|
HC TRAY CATH URETHRAL 14FR
|
Facility
|
OP
|
$24.52
|
|
| Hospital Charge Code |
901607380
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$22.07 |
| Rate for Payer: Adventist Health Commercial |
$4.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.40
|
| Rate for Payer: Blue Shield of California Commercial |
$14.98
|
| Rate for Payer: Blue Shield of California EPN |
$9.78
|
| Rate for Payer: Cash Price |
$13.49
|
| Rate for Payer: Central Health Plan Commercial |
$19.62
|
| Rate for Payer: Cigna of CA HMO |
$15.69
|
| Rate for Payer: Cigna of CA PPO |
$18.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.81
|
| Rate for Payer: EPIC Health Plan Senior |
$9.81
|
| Rate for Payer: Galaxy Health WC |
$20.84
|
| Rate for Payer: Global Benefits Group Commercial |
$14.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.07
|
| Rate for Payer: InnovAge PACE Commercial |
$12.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.16
|
| Rate for Payer: Multiplan Commercial |
$18.39
|
| Rate for Payer: Networks By Design Commercial |
$15.94
|
| Rate for Payer: Prime Health Services Commercial |
$20.84
|
| Rate for Payer: Riverside University Health System MISP |
$9.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.26
|
| Rate for Payer: United Healthcare All Other HMO |
$12.26
|
| Rate for Payer: United Healthcare HMO Rider |
$12.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.84
|
| Rate for Payer: Vantage Medical Group Senior |
$20.84
|
|
|
HC TRAY CATH URN METER 14FR SLCN
|
Facility
|
OP
|
$120.38
|
|
| Hospital Charge Code |
901607613
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.08 |
| Max. Negotiated Rate |
$108.34 |
| Rate for Payer: Adventist Health Commercial |
$24.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$73.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$102.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.28
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$58.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.70
|
| Rate for Payer: Blue Shield of California Commercial |
$73.55
|
| Rate for Payer: Blue Shield of California EPN |
$48.03
|
| Rate for Payer: Cash Price |
$66.21
|
| Rate for Payer: Central Health Plan Commercial |
$96.30
|
| Rate for Payer: Cigna of CA HMO |
$77.04
|
| Rate for Payer: Cigna of CA PPO |
$89.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$102.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$102.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.15
|
| Rate for Payer: EPIC Health Plan Senior |
$48.15
|
| Rate for Payer: Galaxy Health WC |
$102.32
|
| Rate for Payer: Global Benefits Group Commercial |
$72.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.34
|
| Rate for Payer: InnovAge PACE Commercial |
$60.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$74.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$84.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$84.27
|
| Rate for Payer: Multiplan Commercial |
$90.28
|
| Rate for Payer: Networks By Design Commercial |
$78.25
|
| Rate for Payer: Prime Health Services Commercial |
$102.32
|
| Rate for Payer: Riverside University Health System MISP |
$48.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.19
|
| Rate for Payer: United Healthcare All Other HMO |
$60.19
|
| Rate for Payer: United Healthcare HMO Rider |
$60.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$60.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$102.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$102.32
|
| Rate for Payer: Vantage Medical Group Senior |
$102.32
|
|
|
HC TRAY CATH URN METER 14FR SLCN
|
Facility
|
IP
|
$120.38
|
|
| Hospital Charge Code |
901607613
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.08 |
| Max. Negotiated Rate |
$108.34 |
| Rate for Payer: Adventist Health Commercial |
$24.08
|
| Rate for Payer: Cash Price |
$66.21
|
| Rate for Payer: Central Health Plan Commercial |
$96.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.15
|
| Rate for Payer: EPIC Health Plan Senior |
$48.15
|
| Rate for Payer: Galaxy Health WC |
$102.32
|
| Rate for Payer: Global Benefits Group Commercial |
$72.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$74.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.08
|
| Rate for Payer: Multiplan Commercial |
$90.28
|
| Rate for Payer: Networks By Design Commercial |
$78.25
|
| Rate for Payer: Prime Health Services Commercial |
$102.32
|
|
|
HC TRAY FOLEY INS PVP 10CC SYR
|
Facility
|
IP
|
$12.87
|
|
|
Service Code
|
CPT A4310
|
| Hospital Charge Code |
901698655
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.57 |
| Max. Negotiated Rate |
$11.58 |
| Rate for Payer: Adventist Health Commercial |
$2.57
|
| Rate for Payer: Cash Price |
$7.08
|
| Rate for Payer: Central Health Plan Commercial |
$10.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.15
|
| Rate for Payer: EPIC Health Plan Senior |
$5.15
|
| Rate for Payer: Galaxy Health WC |
$10.94
|
| Rate for Payer: Global Benefits Group Commercial |
$7.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.57
|
| Rate for Payer: Multiplan Commercial |
$9.65
|
| Rate for Payer: Networks By Design Commercial |
$8.37
|
| Rate for Payer: Prime Health Services Commercial |
$10.94
|
|
|
HC TRAY FOLEY INS PVP 10CC SYR
|
Facility
|
OP
|
$12.87
|
|
|
Service Code
|
CPT A4310
|
| Hospital Charge Code |
901698655
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.57 |
| Max. Negotiated Rate |
$11.58 |
| Rate for Payer: Adventist Health Commercial |
$2.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.56
|
| Rate for Payer: Blue Shield of California Commercial |
$7.86
|
| Rate for Payer: Blue Shield of California EPN |
$5.14
|
| Rate for Payer: Cash Price |
$7.08
|
| Rate for Payer: Central Health Plan Commercial |
$10.30
|
| Rate for Payer: Cigna of CA HMO |
$8.24
|
| Rate for Payer: Cigna of CA PPO |
$9.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.15
|
| Rate for Payer: EPIC Health Plan Senior |
$5.15
|
| Rate for Payer: Galaxy Health WC |
$10.94
|
| Rate for Payer: Global Benefits Group Commercial |
$7.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.58
|
| Rate for Payer: InnovAge PACE Commercial |
$6.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.01
|
| Rate for Payer: Multiplan Commercial |
$9.65
|
| Rate for Payer: Networks By Design Commercial |
$8.37
|
| Rate for Payer: Prime Health Services Commercial |
$10.94
|
| Rate for Payer: Riverside University Health System MISP |
$5.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.43
|
| Rate for Payer: United Healthcare All Other HMO |
$6.43
|
| Rate for Payer: United Healthcare HMO Rider |
$6.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.94
|
| Rate for Payer: Vantage Medical Group Senior |
$10.94
|
|
|
HC TRAY FOLEY INS PVP 10ML SYR
|
Facility
|
IP
|
$21.16
|
|
|
Service Code
|
CPT A4310
|
| Hospital Charge Code |
901698656
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$19.04 |
| Rate for Payer: Adventist Health Commercial |
$4.23
|
| Rate for Payer: Cash Price |
$11.64
|
| Rate for Payer: Central Health Plan Commercial |
$16.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.46
|
| Rate for Payer: EPIC Health Plan Senior |
$8.46
|
| Rate for Payer: Galaxy Health WC |
$17.99
|
| Rate for Payer: Global Benefits Group Commercial |
$12.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.23
|
| Rate for Payer: Multiplan Commercial |
$15.87
|
| Rate for Payer: Networks By Design Commercial |
$13.75
|
| Rate for Payer: Prime Health Services Commercial |
$17.99
|
|
|
HC TRAY FOLEY INS PVP 10ML SYR
|
Facility
|
OP
|
$21.16
|
|
|
Service Code
|
CPT A4310
|
| Hospital Charge Code |
901698656
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$19.04 |
| Rate for Payer: Adventist Health Commercial |
$4.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.43
|
| Rate for Payer: Blue Shield of California Commercial |
$12.93
|
| Rate for Payer: Blue Shield of California EPN |
$8.44
|
| Rate for Payer: Cash Price |
$11.64
|
| Rate for Payer: Central Health Plan Commercial |
$16.93
|
| Rate for Payer: Cigna of CA HMO |
$13.54
|
| Rate for Payer: Cigna of CA PPO |
$15.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.46
|
| Rate for Payer: EPIC Health Plan Senior |
$8.46
|
| Rate for Payer: Galaxy Health WC |
$17.99
|
| Rate for Payer: Global Benefits Group Commercial |
$12.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.04
|
| Rate for Payer: InnovAge PACE Commercial |
$10.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.81
|
| Rate for Payer: Multiplan Commercial |
$15.87
|
| Rate for Payer: Networks By Design Commercial |
$13.75
|
| Rate for Payer: Prime Health Services Commercial |
$17.99
|
| Rate for Payer: Riverside University Health System MISP |
$8.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.58
|
| Rate for Payer: United Healthcare All Other HMO |
$10.58
|
| Rate for Payer: United Healthcare HMO Rider |
$10.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.99
|
| Rate for Payer: Vantage Medical Group Senior |
$17.99
|
|
|
HC TRAY FOLEY INS W 30ML SYR PVP
|
Facility
|
IP
|
$15.17
|
|
|
Service Code
|
CPT A4338
|
| Hospital Charge Code |
901607398
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.03 |
| Max. Negotiated Rate |
$13.65 |
| Rate for Payer: Adventist Health Commercial |
$3.03
|
| Rate for Payer: Cash Price |
$8.34
|
| Rate for Payer: Central Health Plan Commercial |
$12.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.07
|
| Rate for Payer: EPIC Health Plan Senior |
$6.07
|
| Rate for Payer: Galaxy Health WC |
$12.89
|
| Rate for Payer: Global Benefits Group Commercial |
$9.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.03
|
| Rate for Payer: Multiplan Commercial |
$11.38
|
| Rate for Payer: Networks By Design Commercial |
$9.86
|
| Rate for Payer: Prime Health Services Commercial |
$12.89
|
|
|
HC TRAY FOLEY INS W 30ML SYR PVP
|
Facility
|
OP
|
$15.17
|
|
|
Service Code
|
CPT A4338
|
| Hospital Charge Code |
901607398
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.03 |
| Max. Negotiated Rate |
$13.65 |
| Rate for Payer: Adventist Health Commercial |
$3.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.91
|
| Rate for Payer: Blue Shield of California Commercial |
$9.27
|
| Rate for Payer: Blue Shield of California EPN |
$6.05
|
| Rate for Payer: Cash Price |
$8.34
|
| Rate for Payer: Central Health Plan Commercial |
$12.14
|
| Rate for Payer: Cigna of CA HMO |
$9.71
|
| Rate for Payer: Cigna of CA PPO |
$11.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.07
|
| Rate for Payer: EPIC Health Plan Senior |
$6.07
|
| Rate for Payer: Galaxy Health WC |
$12.89
|
| Rate for Payer: Global Benefits Group Commercial |
$9.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.65
|
| Rate for Payer: InnovAge PACE Commercial |
$7.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.62
|
| Rate for Payer: Multiplan Commercial |
$11.38
|
| Rate for Payer: Networks By Design Commercial |
$9.86
|
| Rate for Payer: Prime Health Services Commercial |
$12.89
|
| Rate for Payer: Riverside University Health System MISP |
$6.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.58
|
| Rate for Payer: United Healthcare All Other HMO |
$7.58
|
| Rate for Payer: United Healthcare HMO Rider |
$7.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.89
|
| Rate for Payer: Vantage Medical Group Senior |
$12.89
|
|
|
HC TRAY FOLEY URN MTR NO CATH
|
Facility
|
OP
|
$140.75
|
|
|
Service Code
|
CPT A4354
|
| Hospital Charge Code |
901698796
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.15 |
| Max. Negotiated Rate |
$126.67 |
| Rate for Payer: Adventist Health Commercial |
$28.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$85.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$119.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$77.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$105.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$68.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$82.66
|
| Rate for Payer: Blue Shield of California Commercial |
$86.00
|
| Rate for Payer: Blue Shield of California EPN |
$56.16
|
| Rate for Payer: Cash Price |
$77.41
|
| Rate for Payer: Central Health Plan Commercial |
$112.60
|
| Rate for Payer: Cigna of CA HMO |
$90.08
|
| Rate for Payer: Cigna of CA PPO |
$104.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$119.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$119.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$119.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.30
|
| Rate for Payer: EPIC Health Plan Senior |
$56.30
|
| Rate for Payer: Galaxy Health WC |
$119.64
|
| Rate for Payer: Global Benefits Group Commercial |
$84.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$126.67
|
| Rate for Payer: InnovAge PACE Commercial |
$70.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$93.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$87.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$98.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$98.53
|
| Rate for Payer: Multiplan Commercial |
$105.56
|
| Rate for Payer: Networks By Design Commercial |
$91.49
|
| Rate for Payer: Prime Health Services Commercial |
$119.64
|
| Rate for Payer: Riverside University Health System MISP |
$56.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$84.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$84.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$70.38
|
| Rate for Payer: United Healthcare All Other HMO |
$70.38
|
| Rate for Payer: United Healthcare HMO Rider |
$70.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$70.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$119.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$119.64
|
| Rate for Payer: Vantage Medical Group Senior |
$119.64
|
|
|
HC TRAY FOLEY URN MTR NO CATH
|
Facility
|
IP
|
$140.75
|
|
|
Service Code
|
CPT A4354
|
| Hospital Charge Code |
901698796
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.15 |
| Max. Negotiated Rate |
$126.67 |
| Rate for Payer: Adventist Health Commercial |
$28.15
|
| Rate for Payer: Cash Price |
$77.41
|
| Rate for Payer: Central Health Plan Commercial |
$112.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.30
|
| Rate for Payer: EPIC Health Plan Senior |
$56.30
|
| Rate for Payer: Galaxy Health WC |
$119.64
|
| Rate for Payer: Global Benefits Group Commercial |
$84.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$126.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$93.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$87.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.15
|
| Rate for Payer: Multiplan Commercial |
$105.56
|
| Rate for Payer: Networks By Design Commercial |
$91.49
|
| Rate for Payer: Prime Health Services Commercial |
$119.64
|
|
|
HC TRAY LEADER FLEX INSERTION
|
Facility
|
IP
|
$4.42
|
|
| Hospital Charge Code |
901698221
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$3.98 |
| Rate for Payer: Adventist Health Commercial |
$0.88
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Central Health Plan Commercial |
$3.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.77
|
| Rate for Payer: EPIC Health Plan Senior |
$1.77
|
| Rate for Payer: Galaxy Health WC |
$3.76
|
| Rate for Payer: Global Benefits Group Commercial |
$2.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.88
|
| Rate for Payer: Multiplan Commercial |
$3.31
|
| Rate for Payer: Networks By Design Commercial |
$2.87
|
| Rate for Payer: Prime Health Services Commercial |
$3.76
|
|
|
HC TRAY LEADER FLEX INSERTION
|
Facility
|
OP
|
$4.42
|
|
| Hospital Charge Code |
901698221
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$3.98 |
| Rate for Payer: Adventist Health Commercial |
$0.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.31
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2.70
|
| Rate for Payer: Blue Shield of California EPN |
$1.76
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Central Health Plan Commercial |
$3.54
|
| Rate for Payer: Cigna of CA HMO |
$2.83
|
| Rate for Payer: Cigna of CA PPO |
$3.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.77
|
| Rate for Payer: EPIC Health Plan Senior |
$1.77
|
| Rate for Payer: Galaxy Health WC |
$3.76
|
| Rate for Payer: Global Benefits Group Commercial |
$2.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.98
|
| Rate for Payer: InnovAge PACE Commercial |
$2.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.09
|
| Rate for Payer: Multiplan Commercial |
$3.31
|
| Rate for Payer: Networks By Design Commercial |
$2.87
|
| Rate for Payer: Prime Health Services Commercial |
$3.76
|
| Rate for Payer: Riverside University Health System MISP |
$1.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.21
|
| Rate for Payer: United Healthcare All Other HMO |
$2.21
|
| Rate for Payer: United Healthcare HMO Rider |
$2.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.76
|
| Rate for Payer: Vantage Medical Group Senior |
$3.76
|
|
|
HC TRAY NICU PICC
|
Facility
|
OP
|
$5.74
|
|
| Hospital Charge Code |
901698414
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$5.17 |
| Rate for Payer: Adventist Health Commercial |
$1.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.37
|
| Rate for Payer: Blue Shield of California Commercial |
$3.51
|
| Rate for Payer: Blue Shield of California EPN |
$2.29
|
| Rate for Payer: Cash Price |
$3.16
|
| Rate for Payer: Central Health Plan Commercial |
$4.59
|
| Rate for Payer: Cigna of CA HMO |
$3.67
|
| Rate for Payer: Cigna of CA PPO |
$4.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.30
|
| Rate for Payer: EPIC Health Plan Senior |
$2.30
|
| Rate for Payer: Galaxy Health WC |
$4.88
|
| Rate for Payer: Global Benefits Group Commercial |
$3.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.17
|
| Rate for Payer: InnovAge PACE Commercial |
$2.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.02
|
| Rate for Payer: Multiplan Commercial |
$4.30
|
| Rate for Payer: Networks By Design Commercial |
$3.73
|
| Rate for Payer: Prime Health Services Commercial |
$4.88
|
| Rate for Payer: Riverside University Health System MISP |
$2.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.87
|
| Rate for Payer: United Healthcare All Other HMO |
$2.87
|
| Rate for Payer: United Healthcare HMO Rider |
$2.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.88
|
| Rate for Payer: Vantage Medical Group Senior |
$4.88
|
|
|
HC TRAY NICU PICC
|
Facility
|
IP
|
$5.74
|
|
| Hospital Charge Code |
901698414
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$5.17 |
| Rate for Payer: Adventist Health Commercial |
$1.15
|
| Rate for Payer: Cash Price |
$3.16
|
| Rate for Payer: Central Health Plan Commercial |
$4.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.30
|
| Rate for Payer: EPIC Health Plan Senior |
$2.30
|
| Rate for Payer: Galaxy Health WC |
$4.88
|
| Rate for Payer: Global Benefits Group Commercial |
$3.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.15
|
| Rate for Payer: Multiplan Commercial |
$4.30
|
| Rate for Payer: Networks By Design Commercial |
$3.73
|
| Rate for Payer: Prime Health Services Commercial |
$4.88
|
|
|
HC TRAY, RADIAL ARTERY CATH 2.5FR
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698160
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$212.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$169.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$205.56
|
| Rate for Payer: Blue Shield of California Commercial |
$213.85
|
| Rate for Payer: Blue Shield of California EPN |
$139.65
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: InnovAge PACE Commercial |
$175.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Riverside University Health System MISP |
$140.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$175.00
|
| Rate for Payer: United Healthcare All Other HMO |
$175.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$175.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC TRAY, RADIAL ARTERY CATH 2.5FR
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698160
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
|
|
HC TREAT FOOT DISLOCATION W/ANEST
|
Facility
|
OP
|
$1,888.00
|
|
|
Service Code
|
CPT 28605
|
| Hospital Charge Code |
902890262
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$293.55 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$774.08
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$485.64
|
| Rate for Payer: Cash Price |
$1,038.40
|
| Rate for Payer: Cash Price |
$1,038.40
|
| Rate for Payer: Cash Price |
$1,038.40
|
| Rate for Payer: Cash Price |
$1,038.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,510.40
|
| Rate for Payer: Cigna of CA HMO |
$1,208.32
|
| Rate for Payer: Cigna of CA PPO |
$1,397.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$411.47
|
| Rate for Payer: EPIC Health Plan Senior |
$304.79
|
| Rate for Payer: Galaxy Health WC |
$1,604.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,132.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,699.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$499.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.79
|
| Rate for Payer: InnovAge PACE Commercial |
$457.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,259.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$293.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$377.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$408.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.42
|
| Rate for Payer: Multiplan Commercial |
$1,416.00
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$1,227.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$304.79
|
| Rate for Payer: Preferred Health Network WC |
$495.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,604.80
|
| Rate for Payer: Prime Health Services Medicare |
$323.08
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Riverside University Health System MISP |
$335.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,132.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,132.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$304.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Vantage Medical Group Senior |
$304.79
|
|
|
HC TREAT FOOT DISLOCATION W/ANEST
|
Facility
|
OP
|
$1,888.00
|
|
|
Service Code
|
CPT 28605
|
| Hospital Charge Code |
902890262
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$293.55 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$377.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$485.64
|
| Rate for Payer: Cash Price |
$1,038.40
|
| Rate for Payer: Cash Price |
$1,038.40
|
| Rate for Payer: Cash Price |
$1,038.40
|
| Rate for Payer: Cash Price |
$1,038.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,510.40
|
| Rate for Payer: Cigna of CA HMO |
$1,208.32
|
| Rate for Payer: Cigna of CA PPO |
$1,397.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$411.47
|
| Rate for Payer: EPIC Health Plan Senior |
$304.79
|
| Rate for Payer: Galaxy Health WC |
$1,604.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,132.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,699.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$499.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.79
|
| Rate for Payer: InnovAge PACE Commercial |
$457.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,259.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$293.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$377.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$408.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.42
|
| Rate for Payer: Multiplan Commercial |
$1,416.00
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$1,227.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$304.79
|
| Rate for Payer: Preferred Health Network WC |
$495.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,604.80
|
| Rate for Payer: Prime Health Services Medicare |
$323.08
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Riverside University Health System MISP |
$335.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,132.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$944.00
|
| Rate for Payer: United Healthcare All Other HMO |
$944.00
|
| Rate for Payer: United Healthcare HMO Rider |
$944.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$944.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$304.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Vantage Medical Group Senior |
$304.79
|
|
|
HC TREAT FOOT DISLOCATION W/ANEST
|
Facility
|
IP
|
$1,888.00
|
|
|
Service Code
|
CPT 28605
|
| Hospital Charge Code |
902890262
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$377.60 |
| Max. Negotiated Rate |
$1,699.20 |
| Rate for Payer: Adventist Health Commercial |
$377.60
|
| Rate for Payer: Cash Price |
$1,038.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,510.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$755.20
|
| Rate for Payer: EPIC Health Plan Senior |
$755.20
|
| Rate for Payer: Galaxy Health WC |
$1,604.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,132.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,699.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,259.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$719.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,168.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$377.60
|
| Rate for Payer: Multiplan Commercial |
$1,416.00
|
| Rate for Payer: Networks By Design Commercial |
$1,227.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,604.80
|
|
|
HC TREAT FOOT DISLOCATION W/ANEST
|
Facility
|
IP
|
$1,888.00
|
|
|
Service Code
|
CPT 28605
|
| Hospital Charge Code |
902890262
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$377.60 |
| Max. Negotiated Rate |
$1,699.20 |
| Rate for Payer: Adventist Health Commercial |
$377.60
|
| Rate for Payer: Cash Price |
$1,038.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,510.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$755.20
|
| Rate for Payer: EPIC Health Plan Senior |
$755.20
|
| Rate for Payer: Galaxy Health WC |
$1,604.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,132.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,699.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,259.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$719.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,168.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$377.60
|
| Rate for Payer: Multiplan Commercial |
$1,416.00
|
| Rate for Payer: Networks By Design Commercial |
$1,227.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,604.80
|
|
|
HC TREAT FX RADIUS & ULNA
|
Facility
|
IP
|
$36,281.00
|
|
|
Service Code
|
CPT 25575
|
| Hospital Charge Code |
900501765
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$7,256.20 |
| Max. Negotiated Rate |
$32,652.90 |
| Rate for Payer: Adventist Health Commercial |
$7,256.20
|
| Rate for Payer: Cash Price |
$19,954.55
|
| Rate for Payer: Central Health Plan Commercial |
$29,024.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,512.40
|
| Rate for Payer: EPIC Health Plan Senior |
$14,512.40
|
| Rate for Payer: Galaxy Health WC |
$30,838.85
|
| Rate for Payer: Global Benefits Group Commercial |
$21,768.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$32,652.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24,199.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,823.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,457.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,256.20
|
| Rate for Payer: Multiplan Commercial |
$27,210.75
|
| Rate for Payer: Networks By Design Commercial |
$23,582.65
|
| Rate for Payer: Prime Health Services Commercial |
$30,838.85
|
|
|
HC TREAT FX RADIUS & ULNA
|
Facility
|
OP
|
$36,281.00
|
|
|
Service Code
|
CPT 25575
|
| Hospital Charge Code |
900501765
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$32,652.90 |
| Rate for Payer: Adventist Health Commercial |
$7,256.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,984.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,076.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,764.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$14,462.30
|
| Rate for Payer: Cash Price |
$19,954.55
|
| Rate for Payer: Cash Price |
$19,954.55
|
| Rate for Payer: Cash Price |
$19,954.55
|
| Rate for Payer: Cash Price |
$19,954.55
|
| Rate for Payer: Central Health Plan Commercial |
$29,024.80
|
| Rate for Payer: Cigna of CA HMO |
$23,219.84
|
| Rate for Payer: Cigna of CA PPO |
$26,847.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,984.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,076.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,253.71
|
| Rate for Payer: EPIC Health Plan Senior |
$9,076.82
|
| Rate for Payer: Galaxy Health WC |
$30,838.85
|
| Rate for Payer: Global Benefits Group Commercial |
$21,768.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$32,652.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14,885.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,076.82
|
| Rate for Payer: InnovAge PACE Commercial |
$13,615.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24,199.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$961.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,076.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,256.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12,162.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,162.94
|
| Rate for Payer: Multiplan Commercial |
$27,210.75
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: Networks By Design Commercial |
$23,582.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9,076.82
|
| Rate for Payer: Preferred Health Network WC |
$14,757.45
|
| Rate for Payer: Prime Health Services Commercial |
$30,838.85
|
| Rate for Payer: Prime Health Services Medicare |
$9,621.43
|
| Rate for Payer: Prime Health Services WC |
$14,314.73
|
| Rate for Payer: Riverside University Health System MISP |
$9,984.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21,768.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$18,140.50
|
| Rate for Payer: United Healthcare All Other HMO |
$18,140.50
|
| Rate for Payer: United Healthcare HMO Rider |
$18,140.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18,140.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$9,076.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,984.50
|
| Rate for Payer: Vantage Medical Group Senior |
$9,076.82
|
|
|
HC TREAT HIP DISLOC W/O ANESTH/MA
|
Facility
|
OP
|
$2,356.00
|
|
|
Service Code
|
CPT 27256
|
| Hospital Charge Code |
900501604
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$284.56 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Commercial |
$471.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$485.64
|
| Rate for Payer: Cash Price |
$1,295.80
|
| Rate for Payer: Cash Price |
$1,295.80
|
| Rate for Payer: Cash Price |
$1,295.80
|
| Rate for Payer: Cash Price |
$1,295.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,884.80
|
| Rate for Payer: Cigna of CA HMO |
$1,507.84
|
| Rate for Payer: Cigna of CA PPO |
$1,743.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$411.47
|
| Rate for Payer: EPIC Health Plan Senior |
$304.79
|
| Rate for Payer: Galaxy Health WC |
$2,002.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,413.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,120.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$499.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.79
|
| Rate for Payer: InnovAge PACE Commercial |
$457.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,571.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$284.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$471.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$408.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.42
|
| Rate for Payer: Multiplan Commercial |
$1,767.00
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$1,531.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$304.79
|
| Rate for Payer: Preferred Health Network WC |
$495.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,002.60
|
| Rate for Payer: Prime Health Services Medicare |
$323.08
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Riverside University Health System MISP |
$335.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,413.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,178.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,178.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,178.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,178.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$304.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Vantage Medical Group Senior |
$304.79
|
|
|
HC TREAT HIP DISLOC W/O ANESTH/MA
|
Facility
|
IP
|
$2,356.00
|
|
|
Service Code
|
CPT 27256
|
| Hospital Charge Code |
900501604
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$471.20 |
| Max. Negotiated Rate |
$2,120.40 |
| Rate for Payer: Adventist Health Commercial |
$471.20
|
| Rate for Payer: Cash Price |
$1,295.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,884.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$942.40
|
| Rate for Payer: EPIC Health Plan Senior |
$942.40
|
| Rate for Payer: Galaxy Health WC |
$2,002.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,413.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,120.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,571.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$897.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,458.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$471.20
|
| Rate for Payer: Multiplan Commercial |
$1,767.00
|
| Rate for Payer: Networks By Design Commercial |
$1,531.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,002.60
|
|
