|
HC CATH VLCNO VISIONS PV IV US
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1753
|
| Hospital Charge Code |
906812508
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cigna of CA HMO |
$2,730.00
|
| Rate for Payer: Cigna of CA PPO |
$2,730.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$936.00
|
| Rate for Payer: Multiplan Commercial |
$3,120.00
|
| Rate for Payer: Networks By Design Commercial |
$1,950.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,463.67
|
| Rate for Payer: United Healthcare All Other HMO |
$1,424.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1,393.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,277.25
|
|
|
HC CATH WHISTLE TIP 10-12FR
|
Facility
|
OP
|
$11.73
|
|
| Hospital Charge Code |
901601347
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$9.97 |
| Rate for Payer: Adventist Health Commercial |
$2.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.20
|
| Rate for Payer: Cash Price |
$5.28
|
| Rate for Payer: Cigna of CA HMO |
$7.51
|
| Rate for Payer: Cigna of CA PPO |
$8.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.69
|
| Rate for Payer: EPIC Health Plan Senior |
$4.69
|
| Rate for Payer: Galaxy Health WC |
$9.97
|
| Rate for Payer: Global Benefits Group Commercial |
$7.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.21
|
| Rate for Payer: Multiplan Commercial |
$9.38
|
| Rate for Payer: Networks By Design Commercial |
$7.62
|
| Rate for Payer: Prime Health Services Commercial |
$9.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.87
|
| Rate for Payer: United Healthcare All Other HMO |
$5.87
|
| Rate for Payer: United Healthcare HMO Rider |
$5.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.97
|
| Rate for Payer: Vantage Medical Group Senior |
$9.97
|
|
|
HC CATH WHISTLE TIP 10-12FR
|
Facility
|
IP
|
$11.73
|
|
| Hospital Charge Code |
901601347
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$9.97 |
| Rate for Payer: Adventist Health Commercial |
$2.35
|
| Rate for Payer: Cash Price |
$5.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.69
|
| Rate for Payer: EPIC Health Plan Senior |
$4.69
|
| Rate for Payer: Galaxy Health WC |
$9.97
|
| Rate for Payer: Global Benefits Group Commercial |
$7.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.82
|
| Rate for Payer: Multiplan Commercial |
$9.38
|
| Rate for Payer: Networks By Design Commercial |
$7.62
|
| Rate for Payer: Prime Health Services Commercial |
$9.97
|
|
|
HC CATH WHISTLE TIP 14-16FR
|
Facility
|
OP
|
$11.73
|
|
| Hospital Charge Code |
901601348
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$9.97 |
| Rate for Payer: Adventist Health Commercial |
$2.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.20
|
| Rate for Payer: Cash Price |
$5.28
|
| Rate for Payer: Cigna of CA HMO |
$7.51
|
| Rate for Payer: Cigna of CA PPO |
$8.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.69
|
| Rate for Payer: EPIC Health Plan Senior |
$4.69
|
| Rate for Payer: Galaxy Health WC |
$9.97
|
| Rate for Payer: Global Benefits Group Commercial |
$7.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.21
|
| Rate for Payer: Multiplan Commercial |
$9.38
|
| Rate for Payer: Networks By Design Commercial |
$7.62
|
| Rate for Payer: Prime Health Services Commercial |
$9.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.87
|
| Rate for Payer: United Healthcare All Other HMO |
$5.87
|
| Rate for Payer: United Healthcare HMO Rider |
$5.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.97
|
| Rate for Payer: Vantage Medical Group Senior |
$9.97
|
|
|
HC CATH WHISTLE TIP 14-16FR
|
Facility
|
IP
|
$11.73
|
|
| Hospital Charge Code |
901601348
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$9.97 |
| Rate for Payer: Adventist Health Commercial |
$2.35
|
| Rate for Payer: Cash Price |
$5.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.69
|
| Rate for Payer: EPIC Health Plan Senior |
$4.69
|
| Rate for Payer: Galaxy Health WC |
$9.97
|
| Rate for Payer: Global Benefits Group Commercial |
$7.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.82
|
| Rate for Payer: Multiplan Commercial |
$9.38
|
| Rate for Payer: Networks By Design Commercial |
$7.62
|
| Rate for Payer: Prime Health Services Commercial |
$9.97
|
|
|
HC CATH WHISTLE TIP 8FR
|
Facility
|
IP
|
$11.73
|
|
| Hospital Charge Code |
901601473
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$9.97 |
| Rate for Payer: Adventist Health Commercial |
$2.35
|
| Rate for Payer: Cash Price |
$5.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.69
|
| Rate for Payer: EPIC Health Plan Senior |
$4.69
|
| Rate for Payer: Galaxy Health WC |
$9.97
|
| Rate for Payer: Global Benefits Group Commercial |
$7.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.82
|
| Rate for Payer: Multiplan Commercial |
$9.38
|
| Rate for Payer: Networks By Design Commercial |
$7.62
|
| Rate for Payer: Prime Health Services Commercial |
$9.97
|
|
|
HC CATH WHISTLE TIP 8FR
|
Facility
|
OP
|
$11.73
|
|
| Hospital Charge Code |
901601473
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$9.97 |
| Rate for Payer: Adventist Health Commercial |
$2.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.20
|
| Rate for Payer: Cash Price |
$5.28
|
| Rate for Payer: Cigna of CA HMO |
$7.51
|
| Rate for Payer: Cigna of CA PPO |
$8.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.69
|
| Rate for Payer: EPIC Health Plan Senior |
$4.69
|
| Rate for Payer: Galaxy Health WC |
$9.97
|
| Rate for Payer: Global Benefits Group Commercial |
$7.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.21
|
| Rate for Payer: Multiplan Commercial |
$9.38
|
| Rate for Payer: Networks By Design Commercial |
$7.62
|
| Rate for Payer: Prime Health Services Commercial |
$9.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.87
|
| Rate for Payer: United Healthcare All Other HMO |
$5.87
|
| Rate for Payer: United Healthcare HMO Rider |
$5.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.97
|
| Rate for Payer: Vantage Medical Group Senior |
$9.97
|
|
|
HC CATH WINGMAN CROSSING
|
Facility
|
OP
|
$3,881.00
|
|
|
Service Code
|
CPT C1714
|
| Hospital Charge Code |
909000020
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$776.20 |
| Max. Negotiated Rate |
$3,298.85 |
| Rate for Payer: Adventist Health Commercial |
$776.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,545.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,298.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,134.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,910.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,383.32
|
| Rate for Payer: Cash Price |
$1,746.45
|
| Rate for Payer: Cigna of CA HMO |
$2,483.84
|
| Rate for Payer: Cigna of CA PPO |
$2,871.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,298.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,298.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,298.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,552.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,552.40
|
| Rate for Payer: Galaxy Health WC |
$3,298.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,328.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,588.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,478.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,402.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$931.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,716.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,716.70
|
| Rate for Payer: Multiplan Commercial |
$3,104.80
|
| Rate for Payer: Networks By Design Commercial |
$2,522.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,298.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,328.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,328.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,940.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,940.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,940.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,940.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,298.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,298.85
|
| Rate for Payer: Vantage Medical Group Senior |
$3,298.85
|
|
|
HC CATH WINGMAN CROSSING
|
Facility
|
IP
|
$3,881.00
|
|
|
Service Code
|
CPT C1714
|
| Hospital Charge Code |
909000020
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$776.20 |
| Max. Negotiated Rate |
$3,298.85 |
| Rate for Payer: Adventist Health Commercial |
$776.20
|
| Rate for Payer: Cash Price |
$1,746.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,552.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,552.40
|
| Rate for Payer: Galaxy Health WC |
$3,298.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,328.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,588.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,478.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,402.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$931.44
|
| Rate for Payer: Multiplan Commercial |
$3,104.80
|
| Rate for Payer: Networks By Design Commercial |
$2,522.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,298.85
|
|
|
HC CAUTERY COVIDIEN BLADE
|
Facility
|
IP
|
$26.00
|
|
| Hospital Charge Code |
906812611
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$22.10 |
| Rate for Payer: Adventist Health Commercial |
$5.20
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.40
|
| Rate for Payer: EPIC Health Plan Senior |
$10.40
|
| Rate for Payer: Galaxy Health WC |
$22.10
|
| Rate for Payer: Global Benefits Group Commercial |
$15.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.24
|
| Rate for Payer: Multiplan Commercial |
$20.80
|
| Rate for Payer: Networks By Design Commercial |
$16.90
|
| Rate for Payer: Prime Health Services Commercial |
$22.10
|
|
|
HC CAUTERY COVIDIEN BLADE
|
Facility
|
OP
|
$26.00
|
|
| Hospital Charge Code |
906812611
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$22.10 |
| Rate for Payer: Adventist Health Commercial |
$5.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.97
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cigna of CA HMO |
$16.64
|
| Rate for Payer: Cigna of CA PPO |
$19.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.40
|
| Rate for Payer: EPIC Health Plan Senior |
$10.40
|
| Rate for Payer: Galaxy Health WC |
$22.10
|
| Rate for Payer: Global Benefits Group Commercial |
$15.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.20
|
| Rate for Payer: Multiplan Commercial |
$20.80
|
| Rate for Payer: Networks By Design Commercial |
$16.90
|
| Rate for Payer: Prime Health Services Commercial |
$22.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.00
|
| Rate for Payer: United Healthcare All Other HMO |
$13.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.10
|
| Rate for Payer: Vantage Medical Group Senior |
$22.10
|
|
|
HC CAUTERY MED AQUAMANTYS SEALER
|
Facility
|
OP
|
$2,275.62
|
|
| Hospital Charge Code |
906812613
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$455.12 |
| Max. Negotiated Rate |
$1,934.28 |
| Rate for Payer: Adventist Health Commercial |
$455.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,492.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,934.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,251.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,706.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,397.46
|
| Rate for Payer: Cash Price |
$1,024.03
|
| Rate for Payer: Cigna of CA HMO |
$1,456.40
|
| Rate for Payer: Cigna of CA PPO |
$1,683.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,934.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,934.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,934.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$910.25
|
| Rate for Payer: EPIC Health Plan Senior |
$910.25
|
| Rate for Payer: Galaxy Health WC |
$1,934.28
|
| Rate for Payer: Global Benefits Group Commercial |
$1,365.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,517.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$867.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,408.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$546.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,592.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,592.93
|
| Rate for Payer: Multiplan Commercial |
$1,820.50
|
| Rate for Payer: Networks By Design Commercial |
$1,479.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,934.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,365.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,365.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,137.81
|
| Rate for Payer: United Healthcare All Other HMO |
$1,137.81
|
| Rate for Payer: United Healthcare HMO Rider |
$1,137.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,137.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,934.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,934.28
|
| Rate for Payer: Vantage Medical Group Senior |
$1,934.28
|
|
|
HC CAUTERY MED AQUAMANTYS SEALER
|
Facility
|
IP
|
$2,275.62
|
|
| Hospital Charge Code |
906812613
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$455.12 |
| Max. Negotiated Rate |
$1,934.28 |
| Rate for Payer: Adventist Health Commercial |
$455.12
|
| Rate for Payer: Cash Price |
$1,024.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$910.25
|
| Rate for Payer: EPIC Health Plan Senior |
$910.25
|
| Rate for Payer: Galaxy Health WC |
$1,934.28
|
| Rate for Payer: Global Benefits Group Commercial |
$1,365.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,517.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$867.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,408.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$546.15
|
| Rate for Payer: Multiplan Commercial |
$1,820.50
|
| Rate for Payer: Networks By Design Commercial |
$1,479.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,934.28
|
|
|
HC CAUTERY MED PLASMA BLADE
|
Facility
|
OP
|
$1,374.00
|
|
| Hospital Charge Code |
906812612
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$274.80 |
| Max. Negotiated Rate |
$1,167.90 |
| Rate for Payer: Adventist Health Commercial |
$274.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$901.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$755.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,030.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$843.77
|
| Rate for Payer: Cash Price |
$618.30
|
| Rate for Payer: Cigna of CA HMO |
$879.36
|
| Rate for Payer: Cigna of CA PPO |
$1,016.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,167.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,167.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$549.60
|
| Rate for Payer: EPIC Health Plan Senior |
$549.60
|
| Rate for Payer: Galaxy Health WC |
$1,167.90
|
| Rate for Payer: Global Benefits Group Commercial |
$824.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$916.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$523.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$850.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$329.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$961.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$961.80
|
| Rate for Payer: Multiplan Commercial |
$1,099.20
|
| Rate for Payer: Networks By Design Commercial |
$893.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,167.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$824.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$824.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$687.00
|
| Rate for Payer: United Healthcare All Other HMO |
$687.00
|
| Rate for Payer: United Healthcare HMO Rider |
$687.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$687.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,167.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,167.90
|
|
|
HC CAUTERY MED PLASMA BLADE
|
Facility
|
IP
|
$1,374.00
|
|
| Hospital Charge Code |
906812612
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$274.80 |
| Max. Negotiated Rate |
$1,167.90 |
| Rate for Payer: Adventist Health Commercial |
$274.80
|
| Rate for Payer: Cash Price |
$618.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$549.60
|
| Rate for Payer: EPIC Health Plan Senior |
$549.60
|
| Rate for Payer: Galaxy Health WC |
$1,167.90
|
| Rate for Payer: Global Benefits Group Commercial |
$824.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$916.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$523.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$850.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$329.76
|
| Rate for Payer: Multiplan Commercial |
$1,099.20
|
| Rate for Payer: Networks By Design Commercial |
$893.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,167.90
|
|
|
HC CAVERNOSGRAPHY INJECTION
|
Facility
|
IP
|
$408.00
|
|
|
Service Code
|
CPT 54230
|
| Hospital Charge Code |
909080039
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$81.60 |
| Max. Negotiated Rate |
$346.80 |
| Rate for Payer: Adventist Health Commercial |
$81.60
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.20
|
| Rate for Payer: EPIC Health Plan Senior |
$163.20
|
| Rate for Payer: Galaxy Health WC |
$346.80
|
| Rate for Payer: Global Benefits Group Commercial |
$244.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$272.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$155.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.92
|
| Rate for Payer: Multiplan Commercial |
$326.40
|
| Rate for Payer: Networks By Design Commercial |
$265.20
|
| Rate for Payer: Prime Health Services Commercial |
$346.80
|
|
|
HC CAVERNOSGRAPHY INJECTION
|
Facility
|
OP
|
$408.00
|
|
|
Service Code
|
CPT 54230
|
| Hospital Charge Code |
909080039
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$81.60 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$81.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$346.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$224.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$250.55
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cigna of CA HMO |
$261.12
|
| Rate for Payer: Cigna of CA PPO |
$301.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$346.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$346.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$346.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.20
|
| Rate for Payer: EPIC Health Plan Senior |
$163.20
|
| Rate for Payer: Galaxy Health WC |
$346.80
|
| Rate for Payer: Global Benefits Group Commercial |
$244.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$103.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$272.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$285.60
|
| Rate for Payer: Multiplan Commercial |
$326.40
|
| Rate for Payer: Networks By Design Commercial |
$265.20
|
| Rate for Payer: Prime Health Services Commercial |
$346.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$244.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$346.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$346.80
|
| Rate for Payer: Vantage Medical Group Senior |
$346.80
|
|
|
HC CAVILON BARRIER WAND 1ML
|
Facility
|
IP
|
$5.90
|
|
|
Service Code
|
CPT A6250
|
| Hospital Charge Code |
901698609
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$5.01 |
| Rate for Payer: Adventist Health Commercial |
$1.18
|
| Rate for Payer: Cash Price |
$2.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.36
|
| Rate for Payer: EPIC Health Plan Senior |
$2.36
|
| Rate for Payer: Galaxy Health WC |
$5.01
|
| Rate for Payer: Global Benefits Group Commercial |
$3.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.42
|
| Rate for Payer: Multiplan Commercial |
$4.72
|
| Rate for Payer: Networks By Design Commercial |
$3.83
|
| Rate for Payer: Prime Health Services Commercial |
$5.01
|
|
|
HC CAVILON BARRIER WAND 1ML
|
Facility
|
OP
|
$5.90
|
|
|
Service Code
|
CPT A6250
|
| Hospital Charge Code |
901698609
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$5.01 |
| Rate for Payer: Adventist Health Commercial |
$1.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.62
|
| Rate for Payer: Cash Price |
$2.66
|
| Rate for Payer: Cigna of CA HMO |
$3.78
|
| Rate for Payer: Cigna of CA PPO |
$4.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.36
|
| Rate for Payer: EPIC Health Plan Senior |
$2.36
|
| Rate for Payer: Galaxy Health WC |
$5.01
|
| Rate for Payer: Global Benefits Group Commercial |
$3.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.13
|
| Rate for Payer: Multiplan Commercial |
$4.72
|
| Rate for Payer: Networks By Design Commercial |
$3.83
|
| Rate for Payer: Prime Health Services Commercial |
$5.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.95
|
| Rate for Payer: United Healthcare All Other HMO |
$2.95
|
| Rate for Payer: United Healthcare HMO Rider |
$2.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.01
|
| Rate for Payer: Vantage Medical Group Senior |
$5.01
|
|
|
HC CBC W DIFFERENTIAL
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
900910093
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.24 |
| Max. Negotiated Rate |
$63.90 |
| Rate for Payer: Adventist Health Commercial |
$10.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$34.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63.90
|
| Rate for Payer: Blue Shield of California Commercial |
$34.79
|
| Rate for Payer: Blue Shield of California EPN |
$22.98
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna of CA HMO |
$33.28
|
| Rate for Payer: Cigna of CA PPO |
$38.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.73
|
| Rate for Payer: EPIC Health Plan Senior |
$6.47
|
| Rate for Payer: Galaxy Health WC |
$44.20
|
| Rate for Payer: Global Benefits Group Commercial |
$31.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.67
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: Networks By Design Commercial |
$33.80
|
| Rate for Payer: Prime Health Services Commercial |
$44.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.24
|
| Rate for Payer: United Healthcare All Other HMO |
$5.24
|
| Rate for Payer: United Healthcare HMO Rider |
$5.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Vantage Medical Group Senior |
$6.47
|
|
|
HC CBC W DIFFERENTIAL
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
900910093
|
|
Hospital Revenue Code
|
305
|
| 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 CBC WITHOUT DIFFERENTIAL
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
900912020
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$88.40 |
| Rate for Payer: Adventist Health Commercial |
$20.80
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.60
|
| Rate for Payer: EPIC Health Plan Senior |
$41.60
|
| Rate for Payer: Galaxy Health WC |
$88.40
|
| Rate for Payer: Global Benefits Group Commercial |
$62.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$69.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$64.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.96
|
| Rate for Payer: Multiplan Commercial |
$83.20
|
| Rate for Payer: Networks By Design Commercial |
$67.60
|
| Rate for Payer: Prime Health Services Commercial |
$88.40
|
|
|
HC CBC WITHOUT DIFFERENTIAL
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
900912020
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.24 |
| Max. Negotiated Rate |
$63.90 |
| Rate for Payer: Adventist Health Commercial |
$10.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$34.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63.90
|
| Rate for Payer: Blue Shield of California Commercial |
$34.79
|
| Rate for Payer: Blue Shield of California EPN |
$22.98
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna of CA HMO |
$33.28
|
| Rate for Payer: Cigna of CA PPO |
$38.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.73
|
| Rate for Payer: EPIC Health Plan Senior |
$6.47
|
| Rate for Payer: Galaxy Health WC |
$44.20
|
| Rate for Payer: Global Benefits Group Commercial |
$31.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.67
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: Networks By Design Commercial |
$33.80
|
| Rate for Payer: Prime Health Services Commercial |
$44.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.24
|
| Rate for Payer: United Healthcare All Other HMO |
$5.24
|
| Rate for Payer: United Healthcare HMO Rider |
$5.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Vantage Medical Group Senior |
$6.47
|
|
|
HC CBC WO DIFFERENTIAL
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
900910086
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$88.40 |
| Rate for Payer: Adventist Health Commercial |
$20.80
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.60
|
| Rate for Payer: EPIC Health Plan Senior |
$41.60
|
| Rate for Payer: Galaxy Health WC |
$88.40
|
| Rate for Payer: Global Benefits Group Commercial |
$62.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$69.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$64.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.96
|
| Rate for Payer: Multiplan Commercial |
$83.20
|
| Rate for Payer: Networks By Design Commercial |
$67.60
|
| Rate for Payer: Prime Health Services Commercial |
$88.40
|
|
|
HC CBC WO DIFFERENTIAL
|
Facility
|
OP
|
$37.04
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
900910086
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.24 |
| Max. Negotiated Rate |
$63.90 |
| Rate for Payer: Adventist Health Commercial |
$7.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63.90
|
| Rate for Payer: Blue Shield of California Commercial |
$24.78
|
| Rate for Payer: Blue Shield of California EPN |
$16.37
|
| Rate for Payer: Cash Price |
$16.67
|
| Rate for Payer: Cash Price |
$16.67
|
| Rate for Payer: Cigna of CA HMO |
$23.71
|
| Rate for Payer: Cigna of CA PPO |
$27.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.73
|
| Rate for Payer: EPIC Health Plan Senior |
$6.47
|
| Rate for Payer: Galaxy Health WC |
$31.48
|
| Rate for Payer: Global Benefits Group Commercial |
$22.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.67
|
| Rate for Payer: Multiplan Commercial |
$29.63
|
| Rate for Payer: Networks By Design Commercial |
$24.08
|
| Rate for Payer: Prime Health Services Commercial |
$31.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.24
|
| Rate for Payer: United Healthcare All Other HMO |
$5.24
|
| Rate for Payer: United Healthcare HMO Rider |
$5.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Vantage Medical Group Senior |
$6.47
|
|
