|
HC ROOM TRAUMA ACUTE 1:4
|
Facility
|
IP
|
$6,054.00
|
|
| Hospital Charge Code |
992300002
|
|
Hospital Revenue Code
|
121
|
| Min. Negotiated Rate |
$1,452.96 |
| Max. Negotiated Rate |
$6,889.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,889.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,238.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,750.00
|
| Rate for Payer: Cash Price |
$2,724.30
|
| Rate for Payer: Cash Price |
$2,724.30
|
| Rate for Payer: Cigna of CA HMO |
$5,225.00
|
| Rate for Payer: Cigna of CA PPO |
$6,580.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,421.60
|
| Rate for Payer: Galaxy Health WC |
$5,145.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,632.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,038.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,306.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,452.96
|
| Rate for Payer: Multiplan Commercial |
$4,843.20
|
| Rate for Payer: Networks By Design Commercial |
$3,935.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,145.90
|
|
|
HC ROOM TRAUMA ACUTE ISOLATION
|
Facility
|
IP
|
$7,844.00
|
|
| Hospital Charge Code |
902300019
|
|
Hospital Revenue Code
|
164
|
| Min. Negotiated Rate |
$1,882.56 |
| Max. Negotiated Rate |
$6,667.40 |
| Rate for Payer: Blue Shield of California Commercial |
$5,238.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,750.00
|
| Rate for Payer: Cash Price |
$3,529.80
|
| Rate for Payer: Cash Price |
$3,529.80
|
| Rate for Payer: Cigna of CA HMO |
$5,225.00
|
| Rate for Payer: Cigna of CA PPO |
$6,580.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,137.60
|
| Rate for Payer: Galaxy Health WC |
$6,667.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,706.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,231.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,988.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,882.56
|
| Rate for Payer: Multiplan Commercial |
$6,275.20
|
| Rate for Payer: Networks By Design Commercial |
$5,098.60
|
| Rate for Payer: Prime Health Services Commercial |
$6,667.40
|
|
|
HC ROOM TRAUMA ACUTE ISOLATION 1:4
|
Facility
|
IP
|
$7,844.00
|
|
| Hospital Charge Code |
992300019
|
|
Hospital Revenue Code
|
164
|
| Min. Negotiated Rate |
$1,882.56 |
| Max. Negotiated Rate |
$6,667.40 |
| Rate for Payer: Blue Shield of California Commercial |
$5,238.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,750.00
|
| Rate for Payer: Cash Price |
$3,529.80
|
| Rate for Payer: Cash Price |
$3,529.80
|
| Rate for Payer: Cigna of CA HMO |
$5,225.00
|
| Rate for Payer: Cigna of CA PPO |
$6,580.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,137.60
|
| Rate for Payer: Galaxy Health WC |
$6,667.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,706.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,231.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,988.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,882.56
|
| Rate for Payer: Multiplan Commercial |
$6,275.20
|
| Rate for Payer: Networks By Design Commercial |
$5,098.60
|
| Rate for Payer: Prime Health Services Commercial |
$6,667.40
|
|
|
HC ROOM TRAUMA DOU/INTEREDIATE ISOLATION
|
Facility
|
IP
|
$11,552.00
|
|
| Hospital Charge Code |
902311719
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$2,772.48 |
| Max. Negotiated Rate |
$9,819.20 |
| Rate for Payer: Blue Shield of California Commercial |
$6,461.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,646.00
|
| Rate for Payer: Cash Price |
$5,198.40
|
| Rate for Payer: Cash Price |
$5,198.40
|
| Rate for Payer: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$6,775.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,620.80
|
| Rate for Payer: Galaxy Health WC |
$9,819.20
|
| Rate for Payer: Global Benefits Group Commercial |
$6,931.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,200.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,705.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,401.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,772.48
|
| Rate for Payer: Multiplan Commercial |
$9,241.60
|
| Rate for Payer: Prime Health Services Commercial |
$9,819.20
|
|
|
HC ROOM TRAUMA DOU/INTERMEDIATE
|
Facility
|
IP
|
$9,641.00
|
|
| Hospital Charge Code |
902311717
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$2,313.84 |
| Max. Negotiated Rate |
$8,194.85 |
| Rate for Payer: Blue Shield of California Commercial |
$6,461.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,646.00
|
| Rate for Payer: Cash Price |
$4,338.45
|
| Rate for Payer: Cash Price |
$4,338.45
|
| Rate for Payer: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$6,775.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,856.40
|
| Rate for Payer: Galaxy Health WC |
$8,194.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,784.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,200.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,430.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,673.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,313.84
|
| Rate for Payer: Multiplan Commercial |
$7,712.80
|
| Rate for Payer: Prime Health Services Commercial |
$8,194.85
|
|
|
HC ROOM TRAUMA ICU
|
Facility
|
IP
|
$26,546.00
|
|
| Hospital Charge Code |
902314716
|
|
Hospital Revenue Code
|
208
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$22,564.10 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,579.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,855.00
|
| Rate for Payer: Blue Shield of California EPN |
$6,367.00
|
| Rate for Payer: Cash Price |
$11,945.70
|
| Rate for Payer: Cash Price |
$11,945.70
|
| Rate for Payer: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$6,775.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,618.40
|
| Rate for Payer: Galaxy Health WC |
$22,564.10
|
| Rate for Payer: Global Benefits Group Commercial |
$15,927.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,650.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,706.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,114.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,371.04
|
| Rate for Payer: Multiplan Commercial |
$21,236.80
|
| Rate for Payer: Prime Health Services Commercial |
$22,564.10
|
|
|
HC ROOM TRAUMA ICU 1:1
|
Facility
|
IP
|
$26,546.00
|
|
| Hospital Charge Code |
992314716
|
|
Hospital Revenue Code
|
208
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$22,564.10 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,579.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,855.00
|
| Rate for Payer: Blue Shield of California EPN |
$6,367.00
|
| Rate for Payer: Cash Price |
$11,945.70
|
| Rate for Payer: Cash Price |
$11,945.70
|
| Rate for Payer: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$6,775.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,618.40
|
| Rate for Payer: Galaxy Health WC |
$22,564.10
|
| Rate for Payer: Global Benefits Group Commercial |
$15,927.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,650.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,706.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,114.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,371.04
|
| Rate for Payer: Multiplan Commercial |
$21,236.80
|
| Rate for Payer: Prime Health Services Commercial |
$22,564.10
|
|
|
HC ROOM TRAUMA ICU ISOLATION
|
Facility
|
IP
|
$25,121.00
|
|
| Hospital Charge Code |
902314715
|
|
Hospital Revenue Code
|
209
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$21,352.85 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,579.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,855.00
|
| Rate for Payer: Blue Shield of California EPN |
$6,367.00
|
| Rate for Payer: Cash Price |
$11,304.45
|
| Rate for Payer: Cash Price |
$11,304.45
|
| Rate for Payer: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$6,775.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,048.40
|
| Rate for Payer: Galaxy Health WC |
$21,352.85
|
| Rate for Payer: Global Benefits Group Commercial |
$15,072.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,650.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,755.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,571.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,029.04
|
| Rate for Payer: Multiplan Commercial |
$20,096.80
|
| Rate for Payer: Prime Health Services Commercial |
$21,352.85
|
|
|
HC ROOM TRAUMA ICU ISOLATION 1:1
|
Facility
|
IP
|
$25,121.00
|
|
| Hospital Charge Code |
992314715
|
|
Hospital Revenue Code
|
209
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$21,352.85 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,579.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,855.00
|
| Rate for Payer: Blue Shield of California EPN |
$6,367.00
|
| Rate for Payer: Cash Price |
$11,304.45
|
| Rate for Payer: Cash Price |
$11,304.45
|
| Rate for Payer: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$6,775.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,048.40
|
| Rate for Payer: Galaxy Health WC |
$21,352.85
|
| Rate for Payer: Global Benefits Group Commercial |
$15,072.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,650.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,755.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,571.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,029.04
|
| Rate for Payer: Multiplan Commercial |
$20,096.80
|
| Rate for Payer: Prime Health Services Commercial |
$21,352.85
|
|
|
HC ROTOVIRUS AG
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT 87425
|
| Hospital Charge Code |
900910976
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.64 |
| Max. Negotiated Rate |
$82.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$77.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$82.00
|
| Rate for Payer: Blue Distinction Transplant |
$21.60
|
| Rate for Payer: Blue Shield of California Commercial |
$23.26
|
| Rate for Payer: Blue Shield of California EPN |
$18.43
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna of CA HMO |
$23.04
|
| Rate for Payer: Cigna of CA PPO |
$26.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Media |
$11.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$11.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.98
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$27.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.65
|
| Rate for Payer: Heritage Provider Network Transplant |
$19.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$19.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.05
|
| Rate for Payer: Multiplan Commercial |
$28.80
|
| Rate for Payer: Networks By Design Commercial |
$23.40
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.70
|
| Rate for Payer: United Healthcare All Other HMO |
$9.70
|
| Rate for Payer: United Healthcare HMO Rider |
$9.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
|
|
HC ROUTINE URINALYSIS
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
CPT 81001
|
| Hospital Charge Code |
900910167
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$2.56 |
| Max. Negotiated Rate |
$27.89 |
| Rate for Payer: Aetna of CA HMO/PPO |
$26.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.89
|
| Rate for Payer: Blue Distinction Transplant |
$7.20
|
| Rate for Payer: Blue Shield of California Commercial |
$7.75
|
| Rate for Payer: Blue Shield of California EPN |
$6.14
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna of CA HMO |
$7.68
|
| Rate for Payer: Cigna of CA PPO |
$8.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.76
|
| Rate for Payer: Dignity Health Media |
$3.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.17
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.20
|
| Rate for Payer: Heritage Provider Network Transplant |
$5.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$5.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.25
|
| Rate for Payer: Multiplan Commercial |
$9.60
|
| Rate for Payer: Networks By Design Commercial |
$7.80
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.56
|
| Rate for Payer: United Healthcare All Other HMO |
$2.56
|
| Rate for Payer: United Healthcare HMO Rider |
$2.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.49
|
| Rate for Payer: Vantage Medical Group Senior |
$3.17
|
|
|
HC RPL GTUBE NOT RQ RV GSTRST TRC
|
Facility
|
OP
|
$2,229.00
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
906743760
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$308.79 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$308.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,337.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$1,003.05
|
| Rate for Payer: Cash Price |
$1,003.05
|
| Rate for Payer: Cigna of CA PPO |
$1,649.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.18
|
| Rate for Payer: Dignity Health Media |
$308.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$416.87
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$308.79
|
| Rate for Payer: EPIC Health Plan Transplant |
$308.79
|
| Rate for Payer: Galaxy Health WC |
$1,894.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,337.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,671.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$506.42
|
| Rate for Payer: Heritage Provider Network Transplant |
$506.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$500.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$500.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$308.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,486.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$389.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$308.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$534.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$389.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$413.78
|
| Rate for Payer: Multiplan Commercial |
$1,783.20
|
| Rate for Payer: Networks By Design Commercial |
$1,448.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,894.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,337.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$370.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: Vantage Medical Group Senior |
$308.79
|
|
|
HC RPL GTUBE NOT RQ RV GSTRST TRC
|
Facility
|
OP
|
$2,229.00
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
906743760
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$308.79 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$308.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,337.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,642.77
|
| Rate for Payer: Blue Shield of California EPN |
$1,301.74
|
| Rate for Payer: Cash Price |
$1,003.05
|
| Rate for Payer: Cash Price |
$1,003.05
|
| Rate for Payer: Cigna of CA HMO |
$1,426.56
|
| Rate for Payer: Cigna of CA PPO |
$1,649.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.18
|
| Rate for Payer: Dignity Health Media |
$308.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$416.87
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$308.79
|
| Rate for Payer: EPIC Health Plan Transplant |
$308.79
|
| Rate for Payer: Galaxy Health WC |
$1,894.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,337.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,671.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$506.42
|
| Rate for Payer: Heritage Provider Network Transplant |
$506.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$500.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$500.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$308.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,486.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$389.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$308.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$534.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$389.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$413.78
|
| Rate for Payer: Multiplan Commercial |
$1,783.20
|
| Rate for Payer: Networks By Design Commercial |
$1,448.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,894.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,337.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,337.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,114.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,114.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,114.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,114.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: Vantage Medical Group Senior |
$308.79
|
|
|
HC RPL GTUBE NOT RQ RV GSTRST TRC
|
Facility
|
IP
|
$2,229.00
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
906743760
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$534.96 |
| Max. Negotiated Rate |
$1,894.65 |
| Rate for Payer: Cash Price |
$1,003.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$891.60
|
| Rate for Payer: Galaxy Health WC |
$1,894.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,337.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,486.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$849.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$534.96
|
| Rate for Payer: Multiplan Commercial |
$1,783.20
|
| Rate for Payer: Networks By Design Commercial |
$1,448.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,894.65
|
|
|
HC RPL GTUBE NOT RQ RV GSTRST TRC
|
Facility
|
IP
|
$2,229.00
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
906743760
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$534.96 |
| Max. Negotiated Rate |
$1,894.65 |
| Rate for Payer: Cash Price |
$1,003.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$891.60
|
| Rate for Payer: Galaxy Health WC |
$1,894.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,337.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,486.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$849.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$534.96
|
| Rate for Payer: Multiplan Commercial |
$1,783.20
|
| Rate for Payer: Networks By Design Commercial |
$1,448.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,894.65
|
|
|
HC RPL GTUBE NOT RQ RV GSTRST TRC
|
Facility
|
OP
|
$2,229.00
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
906743760
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$308.79 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$308.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,337.40
|
| Rate for Payer: Cash Price |
$1,003.05
|
| Rate for Payer: Cash Price |
$1,003.05
|
| Rate for Payer: Cash Price |
$1,003.05
|
| Rate for Payer: Cigna of CA PPO |
$1,649.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.18
|
| Rate for Payer: Dignity Health Media |
$308.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$416.87
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$308.79
|
| Rate for Payer: EPIC Health Plan Transplant |
$308.79
|
| Rate for Payer: Galaxy Health WC |
$1,894.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,337.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,671.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$506.42
|
| Rate for Payer: Heritage Provider Network Transplant |
$506.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$308.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,486.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$389.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$308.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$534.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$389.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$413.78
|
| Rate for Payer: Multiplan Commercial |
$1,783.20
|
| Rate for Payer: Networks By Design Commercial |
$1,448.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,894.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,337.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,114.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,114.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,114.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,114.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: Vantage Medical Group Senior |
$308.79
|
|
|
HC RPL GTUBE NOT RQ RV GSTRST TRC
|
Facility
|
OP
|
$2,229.00
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
906743760
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$308.79 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$308.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,337.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$1,003.05
|
| Rate for Payer: Cash Price |
$1,003.05
|
| Rate for Payer: Cigna of CA PPO |
$1,649.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.18
|
| Rate for Payer: Dignity Health Media |
$308.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$416.87
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$308.79
|
| Rate for Payer: EPIC Health Plan Transplant |
$308.79
|
| Rate for Payer: Galaxy Health WC |
$1,894.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,337.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,671.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$506.42
|
| Rate for Payer: Heritage Provider Network Transplant |
$506.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$500.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$500.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$308.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,486.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$389.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$308.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$534.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$389.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$413.78
|
| Rate for Payer: Multiplan Commercial |
$1,783.20
|
| Rate for Payer: Networks By Design Commercial |
$1,448.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,894.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,337.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: Vantage Medical Group Senior |
$308.79
|
|
|
HC RPL GTUBE NOT RQ RV GSTRST TRC
|
Facility
|
IP
|
$2,229.00
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
906743760
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$534.96 |
| Max. Negotiated Rate |
$1,894.65 |
| Rate for Payer: Cash Price |
$1,003.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$891.60
|
| Rate for Payer: Galaxy Health WC |
$1,894.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,337.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,486.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$849.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$534.96
|
| Rate for Payer: Multiplan Commercial |
$1,783.20
|
| Rate for Payer: Networks By Design Commercial |
$1,448.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,894.65
|
|
|
HC RPL GTUBE NOT RQ RV GSTRST TRC
|
Facility
|
IP
|
$2,229.00
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
906743760
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$534.96 |
| Max. Negotiated Rate |
$1,894.65 |
| Rate for Payer: Cash Price |
$1,003.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$891.60
|
| Rate for Payer: Galaxy Health WC |
$1,894.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,337.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,486.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$849.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$534.96
|
| Rate for Payer: Multiplan Commercial |
$1,783.20
|
| Rate for Payer: Networks By Design Commercial |
$1,448.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,894.65
|
|
|
HC RPR
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900913675
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$118.12 |
| Rate for Payer: Aetna of CA HMO/PPO |
$107.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$118.12
|
| Rate for Payer: Blue Distinction Transplant |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$25.19
|
| Rate for Payer: Blue Shield of California EPN |
$19.97
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.90
|
| Rate for Payer: Dignity Health Media |
$17.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.31
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$17.27
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.27
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.32
|
| Rate for Payer: Heritage Provider Network Transplant |
$28.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$27.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.14
|
| Rate for Payer: Multiplan Commercial |
$31.20
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.99
|
| Rate for Payer: United Healthcare All Other HMO |
$13.99
|
| Rate for Payer: United Healthcare HMO Rider |
$13.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.27
|
|
|
HC RPR DETACHED RETINA
|
Facility
|
IP
|
$6,168.00
|
|
|
Service Code
|
CPT 67101
|
| Hospital Charge Code |
900501630
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,480.32 |
| Max. Negotiated Rate |
$5,242.80 |
| Rate for Payer: Cash Price |
$2,775.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,467.20
|
| Rate for Payer: Galaxy Health WC |
$5,242.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,700.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,114.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,350.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,480.32
|
| Rate for Payer: Multiplan Commercial |
$4,934.40
|
| Rate for Payer: Networks By Design Commercial |
$4,009.20
|
| Rate for Payer: Prime Health Services Commercial |
$5,242.80
|
|
|
HC RPR DETACHED RETINA
|
Facility
|
OP
|
$6,168.00
|
|
|
Service Code
|
CPT 67101
|
| Hospital Charge Code |
900501630
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$553.87 |
| Max. Negotiated Rate |
$12,491.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,911.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,049.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,700.80
|
| Rate for Payer: Cash Price |
$2,775.60
|
| Rate for Payer: Cash Price |
$2,775.60
|
| Rate for Payer: Cash Price |
$2,775.60
|
| Rate for Payer: Cigna of CA PPO |
$4,564.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Dignity Health Media |
$2,911.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,202.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,930.70
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,911.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,911.63
|
| Rate for Payer: Galaxy Health WC |
$5,242.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,700.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,626.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,775.07
|
| Rate for Payer: Heritage Provider Network Transplant |
$4,775.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,911.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,114.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$553.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,911.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,480.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,668.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,901.58
|
| Rate for Payer: Multiplan Commercial |
$4,934.40
|
| Rate for Payer: Networks By Design Commercial |
$4,009.20
|
| Rate for Payer: Prime Health Services Commercial |
$5,242.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,700.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,084.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,084.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,084.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,084.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: Vantage Medical Group Senior |
$2,911.63
|
|
|
HC RPR LIP FLL THCK UP TO HLF VER
|
Facility
|
IP
|
$1,662.00
|
|
|
Service Code
|
CPT 40652
|
| Hospital Charge Code |
900540652
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$398.88 |
| Max. Negotiated Rate |
$1,412.70 |
| Rate for Payer: Cash Price |
$747.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$664.80
|
| Rate for Payer: Galaxy Health WC |
$1,412.70
|
| Rate for Payer: Global Benefits Group Commercial |
$997.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,108.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$633.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$398.88
|
| Rate for Payer: Multiplan Commercial |
$1,329.60
|
| Rate for Payer: Networks By Design Commercial |
$1,080.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,412.70
|
|
|
HC RPR LIP FLL THCK UP TO HLF VER
|
Facility
|
OP
|
$1,662.00
|
|
|
Service Code
|
CPT 40652
|
| Hospital Charge Code |
900540652
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$122.38 |
| Max. Negotiated Rate |
$9,590.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$687.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$997.20
|
| Rate for Payer: Cash Price |
$747.90
|
| Rate for Payer: Cash Price |
$747.90
|
| Rate for Payer: Cash Price |
$747.90
|
| Rate for Payer: Cigna of CA PPO |
$1,229.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Dignity Health Media |
$687.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$756.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$928.04
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$687.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$687.44
|
| Rate for Payer: Galaxy Health WC |
$1,412.70
|
| Rate for Payer: Global Benefits Group Commercial |
$997.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,246.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,127.40
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,127.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$687.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,108.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$122.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$687.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$398.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$866.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$921.17
|
| Rate for Payer: Multiplan Commercial |
$1,329.60
|
| Rate for Payer: Networks By Design Commercial |
$1,080.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,412.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$997.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$831.00
|
| Rate for Payer: United Healthcare All Other HMO |
$831.00
|
| Rate for Payer: United Healthcare HMO Rider |
$831.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$831.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: Vantage Medical Group Senior |
$687.44
|
|
|
HC RPR PROS DEVICE PER 15 MIN
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
CPT L7520
|
| Hospital Charge Code |
905357520
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$3.84 |
| Max. Negotiated Rate |
$111.24 |
| Rate for Payer: Aetna of CA HMO/PPO |
$111.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.53
|
| Rate for Payer: Blue Distinction Transplant |
$9.60
|
| Rate for Payer: Blue Shield of California Commercial |
$11.79
|
| Rate for Payer: Blue Shield of California EPN |
$9.34
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna of CA HMO |
$10.24
|
| Rate for Payer: Cigna of CA PPO |
$11.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.60
|
| Rate for Payer: Dignity Health Media |
$13.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.40
|
| Rate for Payer: Galaxy Health WC |
$13.60
|
| Rate for Payer: Global Benefits Group Commercial |
$9.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.84
|
| Rate for Payer: Multiplan Commercial |
$12.80
|
| Rate for Payer: Networks By Design Commercial |
$10.40
|
| Rate for Payer: Prime Health Services Commercial |
$13.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.60
|
| Rate for Payer: Vantage Medical Group Senior |
$13.60
|
|
