|
HC SBBB UNIT SEARCH CHARGE
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
CPT 86999
|
| Hospital Charge Code |
900904428
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.44 |
| Max. Negotiated Rate |
$103.70 |
| Rate for Payer: Adventist Health Commercial |
$24.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$80.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$74.92
|
| Rate for Payer: Blue Shield of California Commercial |
$81.62
|
| Rate for Payer: Blue Shield of California EPN |
$53.92
|
| Rate for Payer: Cash Price |
$122.00
|
| Rate for Payer: Cash Price |
$122.00
|
| Rate for Payer: Cigna of CA HMO |
$78.08
|
| Rate for Payer: Cigna of CA PPO |
$90.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.01
|
| Rate for Payer: EPIC Health Plan Senior |
$31.12
|
| Rate for Payer: Galaxy Health WC |
$103.70
|
| Rate for Payer: Global Benefits Group Commercial |
$73.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$51.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$31.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$81.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.70
|
| Rate for Payer: Multiplan Commercial |
$97.60
|
| Rate for Payer: Networks By Design Commercial |
$79.30
|
| Rate for Payer: Prime Health Services Commercial |
$103.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$73.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$73.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.44
|
| Rate for Payer: United Healthcare All Other HMO |
$20.44
|
| Rate for Payer: United Healthcare HMO Rider |
$20.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.44
|
| Rate for Payer: Upland Medical Group Pediatric |
$31.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.23
|
| Rate for Payer: Vantage Medical Group Senior |
$31.12
|
|
|
HC SBBB VOLUME REDUCTION
|
Facility
|
OP
|
$106.00
|
|
|
Service Code
|
CPT 86960
|
| Hospital Charge Code |
900904615
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$21.20 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Adventist Health Commercial |
$21.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$69.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.09
|
| Rate for Payer: Cash Price |
$106.00
|
| Rate for Payer: Cash Price |
$106.00
|
| Rate for Payer: Cash Price |
$106.00
|
| Rate for Payer: Cigna of CA HMO |
$67.84
|
| Rate for Payer: Cigna of CA PPO |
$78.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$326.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$217.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$293.94
|
| Rate for Payer: EPIC Health Plan Senior |
$217.73
|
| Rate for Payer: Galaxy Health WC |
$90.10
|
| Rate for Payer: Global Benefits Group Commercial |
$63.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$357.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$217.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$217.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$274.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$291.76
|
| Rate for Payer: Multiplan Commercial |
$84.80
|
| Rate for Payer: Networks By Design Commercial |
$68.90
|
| Rate for Payer: Prime Health Services Commercial |
$90.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$63.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$63.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$217.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Vantage Medical Group Senior |
$217.73
|
|
|
HC SBBB VOLUME REDUCTION
|
Facility
|
IP
|
$106.00
|
|
|
Service Code
|
CPT 86960
|
| Hospital Charge Code |
900904615
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$21.20 |
| Max. Negotiated Rate |
$90.10 |
| Rate for Payer: Adventist Health Commercial |
$21.20
|
| Rate for Payer: Cash Price |
$106.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.40
|
| Rate for Payer: EPIC Health Plan Senior |
$42.40
|
| Rate for Payer: Galaxy Health WC |
$90.10
|
| Rate for Payer: Global Benefits Group Commercial |
$63.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$65.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.44
|
| Rate for Payer: Multiplan Commercial |
$84.80
|
| Rate for Payer: Networks By Design Commercial |
$68.90
|
| Rate for Payer: Prime Health Services Commercial |
$90.10
|
|
|
HC SBBB WASHING OF COMPONENTS
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
CPT 86999
|
| Hospital Charge Code |
900904572
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.44 |
| Max. Negotiated Rate |
$133.45 |
| Rate for Payer: Adventist Health Commercial |
$31.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$102.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$96.41
|
| Rate for Payer: Blue Shield of California Commercial |
$105.03
|
| Rate for Payer: Blue Shield of California EPN |
$69.39
|
| Rate for Payer: Cash Price |
$157.00
|
| Rate for Payer: Cash Price |
$157.00
|
| Rate for Payer: Cigna of CA HMO |
$100.48
|
| Rate for Payer: Cigna of CA PPO |
$116.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.01
|
| Rate for Payer: EPIC Health Plan Senior |
$31.12
|
| Rate for Payer: Galaxy Health WC |
$133.45
|
| Rate for Payer: Global Benefits Group Commercial |
$94.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$51.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$31.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.70
|
| Rate for Payer: Multiplan Commercial |
$125.60
|
| Rate for Payer: Networks By Design Commercial |
$102.05
|
| Rate for Payer: Prime Health Services Commercial |
$133.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$94.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$94.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.44
|
| Rate for Payer: United Healthcare All Other HMO |
$20.44
|
| Rate for Payer: United Healthcare HMO Rider |
$20.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.44
|
| Rate for Payer: Upland Medical Group Pediatric |
$31.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.23
|
| Rate for Payer: Vantage Medical Group Senior |
$31.12
|
|
|
HC SBBB WASHING OF COMPONENTS
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
CPT 86999
|
| Hospital Charge Code |
900904572
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.40 |
| Max. Negotiated Rate |
$133.45 |
| Rate for Payer: Adventist Health Commercial |
$31.40
|
| Rate for Payer: Cash Price |
$157.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.80
|
| Rate for Payer: EPIC Health Plan Senior |
$62.80
|
| Rate for Payer: Galaxy Health WC |
$133.45
|
| Rate for Payer: Global Benefits Group Commercial |
$94.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$97.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.68
|
| Rate for Payer: Multiplan Commercial |
$125.60
|
| Rate for Payer: Networks By Design Commercial |
$102.05
|
| Rate for Payer: Prime Health Services Commercial |
$133.45
|
|
|
HC SBRT
|
Facility
|
OP
|
$7,728.00
|
|
|
Service Code
|
CPT 77373
|
| Hospital Charge Code |
904877373
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,221.00 |
| Max. Negotiated Rate |
$11,670.09 |
| Rate for Payer: Adventist Health Commercial |
$1,545.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5,068.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,346.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,454.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,231.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,670.09
|
| Rate for Payer: Blue Shield of California Commercial |
$4,729.54
|
| Rate for Payer: Blue Shield of California EPN |
$3,122.11
|
| Rate for Payer: Cash Price |
$3,477.60
|
| Rate for Payer: Cash Price |
$3,477.60
|
| Rate for Payer: Cash Price |
$3,477.60
|
| Rate for Payer: Cigna of CA HMO |
$4,945.92
|
| Rate for Payer: Cigna of CA PPO |
$5,718.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,346.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,454.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,231.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,011.93
|
| Rate for Payer: EPIC Health Plan Senior |
$2,231.06
|
| Rate for Payer: Galaxy Health WC |
$6,568.80
|
| Rate for Payer: Global Benefits Group Commercial |
$4,636.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,658.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,609.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,231.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,154.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,820.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,231.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,854.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,811.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,989.62
|
| Rate for Payer: Multiplan Commercial |
$6,182.40
|
| Rate for Payer: Networks By Design Commercial |
$5,023.20
|
| Rate for Payer: Prime Health Services Commercial |
$6,568.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,636.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,748.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,759.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,332.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,221.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,231.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,346.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,454.17
|
| Rate for Payer: Vantage Medical Group Senior |
$2,231.06
|
|
|
HC SBRT
|
Facility
|
IP
|
$7,728.00
|
|
|
Service Code
|
CPT 77373
|
| Hospital Charge Code |
904877373
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,545.60 |
| Max. Negotiated Rate |
$6,568.80 |
| Rate for Payer: Adventist Health Commercial |
$1,545.60
|
| Rate for Payer: Cash Price |
$3,477.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,091.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,091.20
|
| Rate for Payer: Galaxy Health WC |
$6,568.80
|
| Rate for Payer: Global Benefits Group Commercial |
$4,636.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,154.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,944.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,783.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,854.72
|
| Rate for Payer: Multiplan Commercial |
$6,182.40
|
| Rate for Payer: Networks By Design Commercial |
$5,023.20
|
| Rate for Payer: Prime Health Services Commercial |
$6,568.80
|
|
|
HC SCAN & EVAL TESTICLE
|
Facility
|
OP
|
$2,256.00
|
|
|
Service Code
|
CPT 76870
|
| Hospital Charge Code |
906601409
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$100.43 |
| Max. Negotiated Rate |
$1,917.60 |
| Rate for Payer: Adventist Health Commercial |
$451.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,479.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,385.41
|
| Rate for Payer: Blue Shield of California Commercial |
$1,380.67
|
| Rate for Payer: Blue Shield of California EPN |
$911.42
|
| Rate for Payer: Cash Price |
$1,015.20
|
| Rate for Payer: Cash Price |
$1,015.20
|
| Rate for Payer: Cigna of CA HMO |
$1,443.84
|
| Rate for Payer: Cigna of CA PPO |
$1,669.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$1,917.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,353.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$100.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,504.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$541.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$1,804.80
|
| Rate for Payer: Networks By Design Commercial |
$1,466.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,917.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,353.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,353.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$246.56
|
| Rate for Payer: United Healthcare All Other HMO |
$246.56
|
| Rate for Payer: United Healthcare HMO Rider |
$246.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$246.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC SCAN & EVAL TESTICLE
|
Facility
|
IP
|
$2,256.00
|
|
|
Service Code
|
CPT 76870
|
| Hospital Charge Code |
906601409
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$451.20 |
| Max. Negotiated Rate |
$1,917.60 |
| Rate for Payer: Adventist Health Commercial |
$451.20
|
| Rate for Payer: Cash Price |
$1,015.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$902.40
|
| Rate for Payer: EPIC Health Plan Senior |
$902.40
|
| Rate for Payer: Galaxy Health WC |
$1,917.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,353.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,504.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$859.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,396.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$541.44
|
| Rate for Payer: Multiplan Commercial |
$1,804.80
|
| Rate for Payer: Networks By Design Commercial |
$1,466.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,917.60
|
|
|
HC SCAPULA
|
Facility
|
IP
|
$846.00
|
|
|
Service Code
|
CPT 73010
|
| Hospital Charge Code |
909001479
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$169.20 |
| Max. Negotiated Rate |
$719.10 |
| Rate for Payer: Adventist Health Commercial |
$169.20
|
| Rate for Payer: Cash Price |
$380.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$338.40
|
| Rate for Payer: EPIC Health Plan Senior |
$338.40
|
| Rate for Payer: Galaxy Health WC |
$719.10
|
| Rate for Payer: Global Benefits Group Commercial |
$507.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$564.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$322.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$523.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.04
|
| Rate for Payer: Multiplan Commercial |
$676.80
|
| Rate for Payer: Networks By Design Commercial |
$549.90
|
| Rate for Payer: Prime Health Services Commercial |
$719.10
|
|
|
HC SCAPULA
|
Facility
|
OP
|
$846.00
|
|
|
Service Code
|
CPT 73010
|
| Hospital Charge Code |
909001479
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$35.94 |
| Max. Negotiated Rate |
$719.10 |
| Rate for Payer: Adventist Health Commercial |
$169.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$554.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.49
|
| Rate for Payer: Blue Shield of California Commercial |
$517.75
|
| Rate for Payer: Blue Shield of California EPN |
$341.78
|
| Rate for Payer: Cash Price |
$380.70
|
| Rate for Payer: Cash Price |
$380.70
|
| Rate for Payer: Cigna of CA HMO |
$541.44
|
| Rate for Payer: Cigna of CA PPO |
$626.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$719.10
|
| Rate for Payer: Global Benefits Group Commercial |
$507.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$564.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$676.80
|
| Rate for Payer: Networks By Design Commercial |
$549.90
|
| Rate for Payer: Prime Health Services Commercial |
$719.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$507.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$507.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC SCHILLINGS W/ INTRINSIC FACTOR
|
Facility
|
OP
|
$726.00
|
|
|
Service Code
|
CPT 78271
|
| Hospital Charge Code |
909301358
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$145.20 |
| Max. Negotiated Rate |
$617.10 |
| Rate for Payer: Adventist Health Commercial |
$145.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$476.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$617.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$399.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$544.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$445.84
|
| Rate for Payer: Blue Shield of California Commercial |
$444.31
|
| Rate for Payer: Blue Shield of California EPN |
$293.30
|
| Rate for Payer: Cash Price |
$326.70
|
| Rate for Payer: Cigna of CA HMO |
$464.64
|
| Rate for Payer: Cigna of CA PPO |
$537.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$617.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$617.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$617.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$290.40
|
| Rate for Payer: EPIC Health Plan Senior |
$290.40
|
| Rate for Payer: Galaxy Health WC |
$617.10
|
| Rate for Payer: Global Benefits Group Commercial |
$435.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$484.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$276.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$449.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$174.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$508.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$508.20
|
| Rate for Payer: Multiplan Commercial |
$580.80
|
| Rate for Payer: Networks By Design Commercial |
$471.90
|
| Rate for Payer: Prime Health Services Commercial |
$617.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$435.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$435.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$363.00
|
| Rate for Payer: United Healthcare All Other HMO |
$363.00
|
| Rate for Payer: United Healthcare HMO Rider |
$363.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$363.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$617.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$617.10
|
| Rate for Payer: Vantage Medical Group Senior |
$617.10
|
|
|
HC SCHILLINGS W/ INTRINSIC FACTOR
|
Facility
|
IP
|
$726.00
|
|
|
Service Code
|
CPT 78271
|
| Hospital Charge Code |
909301358
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$145.20 |
| Max. Negotiated Rate |
$617.10 |
| Rate for Payer: Adventist Health Commercial |
$145.20
|
| Rate for Payer: Cash Price |
$326.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$290.40
|
| Rate for Payer: EPIC Health Plan Senior |
$290.40
|
| Rate for Payer: Galaxy Health WC |
$617.10
|
| Rate for Payer: Global Benefits Group Commercial |
$435.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$484.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$276.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$449.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$174.24
|
| Rate for Payer: Multiplan Commercial |
$580.80
|
| Rate for Payer: Networks By Design Commercial |
$471.90
|
| Rate for Payer: Prime Health Services Commercial |
$617.10
|
|
|
HC SCHILLINGS W/O INTRINSIC FACTOR
|
Facility
|
IP
|
$740.00
|
|
|
Service Code
|
CPT 78270
|
| Hospital Charge Code |
909301357
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$148.00 |
| Max. Negotiated Rate |
$629.00 |
| Rate for Payer: Adventist Health Commercial |
$148.00
|
| Rate for Payer: Cash Price |
$333.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$296.00
|
| Rate for Payer: EPIC Health Plan Senior |
$296.00
|
| Rate for Payer: Galaxy Health WC |
$629.00
|
| Rate for Payer: Global Benefits Group Commercial |
$444.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$493.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$281.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$458.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.60
|
| Rate for Payer: Multiplan Commercial |
$592.00
|
| Rate for Payer: Networks By Design Commercial |
$481.00
|
| Rate for Payer: Prime Health Services Commercial |
$629.00
|
|
|
HC SCHILLINGS W/O INTRINSIC FACTOR
|
Facility
|
OP
|
$740.00
|
|
|
Service Code
|
CPT 78270
|
| Hospital Charge Code |
909301357
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$148.00 |
| Max. Negotiated Rate |
$629.00 |
| Rate for Payer: Adventist Health Commercial |
$148.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$485.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$629.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$407.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$555.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$454.43
|
| Rate for Payer: Blue Shield of California Commercial |
$452.88
|
| Rate for Payer: Blue Shield of California EPN |
$298.96
|
| Rate for Payer: Cash Price |
$333.00
|
| Rate for Payer: Cigna of CA HMO |
$473.60
|
| Rate for Payer: Cigna of CA PPO |
$547.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$629.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$629.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$629.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$296.00
|
| Rate for Payer: EPIC Health Plan Senior |
$296.00
|
| Rate for Payer: Galaxy Health WC |
$629.00
|
| Rate for Payer: Global Benefits Group Commercial |
$444.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$493.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$281.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$458.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$518.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$518.00
|
| Rate for Payer: Multiplan Commercial |
$592.00
|
| Rate for Payer: Networks By Design Commercial |
$481.00
|
| Rate for Payer: Prime Health Services Commercial |
$629.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$444.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$444.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$370.00
|
| Rate for Payer: United Healthcare All Other HMO |
$370.00
|
| Rate for Payer: United Healthcare HMO Rider |
$370.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$370.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$629.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$629.00
|
| Rate for Payer: Vantage Medical Group Senior |
$629.00
|
|
|
HC SCHILLINGS W & WO INTRINSIC FACTOR
|
Facility
|
OP
|
$1,505.00
|
|
|
Service Code
|
CPT 78272
|
| Hospital Charge Code |
909301359
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$1,279.25 |
| Rate for Payer: Adventist Health Commercial |
$301.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$987.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,279.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$827.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,128.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$924.22
|
| Rate for Payer: Blue Shield of California Commercial |
$921.06
|
| Rate for Payer: Blue Shield of California EPN |
$608.02
|
| Rate for Payer: Cash Price |
$677.25
|
| Rate for Payer: Cigna of CA HMO |
$963.20
|
| Rate for Payer: Cigna of CA PPO |
$1,113.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,279.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,279.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,279.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$602.00
|
| Rate for Payer: EPIC Health Plan Senior |
$602.00
|
| Rate for Payer: Galaxy Health WC |
$1,279.25
|
| Rate for Payer: Global Benefits Group Commercial |
$903.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,003.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$573.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$931.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$361.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,053.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,053.50
|
| Rate for Payer: Multiplan Commercial |
$1,204.00
|
| Rate for Payer: Networks By Design Commercial |
$978.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,279.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$903.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$903.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$752.50
|
| Rate for Payer: United Healthcare All Other HMO |
$752.50
|
| Rate for Payer: United Healthcare HMO Rider |
$752.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$752.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,279.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,279.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,279.25
|
|
|
HC SCHILLINGS W & WO INTRINSIC FACTOR
|
Facility
|
IP
|
$1,505.00
|
|
|
Service Code
|
CPT 78272
|
| Hospital Charge Code |
909301359
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$1,279.25 |
| Rate for Payer: Adventist Health Commercial |
$301.00
|
| Rate for Payer: Cash Price |
$677.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$602.00
|
| Rate for Payer: EPIC Health Plan Senior |
$602.00
|
| Rate for Payer: Galaxy Health WC |
$1,279.25
|
| Rate for Payer: Global Benefits Group Commercial |
$903.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,003.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$573.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$931.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$361.20
|
| Rate for Payer: Multiplan Commercial |
$1,204.00
|
| Rate for Payer: Networks By Design Commercial |
$978.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,279.25
|
|
|
HC SCL 70 AB
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913525
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$34.20 |
| Max. Negotiated Rate |
$145.35 |
| Rate for Payer: Adventist Health Commercial |
$34.20
|
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.40
|
| Rate for Payer: EPIC Health Plan Senior |
$68.40
|
| Rate for Payer: Galaxy Health WC |
$145.35
|
| Rate for Payer: Global Benefits Group Commercial |
$102.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$114.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$105.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.04
|
| Rate for Payer: Multiplan Commercial |
$136.80
|
| Rate for Payer: Networks By Design Commercial |
$111.15
|
| Rate for Payer: Prime Health Services Commercial |
$145.35
|
|
|
HC SCL 70 AB
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913525
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.80 |
| Max. Negotiated Rate |
$150.42 |
| Rate for Payer: Adventist Health Commercial |
$8.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.42
|
| Rate for Payer: Blue Shield of California Commercial |
$29.44
|
| Rate for Payer: Blue Shield of California EPN |
$19.45
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna of CA HMO |
$28.16
|
| Rate for Payer: Cigna of CA PPO |
$32.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.21
|
| Rate for Payer: EPIC Health Plan Senior |
$17.93
|
| Rate for Payer: Galaxy Health WC |
$37.40
|
| Rate for Payer: Global Benefits Group Commercial |
$26.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.03
|
| Rate for Payer: Multiplan Commercial |
$35.20
|
| Rate for Payer: Networks By Design Commercial |
$28.60
|
| Rate for Payer: Prime Health Services Commercial |
$37.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.53
|
| Rate for Payer: United Healthcare All Other HMO |
$14.53
|
| Rate for Payer: United Healthcare HMO Rider |
$14.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC SCLEROTHERAPY FLUID COLLECTION
|
Facility
|
IP
|
$3,990.00
|
|
|
Service Code
|
CPT 49185
|
| Hospital Charge Code |
909049185
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$798.00 |
| Max. Negotiated Rate |
$3,391.50 |
| Rate for Payer: Adventist Health Commercial |
$798.00
|
| Rate for Payer: Cash Price |
$1,795.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,596.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,596.00
|
| Rate for Payer: Galaxy Health WC |
$3,391.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,394.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,661.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,520.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,469.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$957.60
|
| Rate for Payer: Multiplan Commercial |
$3,192.00
|
| Rate for Payer: Networks By Design Commercial |
$2,593.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,391.50
|
|
|
HC SCLEROTHERAPY FLUID COLLECTION
|
Facility
|
OP
|
$3,990.00
|
|
|
Service Code
|
CPT 49185
|
| Hospital Charge Code |
909049185
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$798.00 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$798.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| 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 |
$1,795.50
|
| Rate for Payer: Cash Price |
$1,795.50
|
| Rate for Payer: Cash Price |
$1,795.50
|
| Rate for Payer: Cigna of CA HMO |
$2,553.60
|
| Rate for Payer: Cigna of CA PPO |
$2,952.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,779.22
|
| Rate for Payer: EPIC Health Plan Senior |
$2,058.68
|
| Rate for Payer: Galaxy Health WC |
$3,391.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,394.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,376.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,546.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,661.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,749.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,058.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$957.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,593.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,758.63
|
| Rate for Payer: Multiplan Commercial |
$3,192.00
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$2,593.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,391.50
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,394.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,058.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
HC SCRAPING OF CORNEA, DIAG/SMEAR
|
Facility
|
IP
|
$444.00
|
|
|
Service Code
|
CPT 65430
|
| Hospital Charge Code |
900501649
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$88.80 |
| Max. Negotiated Rate |
$377.40 |
| Rate for Payer: Adventist Health Commercial |
$88.80
|
| Rate for Payer: Cash Price |
$199.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$177.60
|
| Rate for Payer: EPIC Health Plan Senior |
$177.60
|
| Rate for Payer: Galaxy Health WC |
$377.40
|
| Rate for Payer: Global Benefits Group Commercial |
$266.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$296.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$169.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$274.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.56
|
| Rate for Payer: Multiplan Commercial |
$355.20
|
| Rate for Payer: Networks By Design Commercial |
$288.60
|
| Rate for Payer: Prime Health Services Commercial |
$377.40
|
|
|
HC SCRAPING OF CORNEA, DIAG/SMEAR
|
Facility
|
OP
|
$444.00
|
|
|
Service Code
|
CPT 65430
|
| Hospital Charge Code |
900501649
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$88.80 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$88.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$760.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$557.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$199.80
|
| Rate for Payer: Cash Price |
$199.80
|
| Rate for Payer: Cash Price |
$199.80
|
| Rate for Payer: Cigna of CA HMO |
$284.16
|
| Rate for Payer: Cigna of CA PPO |
$328.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$760.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$557.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$684.48
|
| Rate for Payer: EPIC Health Plan Senior |
$507.02
|
| Rate for Payer: Galaxy Health WC |
$377.40
|
| Rate for Payer: Global Benefits Group Commercial |
$266.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$831.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$296.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$261.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$638.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$679.41
|
| Rate for Payer: Multiplan Commercial |
$355.20
|
| Rate for Payer: Multiplan WC |
$807.84
|
| Rate for Payer: Networks By Design Commercial |
$288.60
|
| Rate for Payer: Prime Health Services Commercial |
$377.40
|
| Rate for Payer: Prime Health Services WC |
$799.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$266.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$222.00
|
| Rate for Payer: United Healthcare All Other HMO |
$222.00
|
| Rate for Payer: United Healthcare HMO Rider |
$222.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$222.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$507.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$760.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$557.72
|
| Rate for Payer: Vantage Medical Group Senior |
$507.02
|
|
|
HC SCRENG VIRTUAL CT COLONOGRAPHY
|
Facility
|
IP
|
$2,187.00
|
|
|
Service Code
|
CPT 74263
|
| Hospital Charge Code |
909201972
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$437.40 |
| Max. Negotiated Rate |
$1,858.95 |
| Rate for Payer: Adventist Health Commercial |
$437.40
|
| Rate for Payer: Cash Price |
$984.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.80
|
| Rate for Payer: EPIC Health Plan Senior |
$874.80
|
| Rate for Payer: Galaxy Health WC |
$1,858.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,312.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,458.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$833.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,353.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$524.88
|
| Rate for Payer: Multiplan Commercial |
$1,749.60
|
| Rate for Payer: Networks By Design Commercial |
$1,421.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,858.95
|
|
|
HC SCRENG VIRTUAL CT COLONOGRAPHY
|
Facility
|
OP
|
$1,172.00
|
|
|
Service Code
|
CPT 74263
|
| Hospital Charge Code |
909201972
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$234.40 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$234.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$719.73
|
| Rate for Payer: Blue Shield of California Commercial |
$717.26
|
| Rate for Payer: Blue Shield of California EPN |
$473.49
|
| Rate for Payer: Cash Price |
$527.40
|
| Rate for Payer: Cash Price |
$527.40
|
| Rate for Payer: Cash Price |
$527.40
|
| Rate for Payer: Cigna of CA HMO |
$750.08
|
| Rate for Payer: Cigna of CA PPO |
$867.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.63
|
| Rate for Payer: EPIC Health Plan Senior |
$307.13
|
| Rate for Payer: Galaxy Health WC |
$996.20
|
| Rate for Payer: Global Benefits Group Commercial |
$703.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$781.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$281.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.55
|
| Rate for Payer: Multiplan Commercial |
$937.60
|
| Rate for Payer: Networks By Design Commercial |
$761.80
|
| Rate for Payer: Prime Health Services Commercial |
$996.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$703.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$703.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,781.07
|
| Rate for Payer: United Healthcare All Other HMO |
$1,781.07
|
| Rate for Payer: United Healthcare HMO Rider |
$1,781.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,781.07
|
| Rate for Payer: Upland Medical Group Pediatric |
$307.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
