$413.88
|
| Rate for Payer: United Healthcare HMO Rider |
$404.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$371.06
|
|
|
HC SOCKET INSERT W/O LOCK MECH
|
Facility
|
OP
|
$1,133.00
|
|
|
Service Code
|
CPT L5679
|
| Hospital Charge Code |
915340557
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$371.06 |
| Max. Negotiated Rate |
$1,019.70 |
| Rate for Payer: Adventist Health Commercial |
$464.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$963.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$623.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$849.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$665.41
|
| Rate for Payer: Blue Shield of California Commercial |
$875.81
|
| Rate for Payer: Blue Shield of California EPN |
$571.03
|
| Rate for Payer: Cash Price |
$623.15
|
| Rate for Payer: Cash Price |
$623.15
|
| Rate for Payer: Central Health Plan Commercial |
$906.40
|
| Rate for Payer: Cigna of CA HMO |
$793.10
|
| Rate for Payer: Cigna of CA PPO |
$793.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$963.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$963.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$963.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$453.20
|
| Rate for Payer: EPIC Health Plan Senior |
$453.20
|
| Rate for Payer: Galaxy Health WC |
$963.05
|
| Rate for Payer: Global Benefits Group Commercial |
$679.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,019.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$720.58
|
| Rate for Payer: InnovAge PACE Commercial |
$566.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$755.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$795.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$701.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$464.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$793.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$793.10
|
| Rate for Payer: Multiplan Commercial |
$849.75
|
| Rate for Payer: Networks By Design Commercial |
$566.50
|
| Rate for Payer: Prime Health Services Commercial |
$963.05
|
| Rate for Payer: Riverside University Health System MISP |
$453.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$679.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$679.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$425.21
|
| Rate for Payer: United Healthcare All Other HMO |
$413.88
|
| Rate for Payer: United Healthcare HMO Rider |
$404.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$371.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$963.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$963.05
|
| Rate for Payer: Vantage Medical Group Senior |
$963.05
|
|
|
HC SO DBL SHLDR ELASTIC PRE-FAB
|
Facility
|
OP
|
$284.00
|
|
| Hospital Charge Code |
905353652
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$56.80 |
| Max. Negotiated Rate |
$255.60 |
| Rate for Payer: Adventist Health Commercial |
$56.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$172.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$241.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$156.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$213.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$137.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$166.79
|
| Rate for Payer: Blue Shield of California Commercial |
$173.52
|
| Rate for Payer: Blue Shield of California EPN |
$113.32
|
| Rate for Payer: Cash Price |
$284.00
|
| Rate for Payer: Central Health Plan Commercial |
$227.20
|
| Rate for Payer: Cigna of CA HMO |
$181.76
|
| Rate for Payer: Cigna of CA PPO |
$210.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$241.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$241.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$241.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$113.60
|
| Rate for Payer: EPIC Health Plan Senior |
$113.60
|
| Rate for Payer: Galaxy Health WC |
$241.40
|
| Rate for Payer: Global Benefits Group Commercial |
$170.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$255.60
|
| Rate for Payer: InnovAge PACE Commercial |
$142.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$189.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$175.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$198.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$198.80
|
| Rate for Payer: Multiplan Commercial |
$213.00
|
| Rate for Payer: Networks By Design Commercial |
$184.60
|
| Rate for Payer: Prime Health Services Commercial |
$241.40
|
| Rate for Payer: Riverside University Health System MISP |
$113.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$170.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$170.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$142.00
|
| Rate for Payer: United Healthcare All Other HMO |
$142.00
|
| Rate for Payer: United Healthcare HMO Rider |
$142.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$142.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$241.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$241.40
|
| Rate for Payer: Vantage Medical Group Senior |
$241.40
|
|
|
HC SO DBL SHLDR ELASTIC PRE-FAB
|
Facility
|
IP
|
$284.00
|
|
| Hospital Charge Code |
905353652
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$56.80 |
| Max. Negotiated Rate |
$255.60 |
| Rate for Payer: Adventist Health Commercial |
$56.80
|
| Rate for Payer: Cash Price |
$284.00
|
| Rate for Payer: Central Health Plan Commercial |
$227.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$113.60
|
| Rate for Payer: EPIC Health Plan Senior |
$113.60
|
| Rate for Payer: Galaxy Health WC |
$241.40
|
| Rate for Payer: Global Benefits Group Commercial |
$170.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$255.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$189.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$175.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.80
|
| Rate for Payer: Multiplan Commercial |
$213.00
|
| Rate for Payer: Networks By Design Commercial |
$184.60
|
| Rate for Payer: Prime Health Services Commercial |
$241.40
|
|
|
HC SODIUM
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
CPT 84295
|
| Hospital Charge Code |
900910269
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Cash Price |
$8.25
|
| Rate for Payer: Central Health Plan Commercial |
$12.00
|
| 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 Permanente of CA Commercial/Self Funded |
$10.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.29
|
| 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 SODIUM
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 84295
|
| Hospital Charge Code |
900910269
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$34.87 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.08
|
| Rate for Payer: Blue Shield of California Commercial |
$9.11
|
| Rate for Payer: Blue Shield of California EPN |
$5.96
|
| Rate for Payer: Cash Price |
$8.25
|
| Rate for Payer: Cash Price |
$8.25
|
| 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 |
$7.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.49
|
| Rate for Payer: EPIC Health Plan Senior |
$4.81
|
| 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: Heritage Provider Network Commercial/Senior |
$7.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.81
|
| Rate for Payer: InnovAge PACE Commercial |
$7.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.45
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.81
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
| Rate for Payer: Prime Health Services Medicare |
$5.10
|
| Rate for Payer: Riverside University Health System MISP |
$5.29
|
| 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 |
$3.90
|
| Rate for Payer: United Healthcare All Other HMO |
$3.90
|
| Rate for Payer: United Healthcare HMO Rider |
$3.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.90
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.29
|
| Rate for Payer: Vantage Medical Group Senior |
$4.81
|
|
|
HC SODIUM
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 84295
|
| Hospital Charge Code |
900910269
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$34.87 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.08
|
| Rate for Payer: Blue Shield of California Commercial |
$9.11
|
| Rate for Payer: Blue Shield of California EPN |
$5.96
|
| Rate for Payer: Cash Price |
$8.25
|
| Rate for Payer: Cash Price |
$8.25
|
| 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 |
$7.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.49
|
| Rate for Payer: EPIC Health Plan Senior |
$4.81
|
| 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: Heritage Provider Network Commercial/Senior |
$7.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.81
|
| Rate for Payer: InnovAge PACE Commercial |
$7.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.45
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.81
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
| Rate for Payer: Prime Health Services Medicare |
$5.10
|
| Rate for Payer: Riverside University Health System MISP |
$5.29
|
| 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 |
$3.90
|
| Rate for Payer: United Healthcare All Other HMO |
$3.90
|
| Rate for Payer: United Healthcare HMO Rider |
$3.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.90
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.29
|
| Rate for Payer: Vantage Medical Group Senior |
$4.81
|
|
|
HC SODIUM
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
CPT 84295
|
| Hospital Charge Code |
900910269
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Cash Price |
$8.25
|
| Rate for Payer: Central Health Plan Commercial |
$12.00
|
| 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 Permanente of CA Commercial/Self Funded |
$10.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.29
|
| 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 SODIUM BODY FLUID
|
Facility
|
IP
|
$20.31
|
|
|
Service Code
|
CPT 84302
|
| Hospital Charge Code |
900912246
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.06 |
| Max. Negotiated Rate |
$18.28 |
| Rate for Payer: Adventist Health Commercial |
$4.06
|
| Rate for Payer: Cash Price |
$11.17
|
| Rate for Payer: Central Health Plan Commercial |
$16.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.12
|
| Rate for Payer: EPIC Health Plan Senior |
$8.12
|
| Rate for Payer: Galaxy Health WC |
$17.26
|
| Rate for Payer: Global Benefits Group Commercial |
$12.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.06
|
| Rate for Payer: Multiplan Commercial |
$15.23
|
| Rate for Payer: Networks By Design Commercial |
$13.20
|
| Rate for Payer: Prime Health Services Commercial |
$17.26
|
|
