|
HC RPL GTUBE NOT RQ RV GSTRST TRC
|
Facility
|
OP
|
$2,179.00
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
906743760
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$309.02 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$435.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$309.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$980.55
|
| Rate for Payer: Cash Price |
$980.55
|
| Rate for Payer: Cash Price |
$980.55
|
| Rate for Payer: Cigna of CA HMO |
$1,394.56
|
| Rate for Payer: Cigna of CA PPO |
$1,612.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$309.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$417.18
|
| Rate for Payer: EPIC Health Plan Senior |
$309.02
|
| Rate for Payer: Galaxy Health WC |
$1,852.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,307.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$506.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$309.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,453.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$389.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$309.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$522.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$389.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$414.09
|
| Rate for Payer: Multiplan Commercial |
$1,743.20
|
| Rate for Payer: Multiplan WC |
$492.37
|
| Rate for Payer: Networks By Design Commercial |
$1,416.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,852.15
|
| Rate for Payer: Prime Health Services WC |
$487.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,307.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,089.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,089.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,089.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,089.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$309.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Vantage Medical Group Senior |
$309.02
|
|
|
HC RPL GTUBE NOT RQ RV GSTRST TRC
|
Facility
|
OP
|
$2,179.00
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
906743760
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$309.02 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$435.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$309.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$980.55
|
| Rate for Payer: Cash Price |
$980.55
|
| Rate for Payer: Cash Price |
$980.55
|
| Rate for Payer: Cigna of CA HMO |
$1,394.56
|
| Rate for Payer: Cigna of CA PPO |
$1,612.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$309.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$417.18
|
| Rate for Payer: EPIC Health Plan Senior |
$309.02
|
| Rate for Payer: Galaxy Health WC |
$1,852.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,307.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$506.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$344.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$309.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,453.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$389.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$309.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$522.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$389.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$414.09
|
| Rate for Payer: Multiplan Commercial |
$1,743.20
|
| Rate for Payer: Networks By Design Commercial |
$1,416.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,852.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,307.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,307.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,089.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,089.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,089.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,089.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$309.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Vantage Medical Group Senior |
$309.02
|
|
|
HC RPL GTUBE NOT RQ RV GSTRST TRC
|
Facility
|
IP
|
$2,179.00
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
906743760
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$435.80 |
| Max. Negotiated Rate |
$1,852.15 |
| Rate for Payer: Adventist Health Commercial |
$435.80
|
| Rate for Payer: Cash Price |
$980.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$871.60
|
| Rate for Payer: EPIC Health Plan Senior |
$871.60
|
| Rate for Payer: Galaxy Health WC |
$1,852.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,307.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,453.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$830.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,348.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$522.96
|
| Rate for Payer: Multiplan Commercial |
$1,743.20
|
| Rate for Payer: Networks By Design Commercial |
$1,416.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,852.15
|
|
|
HC RPL GTUBE NOT RQ RV GSTRST TRC
|
Facility
|
IP
|
$2,179.00
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
906743760
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$435.80 |
| Max. Negotiated Rate |
$1,852.15 |
| Rate for Payer: Adventist Health Commercial |
$435.80
|
| Rate for Payer: Cash Price |
$980.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$871.60
|
| Rate for Payer: EPIC Health Plan Senior |
$871.60
|
| Rate for Payer: Galaxy Health WC |
$1,852.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,307.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,453.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$830.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,348.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$522.96
|
| Rate for Payer: Multiplan Commercial |
$1,743.20
|
| Rate for Payer: Networks By Design Commercial |
$1,416.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,852.15
|
|
|
HC RPL GTUBE NOT RQ RV GSTRST TRC
|
Facility
|
IP
|
$2,179.00
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
906743760
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$435.80 |
| Max. Negotiated Rate |
$1,852.15 |
| Rate for Payer: Adventist Health Commercial |
$435.80
|
| Rate for Payer: Cash Price |
$980.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$871.60
|
| Rate for Payer: EPIC Health Plan Senior |
$871.60
|
| Rate for Payer: Galaxy Health WC |
$1,852.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,307.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,453.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$830.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,348.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$522.96
|
| Rate for Payer: Multiplan Commercial |
$1,743.20
|
| Rate for Payer: Networks By Design Commercial |
$1,416.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,852.15
|
|
|
HC RPL GTUBE NOT RQ RV GSTRST TRC
|
Facility
|
OP
|
$2,179.00
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
906743760
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$309.02 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$435.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$309.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$980.55
|
| Rate for Payer: Cash Price |
$980.55
|
| Rate for Payer: Cash Price |
$980.55
|
| Rate for Payer: Cigna of CA HMO |
$1,394.56
|
| Rate for Payer: Cigna of CA PPO |
$1,612.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$309.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$417.18
|
| Rate for Payer: EPIC Health Plan Senior |
$309.02
|
| Rate for Payer: Galaxy Health WC |
$1,852.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,307.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$506.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$344.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$309.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,453.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$389.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$309.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$522.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$389.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$414.09
|
| Rate for Payer: Multiplan Commercial |
$1,743.20
|
| Rate for Payer: Multiplan WC |
$492.37
|
| Rate for Payer: Networks By Design Commercial |
$1,416.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,852.15
|
| Rate for Payer: Prime Health Services WC |
$487.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,307.40
|
| 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: Upland Medical Group Pediatric |
$309.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Vantage Medical Group Senior |
$309.02
|
|
|
HC RPL GTUBE NOT RQ RV GSTRST TRC
|
Facility
|
OP
|
$2,179.00
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
906743760
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$309.02 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$435.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$309.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$980.55
|
| Rate for Payer: Cash Price |
$980.55
|
| Rate for Payer: Cash Price |
$980.55
|
| Rate for Payer: Cigna of CA HMO |
$1,394.56
|
| Rate for Payer: Cigna of CA PPO |
$1,612.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$309.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$417.18
|
| Rate for Payer: EPIC Health Plan Senior |
$309.02
|
| Rate for Payer: Galaxy Health WC |
$1,852.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,307.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$506.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$344.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$309.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,453.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$389.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$309.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$522.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$389.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$414.09
|
| Rate for Payer: Multiplan Commercial |
$1,743.20
|
| Rate for Payer: Networks By Design Commercial |
$1,416.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,852.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,307.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$370.82
|
| 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: Upland Medical Group Pediatric |
$309.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Vantage Medical Group Senior |
$309.02
|
|
|
HC RPL GTUBE NOT RQ RV GSTRST TRC
|
Facility
|
IP
|
$2,179.00
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
906743760
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$435.80 |
| Max. Negotiated Rate |
$1,852.15 |
| Rate for Payer: Adventist Health Commercial |
$435.80
|
| Rate for Payer: Cash Price |
$980.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$871.60
|
| Rate for Payer: EPIC Health Plan Senior |
$871.60
|
| Rate for Payer: Galaxy Health WC |
$1,852.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,307.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,453.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$830.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,348.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$522.96
|
| Rate for Payer: Multiplan Commercial |
$1,743.20
|
| Rate for Payer: Networks By Design Commercial |
$1,416.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,852.15
|
|
|
HC RPOS PRV CCM DFIB TRNSVNS ELTRD
|
Facility
|
IP
|
$1,688.00
|
|
|
Service Code
|
CPT 0924T
|
| Hospital Charge Code |
906811512
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$337.60 |
| Max. Negotiated Rate |
$1,434.80 |
| Rate for Payer: Adventist Health Commercial |
$337.60
|
| Rate for Payer: Cash Price |
$759.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$675.20
|
| Rate for Payer: EPIC Health Plan Senior |
$675.20
|
| Rate for Payer: Galaxy Health WC |
$1,434.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,012.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,125.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$643.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,044.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$405.12
|
| Rate for Payer: Multiplan Commercial |
$1,350.40
|
| Rate for Payer: Networks By Design Commercial |
$1,097.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,434.80
|
|
|
HC RPOS PRV CCM DFIB TRNSVNS ELTRD
|
Facility
|
OP
|
$1,688.00
|
|
|
Service Code
|
CPT 0924T
|
| Hospital Charge Code |
906811512
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$337.60 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$337.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$785.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,036.60
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$759.60
|
| Rate for Payer: Cash Price |
$759.60
|
| Rate for Payer: Cash Price |
$759.60
|
| Rate for Payer: Cigna of CA HMO |
$1,080.32
|
| Rate for Payer: Cigna of CA PPO |
$1,249.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$864.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$785.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,060.51
|
| Rate for Payer: EPIC Health Plan Senior |
$785.56
|
| Rate for Payer: Galaxy Health WC |
$1,434.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,012.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,288.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$785.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,125.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$643.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$785.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$405.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$989.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,052.65
|
| Rate for Payer: Multiplan Commercial |
$1,350.40
|
| Rate for Payer: Networks By Design Commercial |
$1,097.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,434.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,012.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,012.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$785.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Vantage Medical Group Senior |
$785.56
|
|
|
HC RPR
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900913675
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$54.40 |
| Rate for Payer: Adventist Health Commercial |
$12.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.60
|
| Rate for Payer: EPIC Health Plan Senior |
$25.60
|
| Rate for Payer: Galaxy Health WC |
$54.40
|
| Rate for Payer: Global Benefits Group Commercial |
$38.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$39.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.36
|
| Rate for Payer: Multiplan Commercial |
$51.20
|
| Rate for Payer: Networks By Design Commercial |
$41.60
|
| Rate for Payer: Prime Health Services Commercial |
$54.40
|
|
|
HC RPR
|
Facility
|
OP
|
$56.96
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900913675
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.39 |
| Max. Negotiated Rate |
$127.87 |
| Rate for Payer: Adventist Health Commercial |
$11.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$37.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.91
|
| 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 |
$127.87
|
| Rate for Payer: Blue Shield of California Commercial |
$38.11
|
| Rate for Payer: Blue Shield of California EPN |
$25.18
|
| Rate for Payer: Cash Price |
$25.63
|
| Rate for Payer: Cash Price |
$25.63
|
| Rate for Payer: Cigna of CA HMO |
$36.45
|
| Rate for Payer: Cigna of CA PPO |
$42.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.31
|
| Rate for Payer: EPIC Health Plan Senior |
$17.27
|
| Rate for Payer: Galaxy Health WC |
$48.42
|
| Rate for Payer: Global Benefits Group Commercial |
$34.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$37.99
|
| 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 |
$13.67
|
| 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 |
$45.57
|
| Rate for Payer: Networks By Design Commercial |
$37.02
|
| Rate for Payer: Prime Health Services Commercial |
$48.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$34.18
|
| 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: Upland Medical Group Pediatric |
$17.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.91
|
| 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
|
$5,859.00
|
|
|
Service Code
|
CPT 67101
|
| Hospital Charge Code |
900501630
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,171.80 |
| Max. Negotiated Rate |
$4,980.15 |
| Rate for Payer: Adventist Health Commercial |
$1,171.80
|
| Rate for Payer: Cash Price |
$2,636.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,343.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,343.60
|
| Rate for Payer: Galaxy Health WC |
$4,980.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,515.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,907.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,232.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,626.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,406.16
|
| Rate for Payer: Multiplan Commercial |
$4,687.20
|
| Rate for Payer: Networks By Design Commercial |
$3,808.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,980.15
|
|
|
HC RPR DETACHED RETINA
|
Facility
|
OP
|
$5,859.00
|
|
|
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: Adventist Health Commercial |
$1,171.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,187.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,897.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,712.00
|
| Rate for Payer: Cash Price |
$2,636.55
|
| Rate for Payer: Cash Price |
$2,636.55
|
| Rate for Payer: Cash Price |
$2,636.55
|
| Rate for Payer: Cigna of CA HMO |
$3,749.76
|
| Rate for Payer: Cigna of CA PPO |
$4,335.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,187.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,897.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,912.16
|
| Rate for Payer: EPIC Health Plan Senior |
$2,897.90
|
| Rate for Payer: Galaxy Health WC |
$4,980.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,515.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,752.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,897.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,907.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$553.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,897.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,406.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,651.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,883.19
|
| Rate for Payer: Multiplan Commercial |
$4,687.20
|
| Rate for Payer: Multiplan WC |
$4,617.28
|
| Rate for Payer: Networks By Design Commercial |
$3,808.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,980.15
|
| Rate for Payer: Prime Health Services WC |
$4,570.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,515.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,929.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,929.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,929.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,929.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,897.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,187.69
|
| Rate for Payer: Vantage Medical Group Senior |
$2,897.90
|
|
|
HC RPR LIP FLL THCK UP TO HLF VER
|
Facility
|
OP
|
$1,624.00
|
|
|
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: Adventist Health Commercial |
$324.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$970.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$711.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$647.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Cash Price |
$730.80
|
| Rate for Payer: Cash Price |
$730.80
|
| Rate for Payer: Cash Price |
$730.80
|
| Rate for Payer: Cigna of CA HMO |
$1,039.36
|
| Rate for Payer: Cigna of CA PPO |
$1,201.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$970.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$711.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$647.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$873.52
|
| Rate for Payer: EPIC Health Plan Senior |
$647.05
|
| Rate for Payer: Galaxy Health WC |
$1,380.40
|
| Rate for Payer: Global Benefits Group Commercial |
$974.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,061.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$647.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,083.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$122.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$647.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$389.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$815.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$867.05
|
| Rate for Payer: Multiplan Commercial |
$1,299.20
|
| Rate for Payer: Multiplan WC |
$1,030.97
|
| Rate for Payer: Networks By Design Commercial |
$1,055.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,380.40
|
| Rate for Payer: Prime Health Services WC |
$1,020.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$974.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$812.00
|
| Rate for Payer: United Healthcare All Other HMO |
$812.00
|
| Rate for Payer: United Healthcare HMO Rider |
$812.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$812.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$647.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$970.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$711.75
|
| Rate for Payer: Vantage Medical Group Senior |
$647.05
|
|
|
HC RPR LIP FLL THCK UP TO HLF VER
|
Facility
|
IP
|
$1,624.00
|
|
|
Service Code
|
CPT 40652
|
| Hospital Charge Code |
900540652
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$324.80 |
| Max. Negotiated Rate |
$1,380.40 |
| Rate for Payer: Adventist Health Commercial |
$324.80
|
| Rate for Payer: Cash Price |
$730.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$649.60
|
| Rate for Payer: EPIC Health Plan Senior |
$649.60
|
| Rate for Payer: Galaxy Health WC |
$1,380.40
|
| Rate for Payer: Global Benefits Group Commercial |
$974.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,083.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$618.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,005.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$389.76
|
| Rate for Payer: Multiplan Commercial |
$1,299.20
|
| Rate for Payer: Networks By Design Commercial |
$1,055.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,380.40
|
|
|
HC RPR PROS DEVICE PER 15 MIN
|
Facility
|
IP
|
$311.00
|
|
|
Service Code
|
CPT L7520
|
| Hospital Charge Code |
915357520
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$62.20 |
| Max. Negotiated Rate |
$264.35 |
| Rate for Payer: Adventist Health Commercial |
$62.20
|
| Rate for Payer: Cash Price |
$139.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.40
|
| Rate for Payer: EPIC Health Plan Senior |
$124.40
|
| Rate for Payer: Galaxy Health WC |
$264.35
|
| Rate for Payer: Global Benefits Group Commercial |
$186.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$207.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$192.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.64
|
| Rate for Payer: Multiplan Commercial |
$248.80
|
| Rate for Payer: Networks By Design Commercial |
$202.15
|
| Rate for Payer: Prime Health Services Commercial |
$264.35
|
|
|
HC RPR PROS DEVICE PER 15 MIN
|
Facility
|
OP
|
$311.00
|
|
|
Service Code
|
CPT L7520
|
| Hospital Charge Code |
915357520
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$27.67 |
| Max. Negotiated Rate |
$264.35 |
| Rate for Payer: Adventist Health Commercial |
$62.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$203.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$264.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$171.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$233.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$190.99
|
| Rate for Payer: Cash Price |
$139.95
|
| Rate for Payer: Cash Price |
$139.95
|
| Rate for Payer: Cigna of CA HMO |
$199.04
|
| Rate for Payer: Cigna of CA PPO |
$230.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$264.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$264.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$264.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.40
|
| Rate for Payer: EPIC Health Plan Senior |
$124.40
|
| Rate for Payer: Galaxy Health WC |
$264.35
|
| Rate for Payer: Global Benefits Group Commercial |
$186.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$207.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$192.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$217.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$217.70
|
| Rate for Payer: Multiplan Commercial |
$248.80
|
| Rate for Payer: Networks By Design Commercial |
$202.15
|
| Rate for Payer: Prime Health Services Commercial |
$264.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$186.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$186.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$155.50
|
| Rate for Payer: United Healthcare All Other HMO |
$155.50
|
| Rate for Payer: United Healthcare HMO Rider |
$155.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$155.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$264.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$264.35
|
| Rate for Payer: Vantage Medical Group Senior |
$264.35
|
|
|
HC RPR PROS DEVICE PER 15 MIN
|
Facility
|
IP
|
$16.00
|
|
|
Service Code
|
CPT L7520
|
| Hospital Charge Code |
905357520
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$13.60 |
| Rate for Payer: Adventist Health Commercial |
$3.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6.40
|
| Rate for Payer: Galaxy Health WC |
$13.60
|
| Rate for Payer: Global Benefits Group Commercial |
$9.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.90
|
| 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
|
|
|
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 |
$3.20 |
| Max. Negotiated Rate |
$31.29 |
| Rate for Payer: Adventist Health Commercial |
$3.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.49
|
| 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 |
$12.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.83
|
| 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 Medi-Cal |
$13.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6.40
|
| Rate for Payer: Galaxy Health WC |
$13.60
|
| Rate for Payer: Global Benefits Group Commercial |
$9.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.67
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$9.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.20
|
| 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
|
|
|
HC RPR TITER
|
Facility
|
IP
|
$182.00
|
|
|
Service Code
|
CPT 86593
|
| Hospital Charge Code |
900910929
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$154.70 |
| Rate for Payer: Adventist Health Commercial |
$36.40
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.80
|
| Rate for Payer: EPIC Health Plan Senior |
$72.80
|
| Rate for Payer: Galaxy Health WC |
$154.70
|
| Rate for Payer: Global Benefits Group Commercial |
$109.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$121.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$69.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$112.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.68
|
| Rate for Payer: Multiplan Commercial |
$145.60
|
| Rate for Payer: Networks By Design Commercial |
$118.30
|
| Rate for Payer: Prime Health Services Commercial |
$154.70
|
|
|
HC RPR TITER
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 86593
|
| Hospital Charge Code |
900910929
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.56 |
| Max. Negotiated Rate |
$43.49 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.49
|
| Rate for Payer: Blue Shield of California Commercial |
$26.76
|
| Rate for Payer: Blue Shield of California EPN |
$17.68
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna of CA HMO |
$25.60
|
| Rate for Payer: Cigna of CA PPO |
$29.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.94
|
| Rate for Payer: EPIC Health Plan Senior |
$4.40
|
| Rate for Payer: Galaxy Health WC |
$34.00
|
| Rate for Payer: Global Benefits Group Commercial |
$24.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.90
|
| Rate for Payer: Multiplan Commercial |
$32.00
|
| Rate for Payer: Networks By Design Commercial |
$26.00
|
| Rate for Payer: Prime Health Services Commercial |
$34.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.56
|
| Rate for Payer: United Healthcare All Other HMO |
$3.56
|
| Rate for Payer: United Healthcare HMO Rider |
$3.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.84
|
| Rate for Payer: Vantage Medical Group Senior |
$4.40
|
|
|
HC RSPR T-POD PELVIC STBL
|
Facility
|
OP
|
$584.20
|
|
|
Service Code
|
CPT E0944
|
| Hospital Charge Code |
901698449
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$52.42 |
| Max. Negotiated Rate |
$496.57 |
| Rate for Payer: Adventist Health Commercial |
$116.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$383.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$496.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$321.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$438.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$358.76
|
| Rate for Payer: Cash Price |
$262.89
|
| Rate for Payer: Cash Price |
$262.89
|
| Rate for Payer: Cigna of CA HMO |
$373.89
|
| Rate for Payer: Cigna of CA PPO |
$432.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$496.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$496.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$496.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$233.68
|
| Rate for Payer: EPIC Health Plan Senior |
$233.68
|
| Rate for Payer: Galaxy Health WC |
$496.57
|
| Rate for Payer: Global Benefits Group Commercial |
$350.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$52.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$389.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$361.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$408.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.94
|
| Rate for Payer: Multiplan Commercial |
$467.36
|
| Rate for Payer: Networks By Design Commercial |
$379.73
|
| Rate for Payer: Prime Health Services Commercial |
$496.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$350.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$350.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$292.10
|
| Rate for Payer: United Healthcare All Other HMO |
$292.10
|
| Rate for Payer: United Healthcare HMO Rider |
$292.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$292.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$496.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$496.57
|
| Rate for Payer: Vantage Medical Group Senior |
$496.57
|
|
|
HC RSPR T-POD PELVIC STBL
|
Facility
|
IP
|
$584.20
|
|
|
Service Code
|
CPT E0944
|
| Hospital Charge Code |
901698449
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$116.84 |
| Max. Negotiated Rate |
$496.57 |
| Rate for Payer: Adventist Health Commercial |
$116.84
|
| Rate for Payer: Cash Price |
$262.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$233.68
|
| Rate for Payer: EPIC Health Plan Senior |
$233.68
|
| Rate for Payer: Galaxy Health WC |
$496.57
|
| Rate for Payer: Global Benefits Group Commercial |
$350.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$389.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$222.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$361.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.21
|
| Rate for Payer: Multiplan Commercial |
$467.36
|
| Rate for Payer: Networks By Design Commercial |
$379.73
|
| Rate for Payer: Prime Health Services Commercial |
$496.57
|
|
|
HC RSV AG
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
CPT 87420
|
| Hospital Charge Code |
900911613
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.91 |
| Max. Negotiated Rate |
$88.77 |
| Rate for Payer: Adventist Health Commercial |
$6.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$20.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$88.77
|
| Rate for Payer: Blue Shield of California Commercial |
$20.74
|
| Rate for Payer: Blue Shield of California EPN |
$13.70
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cigna of CA HMO |
$19.84
|
| Rate for Payer: Cigna of CA PPO |
$22.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.78
|
| Rate for Payer: EPIC Health Plan Senior |
$13.91
|
| Rate for Payer: Galaxy Health WC |
$26.35
|
| Rate for Payer: Global Benefits Group Commercial |
$18.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.64
|
| Rate for Payer: Multiplan Commercial |
$24.80
|
| Rate for Payer: Networks By Design Commercial |
$20.15
|
| Rate for Payer: Prime Health Services Commercial |
$26.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.27
|
| Rate for Payer: United Healthcare All Other HMO |
$11.27
|
| Rate for Payer: United Healthcare HMO Rider |
$11.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.27
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.30
|
| Rate for Payer: Vantage Medical Group Senior |
$13.91
|
|
