|
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 |
$111.24
|
| 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 |
$199.57
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$217.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$197.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$183.49
|
| 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: 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 TITER
|
Facility
|
OP
|
$182.00
|
|
|
Service Code
|
CPT 86593
|
| Hospital Charge Code |
900910929
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.56 |
| Max. Negotiated Rate |
$154.70 |
| Rate for Payer: Adventist Health Commercial |
$36.40
|
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$36.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$36.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.60
|
| 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 Medi-Cal |
$4.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.45
|
| Rate for Payer: Blue Shield of California Commercial |
$18.44
|
| Rate for Payer: Blue Shield of California Commercial |
$126.85
|
| Rate for Payer: Blue Shield of California Commercial |
$27.88
|
| Rate for Payer: Blue Shield of California Commercial |
$83.90
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Cigna of CA HMO |
$25.60
|
| Rate for Payer: Cigna of CA HMO |
$116.48
|
| Rate for Payer: Cigna of CA PPO |
$134.68
|
| Rate for Payer: Cigna of CA PPO |
$29.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$127.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.26
|
| Rate for Payer: EPIC Health Plan Senior |
$4.84
|
| Rate for Payer: EPIC Health Plan Senior |
$4.84
|
| Rate for Payer: Galaxy Health WC |
$154.70
|
| Rate for Payer: Galaxy Health WC |
$34.00
|
| Rate for Payer: Global Benefits Group Commercial |
$109.20
|
| Rate for Payer: Global Benefits Group Commercial |
$24.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.22
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.57
|
| 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: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$115.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.68
|
| 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 Medi-Cal |
$5.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.90
|
| Rate for Payer: Multiplan Commercial |
$32.00
|
| Rate for Payer: Multiplan Commercial |
$145.60
|
| Rate for Payer: Networks By Design Commercial |
$26.00
|
| Rate for Payer: Networks By Design Commercial |
$118.30
|
| Rate for Payer: Prime Health Services Commercial |
$154.70
|
| Rate for Payer: Prime Health Services Commercial |
$34.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$109.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$109.20
|
| 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 Commercial |
$3.56
|
| Rate for Payer: United Healthcare All Other HMO |
$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 HMO Rider |
$3.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.40
|
| 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 Commercial/Exchange |
$6.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.84
|
| Rate for Payer: Vantage Medical Group Senior |
$4.40
|
| Rate for Payer: Vantage Medical Group Senior |
$4.40
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$127.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$115.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$107.38
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$408.94
|
| 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 Foundation Hospitals Commercial/Self Funded |
$370.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$344.68
|
| 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 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 |
$136.47
|
| 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 |
$374.88
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$408.94
|
| 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 Foundation Hospitals Commercial/Self Funded |
$370.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$59.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$344.68
|
| 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: 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 RSV AG
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
CPT 87420
|
| Hospital Charge Code |
900911613
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$36.80 |
| Max. Negotiated Rate |
$156.40 |
| Rate for Payer: Adventist Health Commercial |
$36.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$128.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.60
|
| Rate for Payer: EPIC Health Plan Senior |
$73.60
|
| Rate for Payer: Galaxy Health WC |
$156.40
|
| Rate for Payer: Global Benefits Group Commercial |
$110.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$116.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$108.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.16
|
| Rate for Payer: Multiplan Commercial |
$147.20
|
| Rate for Payer: Networks By Design Commercial |
$119.60
|
| Rate for Payer: Prime Health Services Commercial |
$156.40
|
|
|
HC RSV AG
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
CPT 87420
|
| Hospital Charge Code |
900911613
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.91 |
| Max. Negotiated Rate |
$156.40 |
| Rate for Payer: Adventist Health Commercial |
$36.80
|
| Rate for Payer: Adventist Health Commercial |
$6.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$77.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$77.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.86
|
| 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 Medi-Cal |
$15.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$92.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$92.77
|
| Rate for Payer: Blue Shield of California Commercial |
$14.29
|
| Rate for Payer: Blue Shield of California Commercial |
$128.25
|
| Rate for Payer: Blue Shield of California Commercial |
$21.61
|
| Rate for Payer: Blue Shield of California Commercial |
$84.82
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna of CA HMO |
$19.84
|
| Rate for Payer: Cigna of CA HMO |
$117.76
|
| Rate for Payer: Cigna of CA PPO |
$136.16
|
| Rate for Payer: Cigna of CA PPO |
$22.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.91
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$128.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.95
|
| Rate for Payer: EPIC Health Plan Senior |
$15.30
|
| Rate for Payer: EPIC Health Plan Senior |
$15.30
|
| Rate for Payer: Galaxy Health WC |
$156.40
|
| Rate for Payer: Galaxy Health WC |
$26.35
|
| Rate for Payer: Global Benefits Group Commercial |
$110.40
|
| Rate for Payer: Global Benefits Group Commercial |
$18.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.81
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.91
|
| 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: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$116.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.16
|
| 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 Medi-Cal |
$17.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.64
|
| Rate for Payer: Multiplan Commercial |
$24.80
|
| Rate for Payer: Multiplan Commercial |
$147.20
|
| Rate for Payer: Networks By Design Commercial |
$20.15
|
| Rate for Payer: Networks By Design Commercial |
$119.60
|
| Rate for Payer: Prime Health Services Commercial |
$156.40
|
| Rate for Payer: Prime Health Services Commercial |
$26.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$110.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$110.40
|
| 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 Commercial |
$11.27
|
| Rate for Payer: United Healthcare All Other HMO |
$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 HMO Rider |
$11.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.27
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.91
|
| 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 Commercial/Exchange |
$20.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.30
|
| Rate for Payer: Vantage Medical Group Senior |
$13.91
|
| Rate for Payer: Vantage Medical Group Senior |
$13.91
|
|
|
HC RSV DFA
|
Facility
|
OP
|
$332.00
|
|
|
Service Code
|
CPT 87280
|
| Hospital Charge Code |
900911537
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.87 |
| Max. Negotiated Rate |
$282.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$77.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.76
|
| Rate for Payer: Vantage Medical Group Senior |
$13.42
|
| Rate for Payer: Vantage Medical Group Senior |
$13.42
|
| Rate for Payer: Adventist Health Commercial |
$66.40
|
| Rate for Payer: Adventist Health Commercial |
$7.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$77.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$92.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$92.77
|
| Rate for Payer: Blue Shield of California Commercial |
$17.98
|
| Rate for Payer: Blue Shield of California Commercial |
$153.05
|
| Rate for Payer: Blue Shield of California Commercial |
$27.18
|
| Rate for Payer: Blue Shield of California Commercial |
$231.40
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA HMO |
$212.48
|
| Rate for Payer: Cigna of CA PPO |
$245.68
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$232.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$27.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.14
|
| Rate for Payer: EPIC Health Plan Senior |
$14.76
|
| Rate for Payer: EPIC Health Plan Senior |
$14.76
|
| Rate for Payer: Galaxy Health WC |
$282.20
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$199.20
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.01
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$210.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.98
|
| Rate for Payer: Multiplan Commercial |
$31.20
|
| Rate for Payer: Multiplan Commercial |
$265.60
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Networks By Design Commercial |
$215.80
|
| Rate for Payer: Prime Health Services Commercial |
$282.20
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$199.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$199.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.87
|
| Rate for Payer: United Healthcare All Other HMO |
$10.87
|
| Rate for Payer: United Healthcare All Other HMO |
$10.87
|
| Rate for Payer: United Healthcare HMO Rider |
$10.87
|
| Rate for Payer: United Healthcare HMO Rider |
$10.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.87
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.13
|
|
|
HC RSV DFA
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
CPT 87280
|
| Hospital Charge Code |
900911537
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$66.40 |
| Max. Negotiated Rate |
$282.20 |
| Rate for Payer: Adventist Health Commercial |
$66.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$232.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$132.80
|
| Rate for Payer: EPIC Health Plan Senior |
$132.80
|
| Rate for Payer: Galaxy Health WC |
$282.20
|
| Rate for Payer: Global Benefits Group Commercial |
$199.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$210.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$195.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.68
|
| Rate for Payer: Multiplan Commercial |
$265.60
|
| Rate for Payer: Networks By Design Commercial |
$215.80
|
| Rate for Payer: Prime Health Services Commercial |
$282.20
|
|
|
HC RT ATTENDANCE AT DELIVERY
|
Facility
|
OP
|
$1,271.00
|
|
|
Service Code
|
CPT 99464
|
| Hospital Charge Code |
900800499
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$99.46 |
| Max. Negotiated Rate |
$1,080.35 |
| Rate for Payer: Dignity Health Medi-Cal |
$1,080.35
|
| Rate for Payer: Adventist Health Commercial |
$254.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$444.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,080.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$699.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$953.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$815.60
|
| Rate for Payer: Blue Shield of California Commercial |
$810.90
|
| Rate for Payer: Blue Shield of California Commercial |
$535.09
|
| Rate for Payer: Cash Price |
$571.95
|
| Rate for Payer: Cash Price |
$571.95
|
| Rate for Payer: Cash Price |
$571.95
|
| Rate for Payer: Cigna of CA HMO |
$813.44
|
| Rate for Payer: Cigna of CA PPO |
$940.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,080.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,080.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$889.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$508.40
|
| Rate for Payer: EPIC Health Plan Senior |
$508.40
|
| Rate for Payer: Galaxy Health WC |
$1,080.35
|
| Rate for Payer: Global Benefits Group Commercial |
$762.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$99.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$807.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$112.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$749.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$305.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$889.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$889.70
|
| Rate for Payer: Multiplan Commercial |
$1,016.80
|
| Rate for Payer: Networks By Design Commercial |
$826.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,080.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$762.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$762.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$764.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$731.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$669.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,080.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,080.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,080.35
|
|
|
HC RT ATTENDANCE AT DELIVERY
|
Facility
|
IP
|
$1,271.00
|
|
|
Service Code
|
CPT 99464
|
| Hospital Charge Code |
900800499
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$254.20 |
| Max. Negotiated Rate |
$1,080.35 |
| Rate for Payer: Adventist Health Commercial |
$254.20
|
| Rate for Payer: Cash Price |
$571.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$889.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$508.40
|
| Rate for Payer: EPIC Health Plan Senior |
$508.40
|
| Rate for Payer: Galaxy Health WC |
$1,080.35
|
| Rate for Payer: Global Benefits Group Commercial |
$762.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$807.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$749.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$305.04
|
| Rate for Payer: Multiplan Commercial |
$1,016.80
|
| Rate for Payer: Networks By Design Commercial |
$826.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,080.35
|
|
|
HC RTN OB ANTPM/C SCTN/PPRTM CARE
|
Facility
|
IP
|
$22,280.00
|
|
|
Service Code
|
CPT 59510
|
| Hospital Charge Code |
988109510
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,456.00 |
| Max. Negotiated Rate |
$18,938.00 |
| Rate for Payer: Adventist Health Commercial |
$4,456.00
|
| Rate for Payer: Cash Price |
$10,026.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15,596.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,912.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8,912.00
|
| Rate for Payer: Galaxy Health WC |
$18,938.00
|
| Rate for Payer: Global Benefits Group Commercial |
$13,368.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14,147.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13,145.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,347.20
|
| Rate for Payer: Multiplan Commercial |
$17,824.00
|
| Rate for Payer: Networks By Design Commercial |
$14,482.00
|
| Rate for Payer: Prime Health Services Commercial |
$18,938.00
|
|
|
HC RTN OB ANTPM/C SCTN/PPRTM CARE
|
Facility
|
OP
|
$22,280.00
|
|
|
Service Code
|
CPT 59510
|
| Hospital Charge Code |
988109510
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,942.61 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$4,456.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18,938.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12,254.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16,710.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,927.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,942.61
|
| Rate for Payer: Blue Shield of California Commercial |
$4,454.70
|
| Rate for Payer: Cash Price |
$10,026.00
|
| Rate for Payer: Cash Price |
$10,026.00
|
| Rate for Payer: Cash Price |
$10,026.00
|
| Rate for Payer: Cigna of CA HMO |
$14,259.20
|
| Rate for Payer: Cigna of CA PPO |
$16,487.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18,938.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$18,938.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18,938.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15,596.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,912.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8,912.00
|
| Rate for Payer: Galaxy Health WC |
$18,938.00
|
| Rate for Payer: Global Benefits Group Commercial |
$13,368.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,859.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14,147.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,365.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13,145.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,347.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15,596.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15,596.00
|
| Rate for Payer: Multiplan Commercial |
$17,824.00
|
| Rate for Payer: Networks By Design Commercial |
$14,482.00
|
| Rate for Payer: Prime Health Services Commercial |
$18,938.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13,368.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,140.00
|
| Rate for Payer: United Healthcare All Other HMO |
$11,140.00
|
| Rate for Payer: United Healthcare HMO Rider |
$11,140.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,140.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18,938.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18,938.00
|
| Rate for Payer: Vantage Medical Group Senior |
$18,938.00
|
|
|
HC RTNR BANDNET DRSNG 50YD X 6IN
|
Facility
|
IP
|
$6.31
|
|
| Hospital Charge Code |
901698302
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$5.36 |
| Rate for Payer: Adventist Health Commercial |
$1.26
|
| Rate for Payer: Cash Price |
$2.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.52
|
| Rate for Payer: EPIC Health Plan Senior |
$2.52
|
| Rate for Payer: Galaxy Health WC |
$5.36
|
| Rate for Payer: Global Benefits Group Commercial |
$3.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.51
|
| Rate for Payer: Multiplan Commercial |
$5.05
|
| Rate for Payer: Networks By Design Commercial |
$4.10
|
| Rate for Payer: Prime Health Services Commercial |
$5.36
|
|
|
HC RTNR BANDNET DRSNG 50YD X 6IN
|
Facility
|
OP
|
$6.31
|
|
| Hospital Charge Code |
901698302
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$5.36 |
| Rate for Payer: Adventist Health Commercial |
$1.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.05
|
| Rate for Payer: Cash Price |
$2.84
|
| Rate for Payer: Cigna of CA HMO |
$4.04
|
| Rate for Payer: Cigna of CA PPO |
$4.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.52
|
| Rate for Payer: EPIC Health Plan Senior |
$2.52
|
| Rate for Payer: Galaxy Health WC |
$5.36
|
| Rate for Payer: Global Benefits Group Commercial |
$3.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.42
|
| Rate for Payer: Multiplan Commercial |
$5.05
|
| Rate for Payer: Networks By Design Commercial |
$4.10
|
| Rate for Payer: Prime Health Services Commercial |
$5.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.15
|
| Rate for Payer: United Healthcare All Other HMO |
$3.15
|
| Rate for Payer: United Healthcare HMO Rider |
$3.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.36
|
| Rate for Payer: Vantage Medical Group Senior |
$5.36
|
|
|
HC RTNR BANDNET DRSNG 50YD X 7IN
|
Facility
|
OP
|
$7.13
|
|
| Hospital Charge Code |
901698298
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$6.06 |
| Rate for Payer: Adventist Health Commercial |
$1.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.58
|
| Rate for Payer: Cash Price |
$3.21
|
| Rate for Payer: Cigna of CA HMO |
$4.56
|
| Rate for Payer: Cigna of CA PPO |
$5.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.85
|
| Rate for Payer: EPIC Health Plan Senior |
$2.85
|
| Rate for Payer: Galaxy Health WC |
$6.06
|
| Rate for Payer: Global Benefits Group Commercial |
$4.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.99
|
| Rate for Payer: Multiplan Commercial |
$5.70
|
| Rate for Payer: Networks By Design Commercial |
$4.63
|
| Rate for Payer: Prime Health Services Commercial |
$6.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.28
|
| 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: Vantage Medical Group Commercial/Exchange |
$6.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.06
|
| Rate for Payer: Vantage Medical Group Senior |
$6.06
|
|
|
HC RTNR BANDNET DRSNG 50YD X 7IN
|
Facility
|
IP
|
$7.13
|
|
| Hospital Charge Code |
901698298
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$6.06 |
| Rate for Payer: Adventist Health Commercial |
$1.43
|
| Rate for Payer: Cash Price |
$3.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.85
|
| Rate for Payer: EPIC Health Plan Senior |
$2.85
|
| Rate for Payer: Galaxy Health WC |
$6.06
|
| Rate for Payer: Global Benefits Group Commercial |
$4.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.71
|
| Rate for Payer: Multiplan Commercial |
$5.70
|
| Rate for Payer: Networks By Design Commercial |
$4.63
|
| Rate for Payer: Prime Health Services Commercial |
$6.06
|
|
|
HC RTNR DRSNG BANDNET 25YD X 6IN
|
Facility
|
OP
|
$8.53
|
|
| Hospital Charge Code |
901698260
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.71 |
| Max. Negotiated Rate |
$7.25 |
| Rate for Payer: Adventist Health Commercial |
$1.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.47
|
| Rate for Payer: Cash Price |
$3.84
|
| Rate for Payer: Cigna of CA HMO |
$5.46
|
| Rate for Payer: Cigna of CA PPO |
$6.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.41
|
| Rate for Payer: EPIC Health Plan Senior |
$3.41
|
| Rate for Payer: Galaxy Health WC |
$7.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.97
|
| Rate for Payer: Multiplan Commercial |
$6.82
|
| Rate for Payer: Networks By Design Commercial |
$5.54
|
| Rate for Payer: Prime Health Services Commercial |
$7.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.26
|
| Rate for Payer: United Healthcare All Other HMO |
$4.26
|
| Rate for Payer: United Healthcare HMO Rider |
$4.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.25
|
| Rate for Payer: Vantage Medical Group Senior |
$7.25
|
|
|
HC RTNR DRSNG BANDNET 25YD X 6IN
|
Facility
|
IP
|
$8.53
|
|
| Hospital Charge Code |
901698260
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.71 |
| Max. Negotiated Rate |
$7.25 |
| Rate for Payer: Adventist Health Commercial |
$1.71
|
| Rate for Payer: Cash Price |
$3.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.41
|
| Rate for Payer: EPIC Health Plan Senior |
$3.41
|
| Rate for Payer: Galaxy Health WC |
$7.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.05
|
| Rate for Payer: Multiplan Commercial |
$6.82
|
| Rate for Payer: Networks By Design Commercial |
$5.54
|
| Rate for Payer: Prime Health Services Commercial |
$7.25
|
|
|
HC RTNR DRSNG BANDNET 5INX50YD
|
Facility
|
IP
|
$8.53
|
|
| Hospital Charge Code |
901698322
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.71 |
| Max. Negotiated Rate |
$7.25 |
| Rate for Payer: Adventist Health Commercial |
$1.71
|
| Rate for Payer: Cash Price |
$3.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.41
|
| Rate for Payer: EPIC Health Plan Senior |
$3.41
|
| Rate for Payer: Galaxy Health WC |
$7.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.05
|
| Rate for Payer: Multiplan Commercial |
$6.82
|
| Rate for Payer: Networks By Design Commercial |
$5.54
|
| Rate for Payer: Prime Health Services Commercial |
$7.25
|
|
|
HC RTNR DRSNG BANDNET 5INX50YD
|
Facility
|
OP
|
$8.53
|
|
| Hospital Charge Code |
901698322
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.71 |
| Max. Negotiated Rate |
$7.25 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.25
|
| Rate for Payer: Vantage Medical Group Senior |
$7.25
|
| Rate for Payer: Adventist Health Commercial |
$1.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.47
|
| Rate for Payer: Cash Price |
$3.84
|
| Rate for Payer: Cigna of CA HMO |
$5.46
|
| Rate for Payer: Cigna of CA PPO |
$6.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.41
|
| Rate for Payer: EPIC Health Plan Senior |
$3.41
|
| Rate for Payer: Galaxy Health WC |
$7.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.97
|
| Rate for Payer: Multiplan Commercial |
$6.82
|
| Rate for Payer: Networks By Design Commercial |
$5.54
|
| Rate for Payer: Prime Health Services Commercial |
$7.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.26
|
| Rate for Payer: United Healthcare All Other HMO |
$4.26
|
| Rate for Payer: United Healthcare HMO Rider |
$4.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.25
|
|
|
HC RTNR DRSNG BANDNET 8INX50YD
|
Facility
|
IP
|
$4.59
|
|
| Hospital Charge Code |
901698274
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: Adventist Health Commercial |
$0.92
|
| Rate for Payer: Cash Price |
$2.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.84
|
| Rate for Payer: EPIC Health Plan Senior |
$1.84
|
| Rate for Payer: Galaxy Health WC |
$3.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.10
|
| Rate for Payer: Multiplan Commercial |
$3.67
|
| Rate for Payer: Networks By Design Commercial |
$2.98
|
| Rate for Payer: Prime Health Services Commercial |
$3.90
|
|
|
HC RTNR DRSNG BANDNET 8INX50YD
|
Facility
|
OP
|
$4.59
|
|
| Hospital Charge Code |
901698274
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: Adventist Health Commercial |
$0.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.95
|
| Rate for Payer: Cash Price |
$2.07
|
| Rate for Payer: Cigna of CA HMO |
$2.94
|
| Rate for Payer: Cigna of CA PPO |
$3.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.84
|
| Rate for Payer: EPIC Health Plan Senior |
$1.84
|
| Rate for Payer: Galaxy Health WC |
$3.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.21
|
| Rate for Payer: Multiplan Commercial |
$3.67
|
| Rate for Payer: Networks By Design Commercial |
$2.98
|
| Rate for Payer: Prime Health Services Commercial |
$3.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.75
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.29
|
| Rate for Payer: United Healthcare All Other HMO |
$2.29
|
| Rate for Payer: United Healthcare HMO Rider |
$2.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.90
|
| Rate for Payer: Vantage Medical Group Senior |
$3.90
|
|
|
HC RTNR DRSNG BANDNET 9IN
|
Facility
|
OP
|
$11.23
|
|
| Hospital Charge Code |
901698412
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$9.55 |
| Rate for Payer: Adventist Health Commercial |
$2.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.21
|
| Rate for Payer: Cash Price |
$5.05
|
| Rate for Payer: Cigna of CA HMO |
$7.19
|
| Rate for Payer: Cigna of CA PPO |
$8.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.49
|
| Rate for Payer: EPIC Health Plan Senior |
$4.49
|
| Rate for Payer: Galaxy Health WC |
$9.55
|
| Rate for Payer: Global Benefits Group Commercial |
$6.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.86
|
| Rate for Payer: Multiplan Commercial |
$8.98
|
| Rate for Payer: Networks By Design Commercial |
$7.30
|
| Rate for Payer: Prime Health Services Commercial |
$9.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.62
|
| Rate for Payer: United Healthcare All Other HMO |
$5.62
|
| Rate for Payer: United Healthcare HMO Rider |
$5.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.55
|
| Rate for Payer: Vantage Medical Group Senior |
$9.55
|
|
|
HC RTNR DRSNG BANDNET 9IN
|
Facility
|
IP
|
$11.23
|
|
| Hospital Charge Code |
901698412
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$9.55 |
| Rate for Payer: Adventist Health Commercial |
$2.25
|
| Rate for Payer: Cash Price |
$5.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.49
|
| Rate for Payer: EPIC Health Plan Senior |
$4.49
|
| Rate for Payer: Galaxy Health WC |
$9.55
|
| Rate for Payer: Global Benefits Group Commercial |
$6.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.70
|
| Rate for Payer: Multiplan Commercial |
$8.98
|
| Rate for Payer: Networks By Design Commercial |
$7.30
|
| Rate for Payer: Prime Health Services Commercial |
$9.55
|
|
