|
HC BILIRUBIN ICTOTEST
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
900910181
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$2.82 |
| Max. Negotiated Rate |
$64.60 |
| Rate for Payer: Adventist Health Commercial |
$15.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.47
|
| Rate for Payer: Blue Shield of California Commercial |
$50.84
|
| Rate for Payer: Blue Shield of California EPN |
$33.59
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna of CA HMO |
$48.64
|
| Rate for Payer: Cigna of CA PPO |
$56.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.70
|
| Rate for Payer: EPIC Health Plan Senior |
$3.48
|
| Rate for Payer: Galaxy Health WC |
$64.60
|
| Rate for Payer: Global Benefits Group Commercial |
$45.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.66
|
| Rate for Payer: Multiplan Commercial |
$60.80
|
| Rate for Payer: Networks By Design Commercial |
$49.40
|
| Rate for Payer: Prime Health Services Commercial |
$64.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.82
|
| Rate for Payer: United Healthcare All Other HMO |
$2.82
|
| Rate for Payer: United Healthcare HMO Rider |
$2.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.82
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.83
|
| Rate for Payer: Vantage Medical Group Senior |
$3.48
|
|
|
HC BILIRUBIN ICTOTEST
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
900910181
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$15.20 |
| Max. Negotiated Rate |
$64.60 |
| Rate for Payer: Adventist Health Commercial |
$15.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.40
|
| Rate for Payer: EPIC Health Plan Senior |
$30.40
|
| Rate for Payer: Galaxy Health WC |
$64.60
|
| Rate for Payer: Global Benefits Group Commercial |
$45.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.24
|
| Rate for Payer: Multiplan Commercial |
$60.80
|
| Rate for Payer: Networks By Design Commercial |
$49.40
|
| Rate for Payer: Prime Health Services Commercial |
$64.60
|
|
|
HC BILIRUBIN TOTAL
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
900910273
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.07 |
| Max. Negotiated Rate |
$49.41 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.41
|
| Rate for Payer: Blue Shield of California Commercial |
$33.45
|
| Rate for Payer: Blue Shield of California EPN |
$22.10
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna of CA HMO |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.78
|
| Rate for Payer: EPIC Health Plan Senior |
$5.02
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.73
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.07
|
| Rate for Payer: United Healthcare All Other HMO |
$4.07
|
| Rate for Payer: United Healthcare HMO Rider |
$4.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.07
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.52
|
| Rate for Payer: Vantage Medical Group Senior |
$5.02
|
|
|
HC BILIRUBIN TOTAL
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
900910273
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.80 |
| Max. Negotiated Rate |
$79.90 |
| Rate for Payer: Adventist Health Commercial |
$18.80
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.60
|
| Rate for Payer: EPIC Health Plan Senior |
$37.60
|
| Rate for Payer: Galaxy Health WC |
$79.90
|
| Rate for Payer: Global Benefits Group Commercial |
$56.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$62.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$58.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.56
|
| Rate for Payer: Multiplan Commercial |
$75.20
|
| Rate for Payer: Networks By Design Commercial |
$61.10
|
| Rate for Payer: Prime Health Services Commercial |
$79.90
|
|
|
HC BILIRUBIN TOTAL CH
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
900912177
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.07 |
| Max. Negotiated Rate |
$72.25 |
| Rate for Payer: Adventist Health Commercial |
$17.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$55.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.41
|
| Rate for Payer: Blue Shield of California Commercial |
$56.87
|
| Rate for Payer: Blue Shield of California EPN |
$37.57
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cigna of CA HMO |
$54.40
|
| Rate for Payer: Cigna of CA PPO |
$62.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.78
|
| Rate for Payer: EPIC Health Plan Senior |
$5.02
|
| Rate for Payer: Galaxy Health WC |
$72.25
|
| Rate for Payer: Global Benefits Group Commercial |
$51.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.73
|
| Rate for Payer: Multiplan Commercial |
$68.00
|
| Rate for Payer: Networks By Design Commercial |
$55.25
|
| Rate for Payer: Prime Health Services Commercial |
$72.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.07
|
| Rate for Payer: United Healthcare All Other HMO |
$4.07
|
| Rate for Payer: United Healthcare HMO Rider |
$4.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.07
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.52
|
| Rate for Payer: Vantage Medical Group Senior |
$5.02
|
|
|
HC BILIRUBIN TOTAL CH
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
900912177
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$72.25 |
| Rate for Payer: Adventist Health Commercial |
$17.00
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.00
|
| Rate for Payer: EPIC Health Plan Senior |
$34.00
|
| Rate for Payer: Galaxy Health WC |
$72.25
|
| Rate for Payer: Global Benefits Group Commercial |
$51.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$52.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.40
|
| Rate for Payer: Multiplan Commercial |
$68.00
|
| Rate for Payer: Networks By Design Commercial |
$55.25
|
| Rate for Payer: Prime Health Services Commercial |
$72.25
|
|
|
HC BILIRUBIN TRANSCUTANEOUS
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
CPT 88720
|
| Hospital Charge Code |
900912154
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.07 |
| Max. Negotiated Rate |
$49.47 |
| Rate for Payer: Adventist Health Commercial |
$4.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.47
|
| Rate for Payer: Blue Shield of California Commercial |
$14.05
|
| Rate for Payer: Blue Shield of California EPN |
$9.28
|
| Rate for Payer: Cash Price |
$9.45
|
| Rate for Payer: Cash Price |
$9.45
|
| Rate for Payer: Cigna of CA HMO |
$13.44
|
| Rate for Payer: Cigna of CA PPO |
$15.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.78
|
| Rate for Payer: EPIC Health Plan Senior |
$5.02
|
| Rate for Payer: Galaxy Health WC |
$17.85
|
| Rate for Payer: Global Benefits Group Commercial |
$12.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.73
|
| Rate for Payer: Multiplan Commercial |
$16.80
|
| Rate for Payer: Networks By Design Commercial |
$13.65
|
| Rate for Payer: Prime Health Services Commercial |
$17.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.07
|
| Rate for Payer: United Healthcare All Other HMO |
$4.07
|
| Rate for Payer: United Healthcare HMO Rider |
$4.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.07
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.52
|
| Rate for Payer: Vantage Medical Group Senior |
$5.02
|
|
|
HC BILIRUBIN TRANSCUTANEOUS
|
Facility
|
IP
|
$144.00
|
|
|
Service Code
|
CPT 88720
|
| Hospital Charge Code |
900912154
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.80 |
| Max. Negotiated Rate |
$122.40 |
| Rate for Payer: Adventist Health Commercial |
$28.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.60
|
| Rate for Payer: EPIC Health Plan Senior |
$57.60
|
| Rate for Payer: Galaxy Health WC |
$122.40
|
| Rate for Payer: Global Benefits Group Commercial |
$86.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$96.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$89.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.56
|
| Rate for Payer: Multiplan Commercial |
$115.20
|
| Rate for Payer: Networks By Design Commercial |
$93.60
|
| Rate for Payer: Prime Health Services Commercial |
$122.40
|
|
|
HC BIL STNT PLCMNT NEW ACC W CATH
|
Facility
|
OP
|
$14,049.00
|
|
|
Service Code
|
CPT 47540
|
| Hospital Charge Code |
909047540
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,809.80 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$2,809.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,119.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,154.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,413.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,822.94
|
| Rate for Payer: Cash Price |
$6,322.05
|
| Rate for Payer: Cash Price |
$6,322.05
|
| Rate for Payer: Cash Price |
$6,322.05
|
| Rate for Payer: Cigna of CA HMO |
$8,991.36
|
| Rate for Payer: Cigna of CA PPO |
$10,396.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,119.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,154.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,413.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,007.74
|
| Rate for Payer: EPIC Health Plan Senior |
$7,413.14
|
| Rate for Payer: Galaxy Health WC |
$11,941.65
|
| Rate for Payer: Global Benefits Group Commercial |
$8,429.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,157.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7,974.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,413.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,370.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,018.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,413.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,371.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,340.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,933.61
|
| Rate for Payer: Multiplan Commercial |
$11,239.20
|
| Rate for Payer: Multiplan WC |
$11,811.52
|
| Rate for Payer: Networks By Design Commercial |
$9,131.85
|
| Rate for Payer: Prime Health Services Commercial |
$11,941.65
|
| Rate for Payer: Prime Health Services WC |
$11,690.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,429.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,413.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,119.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,154.45
|
| Rate for Payer: Vantage Medical Group Senior |
$7,413.14
|
|
|
HC BIL STNT PLCMNT NEW ACC W CATH
|
Facility
|
IP
|
$14,049.00
|
|
|
Service Code
|
CPT 47540
|
| Hospital Charge Code |
909047540
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,809.80 |
| Max. Negotiated Rate |
$11,941.65 |
| Rate for Payer: Adventist Health Commercial |
$2,809.80
|
| Rate for Payer: Cash Price |
$6,322.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,619.60
|
| Rate for Payer: EPIC Health Plan Senior |
$5,619.60
|
| Rate for Payer: Galaxy Health WC |
$11,941.65
|
| Rate for Payer: Global Benefits Group Commercial |
$8,429.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,370.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,352.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,696.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,371.76
|
| Rate for Payer: Multiplan Commercial |
$11,239.20
|
| Rate for Payer: Networks By Design Commercial |
$9,131.85
|
| Rate for Payer: Prime Health Services Commercial |
$11,941.65
|
|
|
HC BIL STNT PLCMT NEW ACC WO CATH
|
Facility
|
IP
|
$14,049.00
|
|
|
Service Code
|
CPT 47539
|
| Hospital Charge Code |
909047539
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,809.80 |
| Max. Negotiated Rate |
$11,941.65 |
| Rate for Payer: Adventist Health Commercial |
$2,809.80
|
| Rate for Payer: Cash Price |
$6,322.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,619.60
|
| Rate for Payer: EPIC Health Plan Senior |
$5,619.60
|
| Rate for Payer: Galaxy Health WC |
$11,941.65
|
| Rate for Payer: Global Benefits Group Commercial |
$8,429.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,370.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,352.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,696.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,371.76
|
| Rate for Payer: Multiplan Commercial |
$11,239.20
|
| Rate for Payer: Networks By Design Commercial |
$9,131.85
|
| Rate for Payer: Prime Health Services Commercial |
$11,941.65
|
|
|
HC BIL STNT PLCMT NEW ACC WO CATH
|
Facility
|
OP
|
$14,049.00
|
|
|
Service Code
|
CPT 47539
|
| Hospital Charge Code |
909047539
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,809.80 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$2,809.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,119.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,154.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,413.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,822.94
|
| Rate for Payer: Cash Price |
$6,322.05
|
| Rate for Payer: Cash Price |
$6,322.05
|
| Rate for Payer: Cash Price |
$6,322.05
|
| Rate for Payer: Cigna of CA HMO |
$8,991.36
|
| Rate for Payer: Cigna of CA PPO |
$10,396.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,119.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,154.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,413.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,007.74
|
| Rate for Payer: EPIC Health Plan Senior |
$7,413.14
|
| Rate for Payer: Galaxy Health WC |
$11,941.65
|
| Rate for Payer: Global Benefits Group Commercial |
$8,429.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,157.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7,678.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,413.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,370.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,684.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,413.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,371.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,340.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,933.61
|
| Rate for Payer: Multiplan Commercial |
$11,239.20
|
| Rate for Payer: Multiplan WC |
$11,811.52
|
| Rate for Payer: Networks By Design Commercial |
$9,131.85
|
| Rate for Payer: Prime Health Services Commercial |
$11,941.65
|
| Rate for Payer: Prime Health Services WC |
$11,690.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,429.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,413.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,119.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,154.45
|
| Rate for Payer: Vantage Medical Group Senior |
$7,413.14
|
|
|
HC BINDER ABD 9IN TRI-PANEL S/M
|
Facility
|
IP
|
$152.00
|
|
| Hospital Charge Code |
901698665
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$30.40 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.80
|
| Rate for Payer: EPIC Health Plan Senior |
$60.80
|
| Rate for Payer: Galaxy Health WC |
$129.20
|
| Rate for Payer: Global Benefits Group Commercial |
$91.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$101.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$94.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.48
|
| Rate for Payer: Multiplan Commercial |
$121.60
|
| Rate for Payer: Networks By Design Commercial |
$98.80
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
|
|
HC BINDER ABD 9IN TRI-PANEL S/M
|
Facility
|
OP
|
$152.00
|
|
| Hospital Charge Code |
901698665
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$30.40 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$99.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$129.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$114.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$93.34
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cigna of CA HMO |
$97.28
|
| Rate for Payer: Cigna of CA PPO |
$112.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$129.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$129.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$129.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.80
|
| Rate for Payer: EPIC Health Plan Senior |
$60.80
|
| Rate for Payer: Galaxy Health WC |
$129.20
|
| Rate for Payer: Global Benefits Group Commercial |
$91.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$101.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$94.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$106.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$106.40
|
| Rate for Payer: Multiplan Commercial |
$121.60
|
| Rate for Payer: Networks By Design Commercial |
$98.80
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$91.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$91.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$76.00
|
| Rate for Payer: United Healthcare All Other HMO |
$76.00
|
| Rate for Payer: United Healthcare HMO Rider |
$76.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$76.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$129.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$129.20
|
| Rate for Payer: Vantage Medical Group Senior |
$129.20
|
|
|
HC BIOBAG LARVAE 10X10CM
|
Facility
|
OP
|
$713.00
|
|
| Hospital Charge Code |
901698179
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$142.60 |
| Max. Negotiated Rate |
$606.05 |
| Rate for Payer: Adventist Health Commercial |
$142.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$467.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$606.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$392.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$534.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$437.85
|
| Rate for Payer: Cash Price |
$320.85
|
| Rate for Payer: Cigna of CA HMO |
$456.32
|
| Rate for Payer: Cigna of CA PPO |
$527.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$606.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$606.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$606.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$285.20
|
| Rate for Payer: EPIC Health Plan Senior |
$285.20
|
| Rate for Payer: Galaxy Health WC |
$606.05
|
| Rate for Payer: Global Benefits Group Commercial |
$427.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$475.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$271.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$441.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$499.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$499.10
|
| Rate for Payer: Multiplan Commercial |
$570.40
|
| Rate for Payer: Networks By Design Commercial |
$463.45
|
| Rate for Payer: Prime Health Services Commercial |
$606.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$427.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$427.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$356.50
|
| Rate for Payer: United Healthcare All Other HMO |
$356.50
|
| Rate for Payer: United Healthcare HMO Rider |
$356.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$356.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$606.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$606.05
|
| Rate for Payer: Vantage Medical Group Senior |
$606.05
|
|
|
HC BIOBAG LARVAE 10X10CM
|
Facility
|
IP
|
$713.00
|
|
| Hospital Charge Code |
901698179
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$142.60 |
| Max. Negotiated Rate |
$606.05 |
| Rate for Payer: Adventist Health Commercial |
$142.60
|
| Rate for Payer: Cash Price |
$320.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$285.20
|
| Rate for Payer: EPIC Health Plan Senior |
$285.20
|
| Rate for Payer: Galaxy Health WC |
$606.05
|
| Rate for Payer: Global Benefits Group Commercial |
$427.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$475.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$271.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$441.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.12
|
| Rate for Payer: Multiplan Commercial |
$570.40
|
| Rate for Payer: Networks By Design Commercial |
$463.45
|
| Rate for Payer: Prime Health Services Commercial |
$606.05
|
|
|
HC BIOBAG LARVAE 12X6CM
|
Facility
|
OP
|
$2,001.00
|
|
| Hospital Charge Code |
901698178
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$400.20 |
| Max. Negotiated Rate |
$1,700.85 |
| Rate for Payer: Adventist Health Commercial |
$400.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,312.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,700.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,100.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,500.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,228.81
|
| Rate for Payer: Cash Price |
$900.45
|
| Rate for Payer: Cigna of CA HMO |
$1,280.64
|
| Rate for Payer: Cigna of CA PPO |
$1,480.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,700.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,700.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,700.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$800.40
|
| Rate for Payer: EPIC Health Plan Senior |
$800.40
|
| Rate for Payer: Galaxy Health WC |
$1,700.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,200.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,334.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$762.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,238.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$480.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,400.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,400.70
|
| Rate for Payer: Multiplan Commercial |
$1,600.80
|
| Rate for Payer: Networks By Design Commercial |
$1,300.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,700.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,200.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,200.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,000.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,000.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,000.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,700.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,700.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,700.85
|
|
|
HC BIOBAG LARVAE 12X6CM
|
Facility
|
IP
|
$2,001.00
|
|
| Hospital Charge Code |
901698178
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$400.20 |
| Max. Negotiated Rate |
$1,700.85 |
| Rate for Payer: Adventist Health Commercial |
$400.20
|
| Rate for Payer: Cash Price |
$900.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$800.40
|
| Rate for Payer: EPIC Health Plan Senior |
$800.40
|
| Rate for Payer: Galaxy Health WC |
$1,700.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,200.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,334.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$762.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,238.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$480.24
|
| Rate for Payer: Multiplan Commercial |
$1,600.80
|
| Rate for Payer: Networks By Design Commercial |
$1,300.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,700.85
|
|
|
HC BIOBAG LARVAE 2.5 X 4CM
|
Facility
|
IP
|
$1,817.00
|
|
| Hospital Charge Code |
901698175
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$363.40 |
| Max. Negotiated Rate |
$1,544.45 |
| Rate for Payer: Adventist Health Commercial |
$363.40
|
| Rate for Payer: Cash Price |
$817.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$726.80
|
| Rate for Payer: EPIC Health Plan Senior |
$726.80
|
| Rate for Payer: Galaxy Health WC |
$1,544.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,090.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,211.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$692.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,124.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$436.08
|
| Rate for Payer: Multiplan Commercial |
$1,453.60
|
| Rate for Payer: Networks By Design Commercial |
$1,181.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,544.45
|
|
|
HC BIOBAG LARVAE 2.5 X 4CM
|
Facility
|
OP
|
$1,817.00
|
|
| Hospital Charge Code |
901698175
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$363.40 |
| Max. Negotiated Rate |
$1,544.45 |
| Rate for Payer: Adventist Health Commercial |
$363.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,191.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,544.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$999.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,362.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,115.82
|
| Rate for Payer: Cash Price |
$817.65
|
| Rate for Payer: Cigna of CA HMO |
$1,162.88
|
| Rate for Payer: Cigna of CA PPO |
$1,344.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,544.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,544.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,544.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$726.80
|
| Rate for Payer: EPIC Health Plan Senior |
$726.80
|
| Rate for Payer: Galaxy Health WC |
$1,544.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,090.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,211.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$692.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,124.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$436.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,271.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,271.90
|
| Rate for Payer: Multiplan Commercial |
$1,453.60
|
| Rate for Payer: Networks By Design Commercial |
$1,181.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,544.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,090.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,090.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$908.50
|
| Rate for Payer: United Healthcare All Other HMO |
$908.50
|
| Rate for Payer: United Healthcare HMO Rider |
$908.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$908.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,544.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,544.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1,544.45
|
|
|
HC BIOBAG LARVAE 5X4CM
|
Facility
|
IP
|
$1,863.00
|
|
| Hospital Charge Code |
901698176
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$372.60 |
| Max. Negotiated Rate |
$1,583.55 |
| Rate for Payer: Adventist Health Commercial |
$372.60
|
| Rate for Payer: Cash Price |
$838.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$745.20
|
| Rate for Payer: EPIC Health Plan Senior |
$745.20
|
| Rate for Payer: Galaxy Health WC |
$1,583.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,117.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,242.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$709.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,153.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$447.12
|
| Rate for Payer: Multiplan Commercial |
$1,490.40
|
| Rate for Payer: Networks By Design Commercial |
$1,210.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,583.55
|
|
|
HC BIOBAG LARVAE 5X4CM
|
Facility
|
OP
|
$1,863.00
|
|
| Hospital Charge Code |
901698176
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$372.60 |
| Max. Negotiated Rate |
$1,583.55 |
| Rate for Payer: Adventist Health Commercial |
$372.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,221.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,583.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,024.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,397.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,144.07
|
| Rate for Payer: Cash Price |
$838.35
|
| Rate for Payer: Cigna of CA HMO |
$1,192.32
|
| Rate for Payer: Cigna of CA PPO |
$1,378.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,583.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,583.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,583.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$745.20
|
| Rate for Payer: EPIC Health Plan Senior |
$745.20
|
| Rate for Payer: Galaxy Health WC |
$1,583.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,117.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,242.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$709.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,153.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$447.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,304.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,304.10
|
| Rate for Payer: Multiplan Commercial |
$1,490.40
|
| Rate for Payer: Networks By Design Commercial |
$1,210.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,583.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,117.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,117.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$931.50
|
| Rate for Payer: United Healthcare All Other HMO |
$931.50
|
| Rate for Payer: United Healthcare HMO Rider |
$931.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$931.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,583.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,583.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,583.55
|
|
|
HC BIOBAG LARVAE 6X5CM
|
Facility
|
IP
|
$1,909.00
|
|
| Hospital Charge Code |
901698177
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$381.80 |
| Max. Negotiated Rate |
$1,622.65 |
| Rate for Payer: Adventist Health Commercial |
$381.80
|
| Rate for Payer: Cash Price |
$859.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$763.60
|
| Rate for Payer: EPIC Health Plan Senior |
$763.60
|
| Rate for Payer: Galaxy Health WC |
$1,622.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,145.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,273.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$727.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,181.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$458.16
|
| Rate for Payer: Multiplan Commercial |
$1,527.20
|
| Rate for Payer: Networks By Design Commercial |
$1,240.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,622.65
|
|
|
HC BIOBAG LARVAE 6X5CM
|
Facility
|
OP
|
$1,909.00
|
|
| Hospital Charge Code |
901698177
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$381.80 |
| Max. Negotiated Rate |
$1,622.65 |
| Rate for Payer: Adventist Health Commercial |
$381.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,252.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,622.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,049.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,431.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,172.32
|
| Rate for Payer: Cash Price |
$859.05
|
| Rate for Payer: Cigna of CA HMO |
$1,221.76
|
| Rate for Payer: Cigna of CA PPO |
$1,412.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,622.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,622.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,622.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$763.60
|
| Rate for Payer: EPIC Health Plan Senior |
$763.60
|
| Rate for Payer: Galaxy Health WC |
$1,622.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,145.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,273.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$727.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,181.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$458.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,336.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,336.30
|
| Rate for Payer: Multiplan Commercial |
$1,527.20
|
| Rate for Payer: Networks By Design Commercial |
$1,240.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,622.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,145.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,145.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$954.50
|
| Rate for Payer: United Healthcare All Other HMO |
$954.50
|
| Rate for Payer: United Healthcare HMO Rider |
$954.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$954.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,622.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,622.65
|
| Rate for Payer: Vantage Medical Group Senior |
$1,622.65
|
|
|
HC BIOFEEDBACK PERI/URO/RECTAL
|
Facility
|
OP
|
$288.00
|
|
|
Service Code
|
CPT 90911
|
| Hospital Charge Code |
906790911
|
|
Hospital Revenue Code
|
917
|
| Min. Negotiated Rate |
$57.60 |
| Max. Negotiated Rate |
$1,570.00 |
| Rate for Payer: Adventist Health Commercial |
$57.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$188.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$244.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$158.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$216.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$176.86
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cigna of CA HMO |
$184.32
|
| Rate for Payer: Cigna of CA PPO |
$213.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$244.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$244.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$244.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.20
|
| Rate for Payer: EPIC Health Plan Senior |
$115.20
|
| Rate for Payer: Galaxy Health WC |
$244.80
|
| Rate for Payer: Global Benefits Group Commercial |
$172.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$192.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$178.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$201.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$201.60
|
| Rate for Payer: Multiplan Commercial |
$230.40
|
| Rate for Payer: Networks By Design Commercial |
$187.20
|
| Rate for Payer: Prime Health Services Commercial |
$244.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$172.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$172.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,570.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,496.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,129.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,035.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$244.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$244.80
|
| Rate for Payer: Vantage Medical Group Senior |
$244.80
|
|
