|
HC HP CANADIAN TYPE W SACH
|
Facility
|
OP
|
$15,701.00
|
|
|
Service Code
|
CPT L5280
|
| Hospital Charge Code |
905355280
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,768.24 |
| Max. Negotiated Rate |
$13,345.85 |
| Rate for Payer: Adventist Health Commercial |
$6,437.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,345.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,635.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,775.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,094.02
|
| Rate for Payer: Blue Shield of California Commercial |
$11,587.34
|
| Rate for Payer: Blue Shield of California EPN |
$7,630.69
|
| Rate for Payer: Cash Price |
$7,065.45
|
| Rate for Payer: Cash Price |
$7,065.45
|
| Rate for Payer: Cigna of CA HMO |
$10,990.70
|
| Rate for Payer: Cigna of CA PPO |
$10,990.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,345.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,345.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,345.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,280.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,280.40
|
| Rate for Payer: Galaxy Health WC |
$13,345.85
|
| Rate for Payer: Global Benefits Group Commercial |
$9,420.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,853.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,472.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,358.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,718.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,768.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,990.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,990.70
|
| Rate for Payer: Multiplan Commercial |
$12,560.80
|
| Rate for Payer: Networks By Design Commercial |
$7,850.50
|
| Rate for Payer: Prime Health Services Commercial |
$13,345.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,420.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,420.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,892.59
|
| Rate for Payer: United Healthcare All Other HMO |
$5,735.58
|
| Rate for Payer: United Healthcare HMO Rider |
$5,611.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,142.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,345.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,345.85
|
| Rate for Payer: Vantage Medical Group Senior |
$13,345.85
|
|
|
HC HP CANADIAN TYPE W SACH
|
Facility
|
IP
|
$15,701.00
|
|
|
Service Code
|
CPT L5280
|
| Hospital Charge Code |
915355280
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,140.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$3,140.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$7,065.45
|
| Rate for Payer: Cash Price |
$7,065.45
|
| Rate for Payer: Cigna of CA HMO |
$10,990.70
|
| Rate for Payer: Cigna of CA PPO |
$10,990.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,280.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,280.40
|
| Rate for Payer: Galaxy Health WC |
$13,345.85
|
| Rate for Payer: Global Benefits Group Commercial |
$9,420.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,472.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,982.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,718.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,768.24
|
| Rate for Payer: Multiplan Commercial |
$12,560.80
|
| Rate for Payer: Networks By Design Commercial |
$7,850.50
|
| Rate for Payer: Prime Health Services Commercial |
$13,345.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,892.59
|
| Rate for Payer: United Healthcare All Other HMO |
$5,735.58
|
| Rate for Payer: United Healthcare HMO Rider |
$5,611.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,142.08
|
|
|
HC HP CANADIAN TYPE W SACH
|
Facility
|
IP
|
$15,701.00
|
|
|
Service Code
|
CPT L5280
|
| Hospital Charge Code |
905355280
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,140.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$3,140.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$7,065.45
|
| Rate for Payer: Cash Price |
$7,065.45
|
| Rate for Payer: Cigna of CA HMO |
$10,990.70
|
| Rate for Payer: Cigna of CA PPO |
$10,990.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,280.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,280.40
|
| Rate for Payer: Galaxy Health WC |
$13,345.85
|
| Rate for Payer: Global Benefits Group Commercial |
$9,420.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,472.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,982.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,718.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,768.24
|
| Rate for Payer: Multiplan Commercial |
$12,560.80
|
| Rate for Payer: Networks By Design Commercial |
$7,850.50
|
| Rate for Payer: Prime Health Services Commercial |
$13,345.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,892.59
|
| Rate for Payer: United Healthcare All Other HMO |
$5,735.58
|
| Rate for Payer: United Healthcare HMO Rider |
$5,611.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,142.08
|
|
|
HC HP CANADIAN TYPE W SACH
|
Facility
|
OP
|
$15,701.00
|
|
|
Service Code
|
CPT L5280
|
| Hospital Charge Code |
915355280
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,768.24 |
| Max. Negotiated Rate |
$13,345.85 |
| Rate for Payer: Adventist Health Commercial |
$6,437.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,345.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,635.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,775.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,094.02
|
| Rate for Payer: Blue Shield of California Commercial |
$11,587.34
|
| Rate for Payer: Blue Shield of California EPN |
$7,630.69
|
| Rate for Payer: Cash Price |
$7,065.45
|
| Rate for Payer: Cash Price |
$7,065.45
|
| Rate for Payer: Cigna of CA HMO |
$10,990.70
|
| Rate for Payer: Cigna of CA PPO |
$10,990.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,345.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,345.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,345.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,280.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,280.40
|
| Rate for Payer: Galaxy Health WC |
$13,345.85
|
| Rate for Payer: Global Benefits Group Commercial |
$9,420.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,853.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,472.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,358.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,718.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,768.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,990.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,990.70
|
| Rate for Payer: Multiplan Commercial |
$12,560.80
|
| Rate for Payer: Networks By Design Commercial |
$7,850.50
|
| Rate for Payer: Prime Health Services Commercial |
$13,345.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,420.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,420.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,892.59
|
| Rate for Payer: United Healthcare All Other HMO |
$5,735.58
|
| Rate for Payer: United Healthcare HMO Rider |
$5,611.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,142.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,345.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,345.85
|
| Rate for Payer: Vantage Medical Group Senior |
$13,345.85
|
|
|
HC HP PROS MID SKT ENDO,NO-COVER
|
Facility
|
OP
|
$10,808.00
|
|
|
Service Code
|
CPT L5341
|
| Hospital Charge Code |
915355341
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,593.92 |
| Max. Negotiated Rate |
$9,186.80 |
| Rate for Payer: Adventist Health Commercial |
$4,431.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,186.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,944.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,106.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,259.99
|
| Rate for Payer: Blue Shield of California Commercial |
$7,976.30
|
| Rate for Payer: Blue Shield of California EPN |
$5,252.69
|
| Rate for Payer: Cash Price |
$4,863.60
|
| Rate for Payer: Cash Price |
$4,863.60
|
| Rate for Payer: Cigna of CA HMO |
$7,565.60
|
| Rate for Payer: Cigna of CA PPO |
$7,565.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,186.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,186.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,186.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,323.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,323.20
|
| Rate for Payer: Galaxy Health WC |
$9,186.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6,484.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7,263.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,208.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,214.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,690.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,593.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,565.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,565.60
|
| Rate for Payer: Multiplan Commercial |
$8,646.40
|
| Rate for Payer: Networks By Design Commercial |
$5,404.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,186.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,484.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,484.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,056.24
|
| Rate for Payer: United Healthcare All Other HMO |
$3,948.16
|
| Rate for Payer: United Healthcare HMO Rider |
$3,862.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,539.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,186.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,186.80
|
| Rate for Payer: Vantage Medical Group Senior |
$9,186.80
|
|
|
HC HP PROS MID SKT ENDO,NO-COVER
|
Facility
|
IP
|
$10,808.00
|
|
|
Service Code
|
CPT L5341
|
| Hospital Charge Code |
915355341
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,161.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$2,161.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$4,863.60
|
| Rate for Payer: Cash Price |
$4,863.60
|
| Rate for Payer: Cigna of CA HMO |
$7,565.60
|
| Rate for Payer: Cigna of CA PPO |
$7,565.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,323.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,323.20
|
| Rate for Payer: Galaxy Health WC |
$9,186.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6,484.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,208.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,117.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,690.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,593.92
|
| Rate for Payer: Multiplan Commercial |
$8,646.40
|
| Rate for Payer: Networks By Design Commercial |
$5,404.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,186.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,056.24
|
| Rate for Payer: United Healthcare All Other HMO |
$3,948.16
|
| Rate for Payer: United Healthcare HMO Rider |
$3,862.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,539.62
|
|
|
HC HP PROS MID SKT ENDO,NO-COVER
|
Facility
|
IP
|
$10,808.00
|
|
|
Service Code
|
CPT L5341
|
| Hospital Charge Code |
905355341
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,161.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$2,161.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$4,863.60
|
| Rate for Payer: Cash Price |
$4,863.60
|
| Rate for Payer: Cigna of CA HMO |
$7,565.60
|
| Rate for Payer: Cigna of CA PPO |
$7,565.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,323.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,323.20
|
| Rate for Payer: Galaxy Health WC |
$9,186.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6,484.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,208.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,117.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,690.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,593.92
|
| Rate for Payer: Multiplan Commercial |
$8,646.40
|
| Rate for Payer: Networks By Design Commercial |
$5,404.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,186.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,056.24
|
| Rate for Payer: United Healthcare All Other HMO |
$3,948.16
|
| Rate for Payer: United Healthcare HMO Rider |
$3,862.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,539.62
|
|
|
HC HP PROS MID SKT ENDO,NO-COVER
|
Facility
|
OP
|
$10,808.00
|
|
|
Service Code
|
CPT L5341
|
| Hospital Charge Code |
905355341
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,593.92 |
| Max. Negotiated Rate |
$9,186.80 |
| Rate for Payer: Adventist Health Commercial |
$4,431.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,186.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,944.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,106.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,259.99
|
| Rate for Payer: Blue Shield of California Commercial |
$7,976.30
|
| Rate for Payer: Blue Shield of California EPN |
$5,252.69
|
| Rate for Payer: Cash Price |
$4,863.60
|
| Rate for Payer: Cash Price |
$4,863.60
|
| Rate for Payer: Cigna of CA HMO |
$7,565.60
|
| Rate for Payer: Cigna of CA PPO |
$7,565.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,186.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,186.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,186.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,323.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,323.20
|
| Rate for Payer: Galaxy Health WC |
$9,186.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6,484.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7,263.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,208.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,214.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,690.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,593.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,565.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,565.60
|
| Rate for Payer: Multiplan Commercial |
$8,646.40
|
| Rate for Payer: Networks By Design Commercial |
$5,404.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,186.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,484.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,484.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,056.24
|
| Rate for Payer: United Healthcare All Other HMO |
$3,948.16
|
| Rate for Payer: United Healthcare HMO Rider |
$3,862.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,539.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,186.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,186.80
|
| Rate for Payer: Vantage Medical Group Senior |
$9,186.80
|
|
|
HC HPV BY NUCLEIC ACID
|
Facility
|
IP
|
$161.00
|
|
|
Service Code
|
CPT 87626
|
| Hospital Charge Code |
900913641
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.20 |
| Max. Negotiated Rate |
$136.85 |
| Rate for Payer: Adventist Health Commercial |
$32.20
|
| Rate for Payer: Cash Price |
$72.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.40
|
| Rate for Payer: EPIC Health Plan Senior |
$64.40
|
| Rate for Payer: Galaxy Health WC |
$136.85
|
| Rate for Payer: Global Benefits Group Commercial |
$96.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$107.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$99.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.64
|
| Rate for Payer: Multiplan Commercial |
$128.80
|
| Rate for Payer: Networks By Design Commercial |
$104.65
|
| Rate for Payer: Prime Health Services Commercial |
$136.85
|
|
|
HC HPV BY NUCLEIC ACID
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
CPT 87626
|
| Hospital Charge Code |
900913641
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$119.00 |
| Rate for Payer: Adventist Health Commercial |
$28.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$91.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$105.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$77.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$70.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$117.03
|
| Rate for Payer: Blue Shield of California Commercial |
$93.66
|
| Rate for Payer: Blue Shield of California EPN |
$61.88
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna of CA HMO |
$89.60
|
| Rate for Payer: Cigna of CA PPO |
$103.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$105.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$77.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$70.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.77
|
| Rate for Payer: EPIC Health Plan Senior |
$70.20
|
| Rate for Payer: Galaxy Health WC |
$119.00
|
| Rate for Payer: Global Benefits Group Commercial |
$84.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$115.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$70.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$93.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$70.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$88.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$94.07
|
| Rate for Payer: Multiplan Commercial |
$112.00
|
| Rate for Payer: Networks By Design Commercial |
$91.00
|
| Rate for Payer: Prime Health Services Commercial |
$119.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$84.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$84.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$70.00
|
| Rate for Payer: United Healthcare All Other HMO |
$70.00
|
| Rate for Payer: United Healthcare HMO Rider |
$70.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$70.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$70.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$105.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$77.22
|
| Rate for Payer: Vantage Medical Group Senior |
$70.20
|
|
|
HC H. PYLORI AB, IGG
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
CPT 86677
|
| Hospital Charge Code |
900913556
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$54.00 |
| Max. Negotiated Rate |
$229.50 |
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.00
|
| Rate for Payer: EPIC Health Plan Senior |
$108.00
|
| Rate for Payer: Galaxy Health WC |
$229.50
|
| Rate for Payer: Global Benefits Group Commercial |
$162.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$180.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$167.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.80
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: Networks By Design Commercial |
$175.50
|
| Rate for Payer: Prime Health Services Commercial |
$229.50
|
|
|
HC H. PYLORI AB, IGG
|
Facility
|
OP
|
$74.00
|
|
|
Service Code
|
CPT 86677
|
| Hospital Charge Code |
900913556
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.65 |
| Max. Negotiated Rate |
$147.09 |
| Rate for Payer: Adventist Health Commercial |
$14.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$48.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.09
|
| Rate for Payer: Blue Shield of California Commercial |
$49.51
|
| Rate for Payer: Blue Shield of California EPN |
$32.71
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna of CA HMO |
$47.36
|
| Rate for Payer: Cigna of CA PPO |
$54.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.75
|
| Rate for Payer: EPIC Health Plan Senior |
$16.85
|
| Rate for Payer: Galaxy Health WC |
$62.90
|
| Rate for Payer: Global Benefits Group Commercial |
$44.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$49.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.58
|
| Rate for Payer: Multiplan Commercial |
$59.20
|
| Rate for Payer: Networks By Design Commercial |
$48.10
|
| Rate for Payer: Prime Health Services Commercial |
$62.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$44.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$44.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.65
|
| Rate for Payer: United Healthcare All Other HMO |
$13.65
|
| Rate for Payer: United Healthcare HMO Rider |
$13.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.65
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.54
|
| Rate for Payer: Vantage Medical Group Senior |
$16.85
|
|
|
HC H REFLEX SOLEUS
|
Facility
|
IP
|
$187.00
|
|
| Hospital Charge Code |
900600259
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$37.40 |
| Max. Negotiated Rate |
$158.95 |
| Rate for Payer: Adventist Health Commercial |
$37.40
|
| Rate for Payer: Cash Price |
$84.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.80
|
| Rate for Payer: EPIC Health Plan Senior |
$74.80
|
| Rate for Payer: Galaxy Health WC |
$158.95
|
| Rate for Payer: Global Benefits Group Commercial |
$112.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$124.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$115.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.88
|
| Rate for Payer: Multiplan Commercial |
$149.60
|
| Rate for Payer: Networks By Design Commercial |
$121.55
|
| Rate for Payer: Prime Health Services Commercial |
$158.95
|
|
|
HC H REFLEX SOLEUS
|
Facility
|
OP
|
$187.00
|
|
| Hospital Charge Code |
900600259
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$37.40 |
| Max. Negotiated Rate |
$1,297.00 |
| Rate for Payer: Adventist Health Commercial |
$37.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$122.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$158.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$102.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$140.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.84
|
| Rate for Payer: Blue Shield of California Commercial |
$114.44
|
| Rate for Payer: Blue Shield of California EPN |
$75.55
|
| Rate for Payer: Cash Price |
$84.15
|
| Rate for Payer: Cash Price |
$84.15
|
| Rate for Payer: Cigna of CA HMO |
$119.68
|
| Rate for Payer: Cigna of CA PPO |
$138.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$158.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$158.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$158.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.80
|
| Rate for Payer: EPIC Health Plan Senior |
$74.80
|
| Rate for Payer: Galaxy Health WC |
$158.95
|
| Rate for Payer: Global Benefits Group Commercial |
$112.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$124.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$115.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$130.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$130.90
|
| Rate for Payer: Multiplan Commercial |
$149.60
|
| Rate for Payer: Networks By Design Commercial |
$121.55
|
| Rate for Payer: Prime Health Services Commercial |
$158.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$112.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$112.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,297.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,024.00
|
| Rate for Payer: United Healthcare HMO Rider |
$776.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$711.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$158.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$158.95
|
| Rate for Payer: Vantage Medical Group Senior |
$158.95
|
|
|
HC HRHC INT TRANAL DARTLZN 2+
|
Facility
|
OP
|
$8,548.00
|
|
|
Service Code
|
CPT 46948
|
| Hospital Charge Code |
906706948
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$655.49 |
| Max. Negotiated Rate |
$16,122.00 |
| Rate for Payer: Adventist Health Commercial |
$1,709.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,226.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,832.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,484.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$3,846.60
|
| Rate for Payer: Cash Price |
$3,846.60
|
| Rate for Payer: Cash Price |
$3,846.60
|
| Rate for Payer: Cigna of CA HMO |
$5,470.72
|
| Rate for Payer: Cigna of CA PPO |
$6,325.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,226.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,832.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,484.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,704.05
|
| Rate for Payer: EPIC Health Plan Senior |
$3,484.48
|
| Rate for Payer: Galaxy Health WC |
$7,265.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,128.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,714.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$655.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,484.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,701.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$741.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,484.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,051.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,390.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,669.20
|
| Rate for Payer: Multiplan Commercial |
$6,838.40
|
| Rate for Payer: Multiplan WC |
$5,551.91
|
| Rate for Payer: Networks By Design Commercial |
$5,556.20
|
| Rate for Payer: Prime Health Services Commercial |
$7,265.80
|
| Rate for Payer: Prime Health Services WC |
$5,495.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,128.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,984.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,484.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,226.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,832.93
|
| Rate for Payer: Vantage Medical Group Senior |
$3,484.48
|
|
|
HC HRHC INT TRANAL DARTLZN 2+
|
Facility
|
IP
|
$8,548.00
|
|
|
Service Code
|
CPT 46948
|
| Hospital Charge Code |
906706948
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,709.60 |
| Max. Negotiated Rate |
$7,265.80 |
| Rate for Payer: Adventist Health Commercial |
$1,709.60
|
| Rate for Payer: Cash Price |
$3,846.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,419.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,419.20
|
| Rate for Payer: Galaxy Health WC |
$7,265.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,128.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,701.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,256.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,291.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,051.52
|
| Rate for Payer: Multiplan Commercial |
$6,838.40
|
| Rate for Payer: Networks By Design Commercial |
$5,556.20
|
| Rate for Payer: Prime Health Services Commercial |
$7,265.80
|
|
|
HC H STRISCPE LRG SNGL USE BRNCHSCPE 5.8 MM OD 2.8 MM WC
|
Facility
|
IP
|
$738.00
|
|
| Hospital Charge Code |
900831715
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$147.60 |
| Max. Negotiated Rate |
$627.30 |
| Rate for Payer: Adventist Health Commercial |
$147.60
|
| Rate for Payer: Cash Price |
$332.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$295.20
|
| Rate for Payer: EPIC Health Plan Senior |
$295.20
|
| Rate for Payer: Galaxy Health WC |
$627.30
|
| Rate for Payer: Global Benefits Group Commercial |
$442.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$492.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$281.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$456.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.12
|
| Rate for Payer: Multiplan Commercial |
$590.40
|
| Rate for Payer: Networks By Design Commercial |
$479.70
|
| Rate for Payer: Prime Health Services Commercial |
$627.30
|
|
|
HC H STRISCPE LRG SNGL USE BRNCHSCPE 5.8 MM OD 2.8 MM WC
|
Facility
|
OP
|
$738.00
|
|
| Hospital Charge Code |
900831715
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$147.60 |
| Max. Negotiated Rate |
$627.30 |
| Rate for Payer: Adventist Health Commercial |
$147.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$484.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$627.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$405.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$553.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$453.21
|
| Rate for Payer: Cash Price |
$332.10
|
| Rate for Payer: Cigna of CA HMO |
$472.32
|
| Rate for Payer: Cigna of CA PPO |
$546.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$627.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$627.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$627.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$295.20
|
| Rate for Payer: EPIC Health Plan Senior |
$295.20
|
| Rate for Payer: Galaxy Health WC |
$627.30
|
| Rate for Payer: Global Benefits Group Commercial |
$442.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$492.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$281.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$456.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$516.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$516.60
|
| Rate for Payer: Multiplan Commercial |
$590.40
|
| Rate for Payer: Networks By Design Commercial |
$479.70
|
| Rate for Payer: Prime Health Services Commercial |
$627.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$442.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$442.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$369.00
|
| Rate for Payer: United Healthcare All Other HMO |
$369.00
|
| Rate for Payer: United Healthcare HMO Rider |
$369.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$369.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$627.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$627.30
|
| Rate for Payer: Vantage Medical Group Senior |
$627.30
|
|
|
HC H STRISCPE NRML SNGL USE BRNCHSCPE 4.9 MM OD 2.2 MM WC
|
Facility
|
OP
|
$738.00
|
|
| Hospital Charge Code |
900831714
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$147.60 |
| Max. Negotiated Rate |
$627.30 |
| Rate for Payer: Adventist Health Commercial |
$147.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$484.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$627.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$405.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$553.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$453.21
|
| Rate for Payer: Cash Price |
$332.10
|
| Rate for Payer: Cigna of CA HMO |
$472.32
|
| Rate for Payer: Cigna of CA PPO |
$546.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$627.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$627.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$627.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$295.20
|
| Rate for Payer: EPIC Health Plan Senior |
$295.20
|
| Rate for Payer: Galaxy Health WC |
$627.30
|
| Rate for Payer: Global Benefits Group Commercial |
$442.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$492.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$281.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$456.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$516.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$516.60
|
| Rate for Payer: Multiplan Commercial |
$590.40
|
| Rate for Payer: Networks By Design Commercial |
$479.70
|
| Rate for Payer: Prime Health Services Commercial |
$627.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$442.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$442.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$369.00
|
| Rate for Payer: United Healthcare All Other HMO |
$369.00
|
| Rate for Payer: United Healthcare HMO Rider |
$369.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$369.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$627.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$627.30
|
| Rate for Payer: Vantage Medical Group Senior |
$627.30
|
|
|
HC H STRISCPE NRML SNGL USE BRNCHSCPE 4.9 MM OD 2.2 MM WC
|
Facility
|
IP
|
$738.00
|
|
| Hospital Charge Code |
900831714
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$147.60 |
| Max. Negotiated Rate |
$627.30 |
| Rate for Payer: Adventist Health Commercial |
$147.60
|
| Rate for Payer: Cash Price |
$332.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$295.20
|
| Rate for Payer: EPIC Health Plan Senior |
$295.20
|
| Rate for Payer: Galaxy Health WC |
$627.30
|
| Rate for Payer: Global Benefits Group Commercial |
$442.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$492.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$281.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$456.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.12
|
| Rate for Payer: Multiplan Commercial |
$590.40
|
| Rate for Payer: Networks By Design Commercial |
$479.70
|
| Rate for Payer: Prime Health Services Commercial |
$627.30
|
|
|
HC H STRISCPE SLIM SNGL USE BRNCHSCPE 3.2 MM OD 1.2 MM WC
|
Facility
|
OP
|
$738.00
|
|
| Hospital Charge Code |
900831713
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$147.60 |
| Max. Negotiated Rate |
$627.30 |
| Rate for Payer: Adventist Health Commercial |
$147.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$484.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$627.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$405.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$553.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$453.21
|
| Rate for Payer: Cash Price |
$332.10
|
| Rate for Payer: Cigna of CA HMO |
$472.32
|
| Rate for Payer: Cigna of CA PPO |
$546.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$627.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$627.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$627.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$295.20
|
| Rate for Payer: EPIC Health Plan Senior |
$295.20
|
| Rate for Payer: Galaxy Health WC |
$627.30
|
| Rate for Payer: Global Benefits Group Commercial |
$442.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$492.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$281.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$456.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$516.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$516.60
|
| Rate for Payer: Multiplan Commercial |
$590.40
|
| Rate for Payer: Networks By Design Commercial |
$479.70
|
| Rate for Payer: Prime Health Services Commercial |
$627.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$442.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$442.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$369.00
|
| Rate for Payer: United Healthcare All Other HMO |
$369.00
|
| Rate for Payer: United Healthcare HMO Rider |
$369.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$369.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$627.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$627.30
|
| Rate for Payer: Vantage Medical Group Senior |
$627.30
|
|
|
HC H STRISCPE SLIM SNGL USE BRNCHSCPE 3.2 MM OD 1.2 MM WC
|
Facility
|
IP
|
$738.00
|
|
| Hospital Charge Code |
900831713
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$147.60 |
| Max. Negotiated Rate |
$627.30 |
| Rate for Payer: Adventist Health Commercial |
$147.60
|
| Rate for Payer: Cash Price |
$332.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$295.20
|
| Rate for Payer: EPIC Health Plan Senior |
$295.20
|
| Rate for Payer: Galaxy Health WC |
$627.30
|
| Rate for Payer: Global Benefits Group Commercial |
$442.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$492.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$281.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$456.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.12
|
| Rate for Payer: Multiplan Commercial |
$590.40
|
| Rate for Payer: Networks By Design Commercial |
$479.70
|
| Rate for Payer: Prime Health Services Commercial |
$627.30
|
|
|
HC H STRISCPE XTRA SNGL USE BRNCHSCPE 6.2 MM OD 3.2 MM WC
|
Facility
|
IP
|
$738.00
|
|
| Hospital Charge Code |
900831716
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$147.60 |
| Max. Negotiated Rate |
$627.30 |
| Rate for Payer: Adventist Health Commercial |
$147.60
|
| Rate for Payer: Cash Price |
$332.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$295.20
|
| Rate for Payer: EPIC Health Plan Senior |
$295.20
|
| Rate for Payer: Galaxy Health WC |
$627.30
|
| Rate for Payer: Global Benefits Group Commercial |
$442.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$492.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$281.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$456.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.12
|
| Rate for Payer: Multiplan Commercial |
$590.40
|
| Rate for Payer: Networks By Design Commercial |
$479.70
|
| Rate for Payer: Prime Health Services Commercial |
$627.30
|
|
|
HC H STRISCPE XTRA SNGL USE BRNCHSCPE 6.2 MM OD 3.2 MM WC
|
Facility
|
OP
|
$738.00
|
|
| Hospital Charge Code |
900831716
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$147.60 |
| Max. Negotiated Rate |
$627.30 |
| Rate for Payer: Adventist Health Commercial |
$147.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$484.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$627.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$405.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$553.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$453.21
|
| Rate for Payer: Cash Price |
$332.10
|
| Rate for Payer: Cigna of CA HMO |
$472.32
|
| Rate for Payer: Cigna of CA PPO |
$546.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$627.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$627.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$627.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$295.20
|
| Rate for Payer: EPIC Health Plan Senior |
$295.20
|
| Rate for Payer: Galaxy Health WC |
$627.30
|
| Rate for Payer: Global Benefits Group Commercial |
$442.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$492.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$281.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$456.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$516.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$516.60
|
| Rate for Payer: Multiplan Commercial |
$590.40
|
| Rate for Payer: Networks By Design Commercial |
$479.70
|
| Rate for Payer: Prime Health Services Commercial |
$627.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$442.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$442.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$369.00
|
| Rate for Payer: United Healthcare All Other HMO |
$369.00
|
| Rate for Payer: United Healthcare HMO Rider |
$369.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$369.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$627.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$627.30
|
| Rate for Payer: Vantage Medical Group Senior |
$627.30
|
|
|
HC H STRISCPE ZERO SNGL USE BRNCHSCPE 2.2 MM OD 0.0 MM WC
|
Facility
|
OP
|
$738.00
|
|
| Hospital Charge Code |
900831712
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$147.60 |
| Max. Negotiated Rate |
$627.30 |
| Rate for Payer: Adventist Health Commercial |
$147.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$484.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$627.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$405.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$553.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$453.21
|
| Rate for Payer: Cash Price |
$332.10
|
| Rate for Payer: Cigna of CA HMO |
$472.32
|
| Rate for Payer: Cigna of CA PPO |
$546.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$627.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$627.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$627.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$295.20
|
| Rate for Payer: EPIC Health Plan Senior |
$295.20
|
| Rate for Payer: Galaxy Health WC |
$627.30
|
| Rate for Payer: Global Benefits Group Commercial |
$442.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$492.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$281.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$456.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$516.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$516.60
|
| Rate for Payer: Multiplan Commercial |
$590.40
|
| Rate for Payer: Networks By Design Commercial |
$479.70
|
| Rate for Payer: Prime Health Services Commercial |
$627.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$442.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$442.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$369.00
|
| Rate for Payer: United Healthcare All Other HMO |
$369.00
|
| Rate for Payer: United Healthcare HMO Rider |
$369.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$369.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$627.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$627.30
|
| Rate for Payer: Vantage Medical Group Senior |
$627.30
|
|
