|
HC ARWY ORAL CHILD SZ 3 LMA
|
Facility
|
OP
|
$49.69
|
|
| Hospital Charge Code |
901604973
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$9.94 |
| Max. Negotiated Rate |
$44.72 |
| Rate for Payer: Adventist Health Commercial |
$9.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$24.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.18
|
| Rate for Payer: Blue Shield of California Commercial |
$30.36
|
| Rate for Payer: Blue Shield of California EPN |
$19.83
|
| Rate for Payer: Cash Price |
$27.33
|
| Rate for Payer: Central Health Plan Commercial |
$39.75
|
| Rate for Payer: Cigna of CA HMO |
$31.80
|
| Rate for Payer: Cigna of CA PPO |
$36.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$19.88
|
| Rate for Payer: Galaxy Health WC |
$42.24
|
| Rate for Payer: Global Benefits Group Commercial |
$29.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.72
|
| Rate for Payer: InnovAge PACE Commercial |
$24.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.78
|
| Rate for Payer: Multiplan Commercial |
$37.27
|
| Rate for Payer: Networks By Design Commercial |
$32.30
|
| Rate for Payer: Prime Health Services Commercial |
$42.24
|
| Rate for Payer: Riverside University Health System MISP |
$19.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$24.84
|
| Rate for Payer: United Healthcare All Other HMO |
$24.84
|
| Rate for Payer: United Healthcare HMO Rider |
$24.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.24
|
| Rate for Payer: Vantage Medical Group Senior |
$42.24
|
|
|
HC ARWY ORAL GUEDEL 8CM
|
Facility
|
IP
|
$3.28
|
|
| Hospital Charge Code |
901600059
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$2.95 |
| Rate for Payer: Adventist Health Commercial |
$0.66
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Central Health Plan Commercial |
$2.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.31
|
| Rate for Payer: EPIC Health Plan Senior |
$1.31
|
| Rate for Payer: Galaxy Health WC |
$2.79
|
| Rate for Payer: Global Benefits Group Commercial |
$1.97
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.66
|
| Rate for Payer: Multiplan Commercial |
$2.46
|
| Rate for Payer: Networks By Design Commercial |
$2.13
|
| Rate for Payer: Prime Health Services Commercial |
$2.79
|
|
|
HC ARWY ORAL GUEDEL 8CM
|
Facility
|
OP
|
$3.28
|
|
| Hospital Charge Code |
901600059
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$2.95 |
| Rate for Payer: Adventist Health Commercial |
$0.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.93
|
| Rate for Payer: Blue Shield of California Commercial |
$2.00
|
| Rate for Payer: Blue Shield of California EPN |
$1.31
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Central Health Plan Commercial |
$2.62
|
| Rate for Payer: Cigna of CA HMO |
$2.10
|
| Rate for Payer: Cigna of CA PPO |
$2.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.79
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.31
|
| Rate for Payer: EPIC Health Plan Senior |
$1.31
|
| Rate for Payer: Galaxy Health WC |
$2.79
|
| Rate for Payer: Global Benefits Group Commercial |
$1.97
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.95
|
| Rate for Payer: InnovAge PACE Commercial |
$1.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.30
|
| Rate for Payer: Multiplan Commercial |
$2.46
|
| Rate for Payer: Networks By Design Commercial |
$2.13
|
| Rate for Payer: Prime Health Services Commercial |
$2.79
|
| Rate for Payer: Riverside University Health System MISP |
$1.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.97
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.64
|
| Rate for Payer: United Healthcare All Other HMO |
$1.64
|
| Rate for Payer: United Healthcare HMO Rider |
$1.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.79
|
| Rate for Payer: Vantage Medical Group Senior |
$2.79
|
|
|
HC ARWY ORAL INFANT SZ 1.5 LMA
|
Facility
|
OP
|
$49.69
|
|
| Hospital Charge Code |
901604969
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$9.94 |
| Max. Negotiated Rate |
$44.72 |
| Rate for Payer: Adventist Health Commercial |
$9.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$24.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.18
|
| Rate for Payer: Blue Shield of California Commercial |
$30.36
|
| Rate for Payer: Blue Shield of California EPN |
$19.83
|
| Rate for Payer: Cash Price |
$27.33
|
| Rate for Payer: Central Health Plan Commercial |
$39.75
|
| Rate for Payer: Cigna of CA HMO |
$31.80
|
| Rate for Payer: Cigna of CA PPO |
$36.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$19.88
|
| Rate for Payer: Galaxy Health WC |
$42.24
|
| Rate for Payer: Global Benefits Group Commercial |
$29.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.72
|
| Rate for Payer: InnovAge PACE Commercial |
$24.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.78
|
| Rate for Payer: Multiplan Commercial |
$37.27
|
| Rate for Payer: Networks By Design Commercial |
$32.30
|
| Rate for Payer: Prime Health Services Commercial |
$42.24
|
| Rate for Payer: Riverside University Health System MISP |
$19.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$24.84
|
| Rate for Payer: United Healthcare All Other HMO |
$24.84
|
| Rate for Payer: United Healthcare HMO Rider |
$24.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.24
|
| Rate for Payer: Vantage Medical Group Senior |
$42.24
|
|
|
HC ARWY ORAL INFANT SZ 1.5 LMA
|
Facility
|
IP
|
$49.69
|
|
| Hospital Charge Code |
901604969
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$9.94 |
| Max. Negotiated Rate |
$44.72 |
| Rate for Payer: Adventist Health Commercial |
$9.94
|
| Rate for Payer: Cash Price |
$27.33
|
| Rate for Payer: Central Health Plan Commercial |
$39.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$19.88
|
| Rate for Payer: Galaxy Health WC |
$42.24
|
| Rate for Payer: Global Benefits Group Commercial |
$29.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.94
|
| Rate for Payer: Multiplan Commercial |
$37.27
|
| Rate for Payer: Networks By Design Commercial |
$32.30
|
| Rate for Payer: Prime Health Services Commercial |
$42.24
|
|
|
HC ARWY ORAL INFANT SZ 2 LMA
|
Facility
|
OP
|
$49.69
|
|
| Hospital Charge Code |
901604970
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$9.94 |
| Max. Negotiated Rate |
$44.72 |
| Rate for Payer: Adventist Health Commercial |
$9.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$24.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.18
|
| Rate for Payer: Blue Shield of California Commercial |
$30.36
|
| Rate for Payer: Blue Shield of California EPN |
$19.83
|
| Rate for Payer: Cash Price |
$27.33
|
| Rate for Payer: Central Health Plan Commercial |
$39.75
|
| Rate for Payer: Cigna of CA HMO |
$31.80
|
| Rate for Payer: Cigna of CA PPO |
$36.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$19.88
|
| Rate for Payer: Galaxy Health WC |
$42.24
|
| Rate for Payer: Global Benefits Group Commercial |
$29.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.72
|
| Rate for Payer: InnovAge PACE Commercial |
$24.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.78
|
| Rate for Payer: Multiplan Commercial |
$37.27
|
| Rate for Payer: Networks By Design Commercial |
$32.30
|
| Rate for Payer: Prime Health Services Commercial |
$42.24
|
| Rate for Payer: Riverside University Health System MISP |
$19.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$24.84
|
| Rate for Payer: United Healthcare All Other HMO |
$24.84
|
| Rate for Payer: United Healthcare HMO Rider |
$24.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.24
|
| Rate for Payer: Vantage Medical Group Senior |
$42.24
|
|
|
HC ARWY ORAL INFANT SZ 2 LMA
|
Facility
|
IP
|
$49.69
|
|
| Hospital Charge Code |
901604970
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$9.94 |
| Max. Negotiated Rate |
$44.72 |
| Rate for Payer: Adventist Health Commercial |
$9.94
|
| Rate for Payer: Cash Price |
$27.33
|
| Rate for Payer: Central Health Plan Commercial |
$39.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$19.88
|
| Rate for Payer: Galaxy Health WC |
$42.24
|
| Rate for Payer: Global Benefits Group Commercial |
$29.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.94
|
| Rate for Payer: Multiplan Commercial |
$37.27
|
| Rate for Payer: Networks By Design Commercial |
$32.30
|
| Rate for Payer: Prime Health Services Commercial |
$42.24
|
|
|
HC ARWY ORAL NEONATE SZ 1 LMA
|
Facility
|
OP
|
$49.69
|
|
| Hospital Charge Code |
901604968
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$9.94 |
| Max. Negotiated Rate |
$44.72 |
| Rate for Payer: Adventist Health Commercial |
$9.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$24.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.18
|
| Rate for Payer: Blue Shield of California Commercial |
$30.36
|
| Rate for Payer: Blue Shield of California EPN |
$19.83
|
| Rate for Payer: Cash Price |
$27.33
|
| Rate for Payer: Central Health Plan Commercial |
$39.75
|
| Rate for Payer: Cigna of CA HMO |
$31.80
|
| Rate for Payer: Cigna of CA PPO |
$36.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$19.88
|
| Rate for Payer: Galaxy Health WC |
$42.24
|
| Rate for Payer: Global Benefits Group Commercial |
$29.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.72
|
| Rate for Payer: InnovAge PACE Commercial |
$24.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.78
|
| Rate for Payer: Multiplan Commercial |
$37.27
|
| Rate for Payer: Networks By Design Commercial |
$32.30
|
| Rate for Payer: Prime Health Services Commercial |
$42.24
|
| Rate for Payer: Riverside University Health System MISP |
$19.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$24.84
|
| Rate for Payer: United Healthcare All Other HMO |
$24.84
|
| Rate for Payer: United Healthcare HMO Rider |
$24.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.24
|
| Rate for Payer: Vantage Medical Group Senior |
$42.24
|
|
|
HC ARWY ORAL NEONATE SZ 1 LMA
|
Facility
|
IP
|
$49.69
|
|
| Hospital Charge Code |
901604968
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$9.94 |
| Max. Negotiated Rate |
$44.72 |
| Rate for Payer: Adventist Health Commercial |
$9.94
|
| Rate for Payer: Cash Price |
$27.33
|
| Rate for Payer: Central Health Plan Commercial |
$39.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$19.88
|
| Rate for Payer: Galaxy Health WC |
$42.24
|
| Rate for Payer: Global Benefits Group Commercial |
$29.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.94
|
| Rate for Payer: Multiplan Commercial |
$37.27
|
| Rate for Payer: Networks By Design Commercial |
$32.30
|
| Rate for Payer: Prime Health Services Commercial |
$42.24
|
|
|
HC ASAHI ASTATO XS 20 300CM
|
Facility
|
OP
|
$741.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812750
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$148.20 |
| Max. Negotiated Rate |
$666.90 |
| Rate for Payer: Adventist Health Commercial |
$148.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$450.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$629.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$407.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$555.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$358.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$435.19
|
| Rate for Payer: Blue Shield of California Commercial |
$452.75
|
| Rate for Payer: Blue Shield of California EPN |
$295.66
|
| Rate for Payer: Cash Price |
$407.55
|
| Rate for Payer: Central Health Plan Commercial |
$592.80
|
| Rate for Payer: Cigna of CA HMO |
$474.24
|
| Rate for Payer: Cigna of CA PPO |
$548.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$629.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$629.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$629.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$296.40
|
| Rate for Payer: EPIC Health Plan Senior |
$296.40
|
| Rate for Payer: Galaxy Health WC |
$629.85
|
| Rate for Payer: Global Benefits Group Commercial |
$444.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$666.90
|
| Rate for Payer: InnovAge PACE Commercial |
$370.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$494.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$282.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$458.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$518.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$518.70
|
| Rate for Payer: Multiplan Commercial |
$555.75
|
| Rate for Payer: Networks By Design Commercial |
$481.65
|
| Rate for Payer: Prime Health Services Commercial |
$629.85
|
| Rate for Payer: Riverside University Health System MISP |
$296.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$444.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$444.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$370.50
|
| Rate for Payer: United Healthcare All Other HMO |
$370.50
|
| Rate for Payer: United Healthcare HMO Rider |
$370.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$370.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$629.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$629.85
|
| Rate for Payer: Vantage Medical Group Senior |
$629.85
|
|
|
HC ASAHI ASTATO XS 20 300CM
|
Facility
|
IP
|
$741.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812750
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$148.20 |
| Max. Negotiated Rate |
$666.90 |
| Rate for Payer: Adventist Health Commercial |
$148.20
|
| Rate for Payer: Cash Price |
$407.55
|
| Rate for Payer: Central Health Plan Commercial |
$592.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$296.40
|
| Rate for Payer: EPIC Health Plan Senior |
$296.40
|
| Rate for Payer: Galaxy Health WC |
$629.85
|
| Rate for Payer: Global Benefits Group Commercial |
$444.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$666.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$494.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$282.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$458.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.20
|
| Rate for Payer: Multiplan Commercial |
$555.75
|
| Rate for Payer: Networks By Design Commercial |
$481.65
|
| Rate for Payer: Prime Health Services Commercial |
$629.85
|
|
|
HC ASCOPE 4RHINO INTV 5.0MM 2.2MM
|
Facility
|
IP
|
$1,430.60
|
|
| Hospital Charge Code |
900831700
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$286.12 |
| Max. Negotiated Rate |
$1,287.54 |
| Rate for Payer: Adventist Health Commercial |
$286.12
|
| Rate for Payer: Cash Price |
$786.83
|
| Rate for Payer: Central Health Plan Commercial |
$1,144.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$572.24
|
| Rate for Payer: EPIC Health Plan Senior |
$572.24
|
| Rate for Payer: Galaxy Health WC |
$1,216.01
|
| Rate for Payer: Global Benefits Group Commercial |
$858.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,287.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$954.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$545.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$885.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$286.12
|
| Rate for Payer: Multiplan Commercial |
$1,072.95
|
| Rate for Payer: Networks By Design Commercial |
$929.89
|
| Rate for Payer: Prime Health Services Commercial |
$1,216.01
|
|
|
HC ASCOPE 4RHINO INTV 5.0MM 2.2MM
|
Facility
|
OP
|
$1,430.60
|
|
| Hospital Charge Code |
900831700
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$286.12 |
| Max. Negotiated Rate |
$1,287.54 |
| Rate for Payer: Adventist Health Commercial |
$286.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$868.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,216.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$786.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,072.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$692.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$840.19
|
| Rate for Payer: Blue Shield of California Commercial |
$874.10
|
| Rate for Payer: Blue Shield of California EPN |
$570.81
|
| Rate for Payer: Cash Price |
$786.83
|
| Rate for Payer: Central Health Plan Commercial |
$1,144.48
|
| Rate for Payer: Cigna of CA HMO |
$915.58
|
| Rate for Payer: Cigna of CA PPO |
$1,058.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,216.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,216.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,216.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$572.24
|
| Rate for Payer: EPIC Health Plan Senior |
$572.24
|
| Rate for Payer: Galaxy Health WC |
$1,216.01
|
| Rate for Payer: Global Benefits Group Commercial |
$858.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,287.54
|
| Rate for Payer: InnovAge PACE Commercial |
$715.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$954.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$545.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$885.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$286.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,001.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,001.42
|
| Rate for Payer: Multiplan Commercial |
$1,072.95
|
| Rate for Payer: Networks By Design Commercial |
$929.89
|
| Rate for Payer: Prime Health Services Commercial |
$1,216.01
|
| Rate for Payer: Riverside University Health System MISP |
$572.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$858.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$858.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$715.30
|
| Rate for Payer: United Healthcare All Other HMO |
$715.30
|
| Rate for Payer: United Healthcare HMO Rider |
$715.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$715.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,216.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,216.01
|
| Rate for Payer: Vantage Medical Group Senior |
$1,216.01
|
|
|
HC ASCOPE 4RHINO SLIM 3.0MM
|
Facility
|
OP
|
$883.20
|
|
| Hospital Charge Code |
900831699
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$176.64 |
| Max. Negotiated Rate |
$794.88 |
| Rate for Payer: Adventist Health Commercial |
$176.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$536.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$750.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$485.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$662.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$427.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$518.70
|
| Rate for Payer: Blue Shield of California Commercial |
$539.64
|
| Rate for Payer: Blue Shield of California EPN |
$352.40
|
| Rate for Payer: Cash Price |
$485.76
|
| Rate for Payer: Central Health Plan Commercial |
$706.56
|
| Rate for Payer: Cigna of CA HMO |
$565.25
|
| Rate for Payer: Cigna of CA PPO |
$653.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$750.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$750.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$750.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$353.28
|
| Rate for Payer: EPIC Health Plan Senior |
$353.28
|
| Rate for Payer: Galaxy Health WC |
$750.72
|
| Rate for Payer: Global Benefits Group Commercial |
$529.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$794.88
|
| Rate for Payer: InnovAge PACE Commercial |
$441.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$589.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$336.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$546.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$618.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$618.24
|
| Rate for Payer: Multiplan Commercial |
$662.40
|
| Rate for Payer: Networks By Design Commercial |
$574.08
|
| Rate for Payer: Prime Health Services Commercial |
$750.72
|
| Rate for Payer: Riverside University Health System MISP |
$353.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$529.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$529.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$441.60
|
| Rate for Payer: United Healthcare All Other HMO |
$441.60
|
| Rate for Payer: United Healthcare HMO Rider |
$441.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$750.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$750.72
|
| Rate for Payer: Vantage Medical Group Senior |
$750.72
|
|
|
HC ASCOPE 4RHINO SLIM 3.0MM
|
Facility
|
IP
|
$883.20
|
|
| Hospital Charge Code |
900831699
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$176.64 |
| Max. Negotiated Rate |
$794.88 |
| Rate for Payer: Adventist Health Commercial |
$176.64
|
| Rate for Payer: Cash Price |
$485.76
|
| Rate for Payer: Central Health Plan Commercial |
$706.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$353.28
|
| Rate for Payer: EPIC Health Plan Senior |
$353.28
|
| Rate for Payer: Galaxy Health WC |
$750.72
|
| Rate for Payer: Global Benefits Group Commercial |
$529.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$794.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$589.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$336.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$546.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.64
|
| Rate for Payer: Multiplan Commercial |
$662.40
|
| Rate for Payer: Networks By Design Commercial |
$574.08
|
| Rate for Payer: Prime Health Services Commercial |
$750.72
|
|
|
HC ASPARAGUS IGE
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913632
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$40.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$115.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.34
|
| Rate for Payer: Blue Shield of California Commercial |
$40.06
|
| Rate for Payer: Blue Shield of California EPN |
$26.20
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Central Health Plan Commercial |
$52.80
|
| Rate for Payer: Cigna of CA HMO |
$42.24
|
| Rate for Payer: Cigna of CA PPO |
$48.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.05
|
| Rate for Payer: EPIC Health Plan Senior |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$56.10
|
| Rate for Payer: Global Benefits Group Commercial |
$39.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$59.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.22
|
| Rate for Payer: InnovAge PACE Commercial |
$7.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.99
|
| Rate for Payer: Multiplan Commercial |
$49.50
|
| Rate for Payer: Networks By Design Commercial |
$42.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.22
|
| Rate for Payer: Prime Health Services Commercial |
$56.10
|
| Rate for Payer: Prime Health Services Medicare |
$5.53
|
| Rate for Payer: Riverside University Health System MISP |
$5.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Other HMO |
$4.23
|
| Rate for Payer: United Healthcare HMO Rider |
$4.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
|
HC ASPARAGUS IGE
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913632
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$59.40 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Central Health Plan Commercial |
$52.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.40
|
| Rate for Payer: EPIC Health Plan Senior |
$26.40
|
| Rate for Payer: Galaxy Health WC |
$56.10
|
| Rate for Payer: Global Benefits Group Commercial |
$39.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$59.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.20
|
| Rate for Payer: Multiplan Commercial |
$49.50
|
| Rate for Payer: Networks By Design Commercial |
$42.90
|
| Rate for Payer: Prime Health Services Commercial |
$56.10
|
|
|
HC ASPIRATION/BLADDER BY NEEDLE
|
Facility
|
IP
|
$2,683.00
|
|
|
Service Code
|
CPT 51100
|
| Hospital Charge Code |
900501596
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$536.60 |
| Max. Negotiated Rate |
$2,414.70 |
| Rate for Payer: Adventist Health Commercial |
$536.60
|
| Rate for Payer: Cash Price |
$1,475.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,146.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,073.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,073.20
|
| Rate for Payer: Galaxy Health WC |
$2,280.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,609.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,414.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,789.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,022.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,660.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$536.60
|
| Rate for Payer: Multiplan Commercial |
$2,012.25
|
| Rate for Payer: Networks By Design Commercial |
$1,743.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,280.55
|
|
|
HC ASPIRATION/BLADDER BY NEEDLE
|
Facility
|
OP
|
$2,683.00
|
|
|
Service Code
|
CPT 51100
|
| Hospital Charge Code |
900501596
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$99.03 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$536.60
|
| 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 |
$463.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$309.02
|
| Rate for Payer: Anthem Blue Cross of CA 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 |
$492.37
|
| Rate for Payer: Cash Price |
$1,475.65
|
| Rate for Payer: Cash Price |
$1,475.65
|
| Rate for Payer: Cash Price |
$1,475.65
|
| Rate for Payer: Cash Price |
$1,475.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,146.40
|
| Rate for Payer: Cigna of CA HMO |
$1,717.12
|
| Rate for Payer: Cigna of CA PPO |
$1,985.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$309.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$417.18
|
| Rate for Payer: EPIC Health Plan Senior |
$309.02
|
| Rate for Payer: Galaxy Health WC |
$2,280.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,609.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,414.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$506.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$309.02
|
| Rate for Payer: InnovAge PACE Commercial |
$463.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,789.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$99.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$309.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$536.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$414.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$414.09
|
| Rate for Payer: Multiplan Commercial |
$2,012.25
|
| Rate for Payer: Multiplan WC |
$492.37
|
| Rate for Payer: Networks By Design Commercial |
$1,743.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$309.02
|
| Rate for Payer: Preferred Health Network WC |
$502.42
|
| Rate for Payer: Prime Health Services Commercial |
$2,280.55
|
| Rate for Payer: Prime Health Services Medicare |
$327.56
|
| Rate for Payer: Prime Health Services WC |
$487.35
|
| Rate for Payer: Riverside University Health System MISP |
$339.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,609.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,341.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,341.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,341.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,341.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$309.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Vantage Medical Group Senior |
$309.02
|
|
|
HC ASPIRATION/BLADDER BY NEEDLE
|
Facility
|
IP
|
$2,683.00
|
|
|
Service Code
|
CPT 51100
|
| Hospital Charge Code |
900501596
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$536.60 |
| Max. Negotiated Rate |
$2,414.70 |
| Rate for Payer: Adventist Health Commercial |
$536.60
|
| Rate for Payer: Cash Price |
$1,475.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,146.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,073.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,073.20
|
| Rate for Payer: Galaxy Health WC |
$2,280.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,609.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,414.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,789.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,022.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,660.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$536.60
|
| Rate for Payer: Multiplan Commercial |
$2,012.25
|
| Rate for Payer: Networks By Design Commercial |
$1,743.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,280.55
|
|
|
HC ASPIRATION/BLADDER BY NEEDLE
|
Facility
|
OP
|
$2,683.00
|
|
|
Service Code
|
CPT 51100
|
| Hospital Charge Code |
900501596
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$89.65 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$536.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$309.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$309.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,299.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,575.73
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$492.37
|
| Rate for Payer: Blue Shield of California Commercial |
$979.68
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$1,475.65
|
| Rate for Payer: Cash Price |
$1,475.65
|
| Rate for Payer: Cash Price |
$1,475.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,146.40
|
| Rate for Payer: Cigna of CA HMO |
$1,717.12
|
| Rate for Payer: Cigna of CA PPO |
$1,985.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$309.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$417.18
|
| Rate for Payer: EPIC Health Plan Senior |
$309.02
|
| Rate for Payer: Galaxy Health WC |
$2,280.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,609.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,414.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$506.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$89.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$309.02
|
| Rate for Payer: InnovAge PACE Commercial |
$463.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,789.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$99.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$309.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$536.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$414.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$414.09
|
| Rate for Payer: Multiplan Commercial |
$2,012.25
|
| Rate for Payer: Multiplan WC |
$492.37
|
| Rate for Payer: Networks By Design Commercial |
$1,743.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$309.02
|
| Rate for Payer: Preferred Health Network WC |
$502.42
|
| Rate for Payer: Prime Health Services Commercial |
$2,280.55
|
| Rate for Payer: Prime Health Services Medicare |
$327.56
|
| Rate for Payer: Prime Health Services WC |
$487.35
|
| Rate for Payer: Riverside University Health System MISP |
$339.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,609.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$309.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Vantage Medical Group Senior |
$309.02
|
|
|
HC ASPIRATION INJECTION INTERM JONT W US GUID
|
Facility
|
IP
|
$1,489.00
|
|
|
Service Code
|
CPT 20606
|
| Hospital Charge Code |
906620606
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$297.80 |
| Max. Negotiated Rate |
$1,340.10 |
| Rate for Payer: Adventist Health Commercial |
$297.80
|
| Rate for Payer: Cash Price |
$818.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,191.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$595.60
|
| Rate for Payer: EPIC Health Plan Senior |
$595.60
|
| Rate for Payer: Galaxy Health WC |
$1,265.65
|
| Rate for Payer: Global Benefits Group Commercial |
$893.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,340.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$993.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$567.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$921.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$297.80
|
| Rate for Payer: Multiplan Commercial |
$1,116.75
|
| Rate for Payer: Networks By Design Commercial |
$967.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,265.65
|
|
|
HC ASPIRATION INJECTION INTERM JONT W US GUID
|
Facility
|
OP
|
$1,489.00
|
|
|
Service Code
|
CPT 20606
|
| Hospital Charge Code |
906620606
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$140.90 |
| Max. Negotiated Rate |
$4,460.00 |
| Rate for Payer: Adventist Health Commercial |
$297.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$879.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.92
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$720.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$874.49
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,402.00
|
| Rate for Payer: Blue Shield of California Commercial |
$979.68
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$818.95
|
| Rate for Payer: Cash Price |
$818.95
|
| Rate for Payer: Cash Price |
$818.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,191.20
|
| Rate for Payer: Cigna of CA HMO |
$952.96
|
| Rate for Payer: Cigna of CA PPO |
$1,101.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$967.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$879.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,187.89
|
| Rate for Payer: EPIC Health Plan Senior |
$879.92
|
| Rate for Payer: Galaxy Health WC |
$1,265.65
|
| Rate for Payer: Global Benefits Group Commercial |
$893.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,340.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,443.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$140.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.92
|
| Rate for Payer: InnovAge PACE Commercial |
$1,319.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$993.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$155.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$297.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,179.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,179.09
|
| Rate for Payer: Multiplan Commercial |
$1,116.75
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: Networks By Design Commercial |
$967.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$879.92
|
| Rate for Payer: Preferred Health Network WC |
$1,430.61
|
| Rate for Payer: Prime Health Services Commercial |
$1,265.65
|
| Rate for Payer: Prime Health Services Medicare |
$932.72
|
| Rate for Payer: Prime Health Services WC |
$1,387.69
|
| Rate for Payer: Riverside University Health System MISP |
$967.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$893.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$879.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Vantage Medical Group Senior |
$879.92
|
|
|
HC ASPIRATION INJECTION MAJOR JONT W US GUID
|
Facility
|
OP
|
$1,489.00
|
|
|
Service Code
|
CPT 20611
|
| Hospital Charge Code |
906620611
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$156.95 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$297.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$375.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$375.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$720.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$874.49
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$597.61
|
| Rate for Payer: Blue Shield of California Commercial |
$979.68
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$818.95
|
| Rate for Payer: Cash Price |
$818.95
|
| Rate for Payer: Cash Price |
$818.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,191.20
|
| Rate for Payer: Cigna of CA HMO |
$952.96
|
| Rate for Payer: Cigna of CA PPO |
$1,101.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$562.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$412.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$375.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.34
|
| Rate for Payer: EPIC Health Plan Senior |
$375.07
|
| Rate for Payer: Galaxy Health WC |
$1,265.65
|
| Rate for Payer: Global Benefits Group Commercial |
$893.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,340.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$615.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$156.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$375.07
|
| Rate for Payer: InnovAge PACE Commercial |
$562.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$993.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$173.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$375.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$297.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$502.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$502.59
|
| Rate for Payer: Multiplan Commercial |
$1,116.75
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: Networks By Design Commercial |
$967.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$375.07
|
| Rate for Payer: Preferred Health Network WC |
$609.81
|
| Rate for Payer: Prime Health Services Commercial |
$1,265.65
|
| Rate for Payer: Prime Health Services Medicare |
$397.57
|
| Rate for Payer: Prime Health Services WC |
$591.52
|
| Rate for Payer: Riverside University Health System MISP |
$412.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$893.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$375.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Vantage Medical Group Senior |
$375.07
|
|
|
HC ASPIRATION INJECTION MAJOR JONT W US GUID
|
Facility
|
IP
|
$1,489.00
|
|
|
Service Code
|
CPT 20611
|
| Hospital Charge Code |
906620611
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$297.80 |
| Max. Negotiated Rate |
$1,340.10 |
| Rate for Payer: Adventist Health Commercial |
$297.80
|
| Rate for Payer: Cash Price |
$818.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,191.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$595.60
|
| Rate for Payer: EPIC Health Plan Senior |
$595.60
|
| Rate for Payer: Galaxy Health WC |
$1,265.65
|
| Rate for Payer: Global Benefits Group Commercial |
$893.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,340.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$993.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$567.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$921.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$297.80
|
| Rate for Payer: Multiplan Commercial |
$1,116.75
|
| Rate for Payer: Networks By Design Commercial |
$967.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,265.65
|
|
