|
HC SYPHILLIS TEST VDRL/ CSF
|
Facility
|
IP
|
$31.00
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
900910861
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.20 |
| Max. Negotiated Rate |
$27.90 |
| Rate for Payer: Adventist Health Commercial |
$6.20
|
| Rate for Payer: Cash Price |
$17.05
|
| Rate for Payer: Central Health Plan Commercial |
$24.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.40
|
| Rate for Payer: EPIC Health Plan Senior |
$12.40
|
| Rate for Payer: Galaxy Health WC |
$26.35
|
| Rate for Payer: Global Benefits Group Commercial |
$18.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.20
|
| Rate for Payer: Multiplan Commercial |
$23.25
|
| Rate for Payer: Networks By Design Commercial |
$20.15
|
| Rate for Payer: Prime Health Services Commercial |
$26.35
|
|
|
HC SYPHILLIS TEST VDRL/ CSF
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
900910861
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$31.05 |
| Rate for Payer: Adventist Health Commercial |
$6.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.30
|
| Rate for Payer: Blue Shield of California Commercial |
$18.82
|
| Rate for Payer: Blue Shield of California EPN |
$12.31
|
| Rate for Payer: Cash Price |
$17.05
|
| Rate for Payer: Cash Price |
$17.05
|
| Rate for Payer: Central Health Plan Commercial |
$24.80
|
| Rate for Payer: Cigna of CA HMO |
$19.84
|
| Rate for Payer: Cigna of CA PPO |
$22.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.76
|
| Rate for Payer: EPIC Health Plan Senior |
$4.27
|
| Rate for Payer: Galaxy Health WC |
$26.35
|
| Rate for Payer: Global Benefits Group Commercial |
$18.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.27
|
| Rate for Payer: InnovAge PACE Commercial |
$6.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.72
|
| Rate for Payer: Multiplan Commercial |
$23.25
|
| Rate for Payer: Networks By Design Commercial |
$20.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.27
|
| Rate for Payer: Prime Health Services Commercial |
$26.35
|
| Rate for Payer: Prime Health Services Medicare |
$4.53
|
| Rate for Payer: Riverside University Health System MISP |
$4.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.46
|
| Rate for Payer: United Healthcare All Other HMO |
$3.46
|
| Rate for Payer: United Healthcare HMO Rider |
$3.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4.27
|
|
|
HC SYRG SPOT NON INDIA INK PRELOADED
|
Facility
|
OP
|
$206.50
|
|
| Hospital Charge Code |
900100367
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.30 |
| Max. Negotiated Rate |
$185.85 |
| Rate for Payer: Adventist Health Commercial |
$41.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$125.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$175.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$113.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$154.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$99.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.28
|
| Rate for Payer: Blue Shield of California Commercial |
$126.17
|
| Rate for Payer: Blue Shield of California EPN |
$82.39
|
| Rate for Payer: Cash Price |
$113.58
|
| Rate for Payer: Central Health Plan Commercial |
$165.20
|
| Rate for Payer: Cigna of CA HMO |
$132.16
|
| Rate for Payer: Cigna of CA PPO |
$152.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$175.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$175.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$82.60
|
| Rate for Payer: EPIC Health Plan Senior |
$82.60
|
| Rate for Payer: Galaxy Health WC |
$175.53
|
| Rate for Payer: Global Benefits Group Commercial |
$123.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$185.85
|
| Rate for Payer: InnovAge PACE Commercial |
$103.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$137.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$127.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$144.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$144.55
|
| Rate for Payer: Multiplan Commercial |
$154.88
|
| Rate for Payer: Networks By Design Commercial |
$134.22
|
| Rate for Payer: Prime Health Services Commercial |
$175.53
|
| Rate for Payer: Riverside University Health System MISP |
$82.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$123.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$123.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$103.25
|
| Rate for Payer: United Healthcare All Other HMO |
$103.25
|
| Rate for Payer: United Healthcare HMO Rider |
$103.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$103.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$175.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.53
|
| Rate for Payer: Vantage Medical Group Senior |
$175.53
|
|
|
HC SYRG SPOT NON INDIA INK PRELOADED
|
Facility
|
IP
|
$206.50
|
|
| Hospital Charge Code |
900100367
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.30 |
| Max. Negotiated Rate |
$185.85 |
| Rate for Payer: Adventist Health Commercial |
$41.30
|
| Rate for Payer: Cash Price |
$113.58
|
| Rate for Payer: Central Health Plan Commercial |
$165.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$82.60
|
| Rate for Payer: EPIC Health Plan Senior |
$82.60
|
| Rate for Payer: Galaxy Health WC |
$175.53
|
| Rate for Payer: Global Benefits Group Commercial |
$123.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$185.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$137.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$127.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.30
|
| Rate for Payer: Multiplan Commercial |
$154.88
|
| Rate for Payer: Networks By Design Commercial |
$134.22
|
| Rate for Payer: Prime Health Services Commercial |
$175.53
|
|
|
HC SYS PEG24 5.5MMX24FR 0.035INX260CM PUSH METHOD
|
Facility
|
OP
|
$406.00
|
|
| Hospital Charge Code |
900100410
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$365.40 |
| Rate for Payer: Adventist Health Commercial |
$81.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$246.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$345.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$223.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$196.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$238.44
|
| Rate for Payer: Blue Shield of California Commercial |
$248.07
|
| Rate for Payer: Blue Shield of California EPN |
$161.99
|
| Rate for Payer: Cash Price |
$223.30
|
| Rate for Payer: Central Health Plan Commercial |
$324.80
|
| Rate for Payer: Cigna of CA HMO |
$259.84
|
| Rate for Payer: Cigna of CA PPO |
$300.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$345.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$345.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$345.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.40
|
| Rate for Payer: EPIC Health Plan Senior |
$162.40
|
| Rate for Payer: Galaxy Health WC |
$345.10
|
| Rate for Payer: Global Benefits Group Commercial |
$243.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$365.40
|
| Rate for Payer: InnovAge PACE Commercial |
$203.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$270.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$154.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$251.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$284.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$284.20
|
| Rate for Payer: Multiplan Commercial |
$304.50
|
| Rate for Payer: Networks By Design Commercial |
$263.90
|
| Rate for Payer: Prime Health Services Commercial |
$345.10
|
| Rate for Payer: Riverside University Health System MISP |
$162.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$243.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$243.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$203.00
|
| Rate for Payer: United Healthcare All Other HMO |
$203.00
|
| Rate for Payer: United Healthcare HMO Rider |
$203.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$203.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$345.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$345.10
|
| Rate for Payer: Vantage Medical Group Senior |
$345.10
|
|
|
HC SYS PEG24 5.5MMX24FR 0.035INX260CM PUSH METHOD
|
Facility
|
IP
|
$406.00
|
|
| Hospital Charge Code |
900100410
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$365.40 |
| Rate for Payer: Adventist Health Commercial |
$81.20
|
| Rate for Payer: Cash Price |
$223.30
|
| Rate for Payer: Central Health Plan Commercial |
$324.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.40
|
| Rate for Payer: EPIC Health Plan Senior |
$162.40
|
| Rate for Payer: Galaxy Health WC |
$345.10
|
| Rate for Payer: Global Benefits Group Commercial |
$243.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$365.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$270.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$154.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$251.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.20
|
| Rate for Payer: Multiplan Commercial |
$304.50
|
| Rate for Payer: Networks By Design Commercial |
$263.90
|
| Rate for Payer: Prime Health Services Commercial |
$345.10
|
|
|
HC SYSTEM NASAL TUBE RTNR 12-14FR
|
Facility
|
IP
|
$580.00
|
|
| Hospital Charge Code |
901698433
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
|
|
HC SYSTEM NASAL TUBE RTNR 12-14FR
|
Facility
|
OP
|
$580.00
|
|
| Hospital Charge Code |
901698433
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$352.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$280.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$340.63
|
| Rate for Payer: Blue Shield of California Commercial |
$354.38
|
| Rate for Payer: Blue Shield of California EPN |
$231.42
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Cigna of CA HMO |
$371.20
|
| Rate for Payer: Cigna of CA PPO |
$429.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$493.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: InnovAge PACE Commercial |
$290.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$406.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Riverside University Health System MISP |
$232.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$290.00
|
| Rate for Payer: United Healthcare All Other HMO |
$290.00
|
| Rate for Payer: United Healthcare HMO Rider |
$290.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC SYSTEM NASAL TUBE RTNR 16-18FR
|
Facility
|
OP
|
$580.00
|
|
| Hospital Charge Code |
901698599
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$352.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$280.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$340.63
|
| Rate for Payer: Blue Shield of California Commercial |
$354.38
|
| Rate for Payer: Blue Shield of California EPN |
$231.42
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Cigna of CA HMO |
$371.20
|
| Rate for Payer: Cigna of CA PPO |
$429.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$493.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: InnovAge PACE Commercial |
$290.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$406.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Riverside University Health System MISP |
$232.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$290.00
|
| Rate for Payer: United Healthcare All Other HMO |
$290.00
|
| Rate for Payer: United Healthcare HMO Rider |
$290.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC SYSTEM NASAL TUBE RTNR 16-18FR
|
Facility
|
IP
|
$580.00
|
|
| Hospital Charge Code |
901698599
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
|
|
HC SYSTEM NASAL TUBE RTNR 8-10FR
|
Facility
|
IP
|
$613.18
|
|
| Hospital Charge Code |
901698432
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$122.64 |
| Max. Negotiated Rate |
$551.86 |
| Rate for Payer: Adventist Health Commercial |
$122.64
|
| Rate for Payer: Cash Price |
$337.25
|
| Rate for Payer: Central Health Plan Commercial |
$490.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$245.27
|
| Rate for Payer: EPIC Health Plan Senior |
$245.27
|
| Rate for Payer: Galaxy Health WC |
$521.20
|
| Rate for Payer: Global Benefits Group Commercial |
$367.91
|
| Rate for Payer: Health Management Network EPO/PPO |
$551.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$408.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$233.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$379.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.64
|
| Rate for Payer: Multiplan Commercial |
$459.88
|
| Rate for Payer: Networks By Design Commercial |
$398.57
|
| Rate for Payer: Prime Health Services Commercial |
$521.20
|
|
|
HC SYSTEM NASAL TUBE RTNR 8-10FR
|
Facility
|
OP
|
$613.18
|
|
| Hospital Charge Code |
901698432
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$122.64 |
| Max. Negotiated Rate |
$551.86 |
| Rate for Payer: Adventist Health Commercial |
$122.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$372.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$521.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$459.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$296.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$360.12
|
| Rate for Payer: Blue Shield of California Commercial |
$374.65
|
| Rate for Payer: Blue Shield of California EPN |
$244.66
|
| Rate for Payer: Cash Price |
$337.25
|
| Rate for Payer: Central Health Plan Commercial |
$490.54
|
| Rate for Payer: Cigna of CA HMO |
$392.44
|
| Rate for Payer: Cigna of CA PPO |
$453.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$521.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$521.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$521.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$245.27
|
| Rate for Payer: EPIC Health Plan Senior |
$245.27
|
| Rate for Payer: Galaxy Health WC |
$521.20
|
| Rate for Payer: Global Benefits Group Commercial |
$367.91
|
| Rate for Payer: Health Management Network EPO/PPO |
$551.86
|
| Rate for Payer: InnovAge PACE Commercial |
$306.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$408.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$233.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$379.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$429.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$429.23
|
| Rate for Payer: Multiplan Commercial |
$459.88
|
| Rate for Payer: Networks By Design Commercial |
$398.57
|
| Rate for Payer: Prime Health Services Commercial |
$521.20
|
| Rate for Payer: Riverside University Health System MISP |
$245.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$367.91
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$367.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$306.59
|
| Rate for Payer: United Healthcare All Other HMO |
$306.59
|
| Rate for Payer: United Healthcare HMO Rider |
$306.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$306.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$521.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$521.20
|
| Rate for Payer: Vantage Medical Group Senior |
$521.20
|
|
|
HC SYTM TORTLEAIR HEAD REPOSITIONING LRG 41-46CM
|
Facility
|
OP
|
$176.75
|
|
| Hospital Charge Code |
901607217
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$35.35 |
| Max. Negotiated Rate |
$159.07 |
| Rate for Payer: Adventist Health Commercial |
$35.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$107.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$150.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$97.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$132.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$85.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$103.81
|
| Rate for Payer: Blue Shield of California Commercial |
$107.99
|
| Rate for Payer: Blue Shield of California EPN |
$70.52
|
| Rate for Payer: Cash Price |
$97.21
|
| Rate for Payer: Central Health Plan Commercial |
$141.40
|
| Rate for Payer: Cigna of CA HMO |
$113.12
|
| Rate for Payer: Cigna of CA PPO |
$130.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$150.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$150.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$150.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.70
|
| Rate for Payer: EPIC Health Plan Senior |
$70.70
|
| Rate for Payer: Galaxy Health WC |
$150.24
|
| Rate for Payer: Global Benefits Group Commercial |
$106.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$159.07
|
| Rate for Payer: InnovAge PACE Commercial |
$88.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$117.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$109.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$123.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$123.72
|
| Rate for Payer: Multiplan Commercial |
$132.56
|
| Rate for Payer: Networks By Design Commercial |
$114.89
|
| Rate for Payer: Prime Health Services Commercial |
$150.24
|
| Rate for Payer: Riverside University Health System MISP |
$70.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$106.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$106.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$88.38
|
| Rate for Payer: United Healthcare All Other HMO |
$88.38
|
| Rate for Payer: United Healthcare HMO Rider |
$88.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$88.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$150.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$150.24
|
| Rate for Payer: Vantage Medical Group Senior |
$150.24
|
|
|
HC SYTM TORTLEAIR HEAD REPOSITIONING LRG 41-46CM
|
Facility
|
IP
|
$176.75
|
|
| Hospital Charge Code |
901607217
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$35.35 |
| Max. Negotiated Rate |
$159.07 |
| Rate for Payer: Adventist Health Commercial |
$35.35
|
| Rate for Payer: Cash Price |
$97.21
|
| Rate for Payer: Central Health Plan Commercial |
$141.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.70
|
| Rate for Payer: EPIC Health Plan Senior |
$70.70
|
| Rate for Payer: Galaxy Health WC |
$150.24
|
| Rate for Payer: Global Benefits Group Commercial |
$106.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$159.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$117.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$109.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.35
|
| Rate for Payer: Multiplan Commercial |
$132.56
|
| Rate for Payer: Networks By Design Commercial |
$114.89
|
| Rate for Payer: Prime Health Services Commercial |
$150.24
|
|
|
HC SYTM TORTLEAIR HEAD REPOSITIONING MED 38-41CM
|
Facility
|
OP
|
$183.75
|
|
| Hospital Charge Code |
901607216
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$36.75 |
| Max. Negotiated Rate |
$165.38 |
| Rate for Payer: Adventist Health Commercial |
$36.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$111.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$156.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$101.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$88.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$107.92
|
| Rate for Payer: Blue Shield of California Commercial |
$112.27
|
| Rate for Payer: Blue Shield of California EPN |
$73.32
|
| Rate for Payer: Cash Price |
$101.06
|
| Rate for Payer: Central Health Plan Commercial |
$147.00
|
| Rate for Payer: Cigna of CA HMO |
$117.60
|
| Rate for Payer: Cigna of CA PPO |
$135.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$156.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$156.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$156.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.50
|
| Rate for Payer: EPIC Health Plan Senior |
$73.50
|
| Rate for Payer: Galaxy Health WC |
$156.19
|
| Rate for Payer: Global Benefits Group Commercial |
$110.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$165.38
|
| Rate for Payer: InnovAge PACE Commercial |
$91.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$122.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$128.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$128.62
|
| Rate for Payer: Multiplan Commercial |
$137.81
|
| Rate for Payer: Networks By Design Commercial |
$119.44
|
| Rate for Payer: Prime Health Services Commercial |
$156.19
|
| Rate for Payer: Riverside University Health System MISP |
$73.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$110.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$110.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$91.88
|
| Rate for Payer: United Healthcare All Other HMO |
$91.88
|
| Rate for Payer: United Healthcare HMO Rider |
$91.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$91.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$156.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$156.19
|
| Rate for Payer: Vantage Medical Group Senior |
$156.19
|
|
|
HC SYTM TORTLEAIR HEAD REPOSITIONING MED 38-41CM
|
Facility
|
IP
|
$183.75
|
|
| Hospital Charge Code |
901607216
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$36.75 |
| Max. Negotiated Rate |
$165.38 |
| Rate for Payer: Adventist Health Commercial |
$36.75
|
| Rate for Payer: Cash Price |
$101.06
|
| Rate for Payer: Central Health Plan Commercial |
$147.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.50
|
| Rate for Payer: EPIC Health Plan Senior |
$73.50
|
| Rate for Payer: Galaxy Health WC |
$156.19
|
| Rate for Payer: Global Benefits Group Commercial |
$110.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$165.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$122.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.75
|
| Rate for Payer: Multiplan Commercial |
$137.81
|
| Rate for Payer: Networks By Design Commercial |
$119.44
|
| Rate for Payer: Prime Health Services Commercial |
$156.19
|
|
|
HC SYTM TORTLEAIR HEAD REPOSITIONING SM 33-38CM
|
Facility
|
OP
|
$183.75
|
|
| Hospital Charge Code |
901607215
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$36.75 |
| Max. Negotiated Rate |
$165.38 |
| Rate for Payer: Adventist Health Commercial |
$36.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$111.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$156.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$101.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$88.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$107.92
|
| Rate for Payer: Blue Shield of California Commercial |
$112.27
|
| Rate for Payer: Blue Shield of California EPN |
$73.32
|
| Rate for Payer: Cash Price |
$101.06
|
| Rate for Payer: Central Health Plan Commercial |
$147.00
|
| Rate for Payer: Cigna of CA HMO |
$117.60
|
| Rate for Payer: Cigna of CA PPO |
$135.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$156.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$156.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$156.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.50
|
| Rate for Payer: EPIC Health Plan Senior |
$73.50
|
| Rate for Payer: Galaxy Health WC |
$156.19
|
| Rate for Payer: Global Benefits Group Commercial |
$110.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$165.38
|
| Rate for Payer: InnovAge PACE Commercial |
$91.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$122.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$128.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$128.62
|
| Rate for Payer: Multiplan Commercial |
$137.81
|
| Rate for Payer: Networks By Design Commercial |
$119.44
|
| Rate for Payer: Prime Health Services Commercial |
$156.19
|
| Rate for Payer: Riverside University Health System MISP |
$73.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$110.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$110.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$91.88
|
| Rate for Payer: United Healthcare All Other HMO |
$91.88
|
| Rate for Payer: United Healthcare HMO Rider |
$91.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$91.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$156.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$156.19
|
| Rate for Payer: Vantage Medical Group Senior |
$156.19
|
|
|
HC SYTM TORTLEAIR HEAD REPOSITIONING SM 33-38CM
|
Facility
|
IP
|
$183.75
|
|
| Hospital Charge Code |
901607215
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$36.75 |
| Max. Negotiated Rate |
$165.38 |
| Rate for Payer: Adventist Health Commercial |
$36.75
|
| Rate for Payer: Cash Price |
$101.06
|
| Rate for Payer: Central Health Plan Commercial |
$147.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.50
|
| Rate for Payer: EPIC Health Plan Senior |
$73.50
|
| Rate for Payer: Galaxy Health WC |
$156.19
|
| Rate for Payer: Global Benefits Group Commercial |
$110.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$165.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$122.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.75
|
| Rate for Payer: Multiplan Commercial |
$137.81
|
| Rate for Payer: Networks By Design Commercial |
$119.44
|
| Rate for Payer: Prime Health Services Commercial |
$156.19
|
|
|
HC SYVEK EXCEL HEMOSTASIS PAD
|
Facility
|
IP
|
$580.00
|
|
| Hospital Charge Code |
906812424
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
|
|
HC SYVEK EXCEL HEMOSTASIS PAD
|
Facility
|
OP
|
$580.00
|
|
| Hospital Charge Code |
906812424
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$352.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$280.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$340.63
|
| Rate for Payer: Blue Shield of California Commercial |
$354.38
|
| Rate for Payer: Blue Shield of California EPN |
$231.42
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Cigna of CA HMO |
$371.20
|
| Rate for Payer: Cigna of CA PPO |
$429.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$493.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: InnovAge PACE Commercial |
$290.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$406.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Riverside University Health System MISP |
$232.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$290.00
|
| Rate for Payer: United Healthcare All Other HMO |
$290.00
|
| Rate for Payer: United Healthcare HMO Rider |
$290.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC SYVEK NT HEMOSTASIS PAD
|
Facility
|
OP
|
$406.00
|
|
| Hospital Charge Code |
906812425
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$365.40 |
| Rate for Payer: Adventist Health Commercial |
$81.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$246.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$345.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$223.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$196.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$238.44
|
| Rate for Payer: Blue Shield of California Commercial |
$248.07
|
| Rate for Payer: Blue Shield of California EPN |
$161.99
|
| Rate for Payer: Cash Price |
$223.30
|
| Rate for Payer: Central Health Plan Commercial |
$324.80
|
| Rate for Payer: Cigna of CA HMO |
$259.84
|
| Rate for Payer: Cigna of CA PPO |
$300.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$345.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$345.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$345.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.40
|
| Rate for Payer: EPIC Health Plan Senior |
$162.40
|
| Rate for Payer: Galaxy Health WC |
$345.10
|
| Rate for Payer: Global Benefits Group Commercial |
$243.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$365.40
|
| Rate for Payer: InnovAge PACE Commercial |
$203.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$270.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$154.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$251.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$284.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$284.20
|
| Rate for Payer: Multiplan Commercial |
$304.50
|
| Rate for Payer: Networks By Design Commercial |
$263.90
|
| Rate for Payer: Prime Health Services Commercial |
$345.10
|
| Rate for Payer: Riverside University Health System MISP |
$162.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$243.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$243.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$203.00
|
| Rate for Payer: United Healthcare All Other HMO |
$203.00
|
| Rate for Payer: United Healthcare HMO Rider |
$203.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$203.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$345.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$345.10
|
| Rate for Payer: Vantage Medical Group Senior |
$345.10
|
|
|
HC SYVEK NT HEMOSTASIS PAD
|
Facility
|
IP
|
$406.00
|
|
| Hospital Charge Code |
906812425
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$365.40 |
| Rate for Payer: Adventist Health Commercial |
$81.20
|
| Rate for Payer: Cash Price |
$223.30
|
| Rate for Payer: Central Health Plan Commercial |
$324.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.40
|
| Rate for Payer: EPIC Health Plan Senior |
$162.40
|
| Rate for Payer: Galaxy Health WC |
$345.10
|
| Rate for Payer: Global Benefits Group Commercial |
$243.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$365.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$270.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$154.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$251.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.20
|
| Rate for Payer: Multiplan Commercial |
$304.50
|
| Rate for Payer: Networks By Design Commercial |
$263.90
|
| Rate for Payer: Prime Health Services Commercial |
$345.10
|
|
|
HC TAGGED WBC WB SCAN
|
Facility
|
IP
|
$3,380.00
|
|
|
Service Code
|
CPT 78806
|
| Hospital Charge Code |
909301443
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$3,042.00 |
| Rate for Payer: Adventist Health Commercial |
$676.00
|
| Rate for Payer: Cash Price |
$1,859.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,704.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,352.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,352.00
|
| Rate for Payer: Galaxy Health WC |
$2,873.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,028.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,042.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,254.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,287.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,092.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$676.00
|
| Rate for Payer: Multiplan Commercial |
$2,535.00
|
| Rate for Payer: Networks By Design Commercial |
$2,197.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,873.00
|
|
|
HC TAGGED WBC WB SCAN
|
Facility
|
OP
|
$3,380.00
|
|
|
Service Code
|
CPT 78806
|
| Hospital Charge Code |
909301443
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$3,042.00 |
| Rate for Payer: Adventist Health Commercial |
$676.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,052.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,873.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,859.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,535.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,636.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,985.07
|
| Rate for Payer: Blue Shield of California Commercial |
$2,051.66
|
| Rate for Payer: Blue Shield of California EPN |
$1,341.86
|
| Rate for Payer: Cash Price |
$1,859.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,704.00
|
| Rate for Payer: Cigna of CA HMO |
$2,163.20
|
| Rate for Payer: Cigna of CA PPO |
$2,501.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,873.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,873.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,873.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,352.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,352.00
|
| Rate for Payer: Galaxy Health WC |
$2,873.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,028.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,042.00
|
| Rate for Payer: InnovAge PACE Commercial |
$1,690.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,254.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,287.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,092.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$676.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,366.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,366.00
|
| Rate for Payer: Multiplan Commercial |
$2,535.00
|
| Rate for Payer: Networks By Design Commercial |
$2,197.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,873.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,352.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,028.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,028.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,690.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,690.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,690.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,690.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,873.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,873.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,873.00
|
|
|
HC TANGNTL BX SKIN EA SEP/ADD LSN
|
Facility
|
OP
|
$432.00
|
|
|
Service Code
|
CPT 11103
|
| Hospital Charge Code |
900511103
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$82.61 |
| Max. Negotiated Rate |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$86.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$367.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$237.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$324.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$209.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$253.71
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Central Health Plan Commercial |
$345.60
|
| Rate for Payer: Cigna of CA HMO |
$276.48
|
| Rate for Payer: Cigna of CA PPO |
$319.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$367.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$367.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$367.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$172.80
|
| Rate for Payer: EPIC Health Plan Senior |
$172.80
|
| Rate for Payer: Galaxy Health WC |
$367.20
|
| Rate for Payer: Global Benefits Group Commercial |
$259.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$388.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$82.61
|
| Rate for Payer: InnovAge PACE Commercial |
$216.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$288.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$91.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$267.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$302.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$302.40
|
| Rate for Payer: Multiplan Commercial |
$324.00
|
| Rate for Payer: Networks By Design Commercial |
$280.80
|
| Rate for Payer: Prime Health Services Commercial |
$367.20
|
| Rate for Payer: Riverside University Health System MISP |
$172.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$259.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$367.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$367.20
|
| Rate for Payer: Vantage Medical Group Senior |
$367.20
|
|
