|
HC AXILLARY CRUTCH EXTENSION
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
CPT L0978
|
| Hospital Charge Code |
905350978
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$80.00 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Adventist Health Commercial |
$80.00
|
| Rate for Payer: Blue Shield of California Commercial |
$309.20
|
| Rate for Payer: Blue Shield of California EPN |
$201.60
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Central Health Plan Commercial |
$320.00
|
| Rate for Payer: Cigna of CA HMO |
$280.00
|
| Rate for Payer: Cigna of CA PPO |
$280.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.00
|
| Rate for Payer: EPIC Health Plan Senior |
$160.00
|
| Rate for Payer: Galaxy Health WC |
$340.00
|
| Rate for Payer: Global Benefits Group Commercial |
$240.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$360.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$266.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$152.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$247.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.00
|
| Rate for Payer: Multiplan Commercial |
$300.00
|
| Rate for Payer: Networks By Design Commercial |
$260.00
|
| Rate for Payer: Prime Health Services Commercial |
$340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$150.12
|
| Rate for Payer: United Healthcare All Other HMO |
$146.12
|
| Rate for Payer: United Healthcare HMO Rider |
$142.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$131.00
|
|
|
HC AXILLARY CRUTCH EXTENSION
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
CPT L0978
|
| Hospital Charge Code |
915350978
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$80.00 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Adventist Health Commercial |
$80.00
|
| Rate for Payer: Blue Shield of California Commercial |
$309.20
|
| Rate for Payer: Blue Shield of California EPN |
$201.60
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Central Health Plan Commercial |
$320.00
|
| Rate for Payer: Cigna of CA HMO |
$280.00
|
| Rate for Payer: Cigna of CA PPO |
$280.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.00
|
| Rate for Payer: EPIC Health Plan Senior |
$160.00
|
| Rate for Payer: Galaxy Health WC |
$340.00
|
| Rate for Payer: Global Benefits Group Commercial |
$240.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$360.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$266.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$152.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$247.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.00
|
| Rate for Payer: Multiplan Commercial |
$300.00
|
| Rate for Payer: Networks By Design Commercial |
$260.00
|
| Rate for Payer: Prime Health Services Commercial |
$340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$150.12
|
| Rate for Payer: United Healthcare All Other HMO |
$146.12
|
| Rate for Payer: United Healthcare HMO Rider |
$142.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$131.00
|
|
|
HC AXILLARY CRUTCH EXTENSION
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
CPT L0978
|
| Hospital Charge Code |
905350978
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$131.00 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Adventist Health Commercial |
$164.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$340.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$220.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$300.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$234.92
|
| Rate for Payer: Blue Shield of California Commercial |
$309.20
|
| Rate for Payer: Blue Shield of California EPN |
$201.60
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Central Health Plan Commercial |
$320.00
|
| Rate for Payer: Cigna of CA HMO |
$280.00
|
| Rate for Payer: Cigna of CA PPO |
$280.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$340.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$340.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$340.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.00
|
| Rate for Payer: EPIC Health Plan Senior |
$160.00
|
| Rate for Payer: Galaxy Health WC |
$340.00
|
| Rate for Payer: Global Benefits Group Commercial |
$240.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$360.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$265.84
|
| Rate for Payer: InnovAge PACE Commercial |
$200.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$266.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$293.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$247.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$280.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$280.00
|
| Rate for Payer: Multiplan Commercial |
$300.00
|
| Rate for Payer: Networks By Design Commercial |
$200.00
|
| Rate for Payer: Prime Health Services Commercial |
$340.00
|
| Rate for Payer: Riverside University Health System MISP |
$160.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$240.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$240.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$150.12
|
| Rate for Payer: United Healthcare All Other HMO |
$146.12
|
| Rate for Payer: United Healthcare HMO Rider |
$142.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$131.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$340.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$340.00
|
| Rate for Payer: Vantage Medical Group Senior |
$340.00
|
|
|
HC AZUR HYRDOCOIL
|
Facility
|
IP
|
$3,900.00
|
|
| Hospital Charge Code |
909020139
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
|
|
HC AZUR HYRDOCOIL
|
Facility
|
OP
|
$3,900.00
|
|
| Hospital Charge Code |
909020139
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,368.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,888.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,290.47
|
| Rate for Payer: Blue Shield of California Commercial |
$2,382.90
|
| Rate for Payer: Blue Shield of California EPN |
$1,556.10
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: Cigna of CA HMO |
$2,496.00
|
| Rate for Payer: Cigna of CA PPO |
$2,886.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: InnovAge PACE Commercial |
$1,950.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,730.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,560.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,340.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,950.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,950.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,950.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,950.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC B ABORTUS AB
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
CPT 86000
|
| Hospital Charge Code |
900911585
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$45.84 |
| Rate for Payer: Adventist Health Commercial |
$5.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$6.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$45.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.30
|
| Rate for Payer: Blue Shield of California Commercial |
$15.78
|
| Rate for Payer: Blue Shield of California EPN |
$10.32
|
| Rate for Payer: Cash Price |
$14.30
|
| Rate for Payer: Cash Price |
$14.30
|
| Rate for Payer: Central Health Plan Commercial |
$20.80
|
| Rate for Payer: Cigna of CA HMO |
$16.64
|
| Rate for Payer: Cigna of CA PPO |
$19.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.42
|
| Rate for Payer: EPIC Health Plan Senior |
$6.98
|
| Rate for Payer: Galaxy Health WC |
$22.10
|
| Rate for Payer: Global Benefits Group Commercial |
$15.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.98
|
| Rate for Payer: InnovAge PACE Commercial |
$10.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.35
|
| Rate for Payer: Multiplan Commercial |
$19.50
|
| Rate for Payer: Networks By Design Commercial |
$16.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6.98
|
| Rate for Payer: Prime Health Services Commercial |
$22.10
|
| Rate for Payer: Prime Health Services Medicare |
$7.40
|
| Rate for Payer: Riverside University Health System MISP |
$7.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.65
|
| Rate for Payer: United Healthcare All Other HMO |
$5.65
|
| Rate for Payer: United Healthcare HMO Rider |
$5.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.65
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.68
|
| Rate for Payer: Vantage Medical Group Senior |
$6.98
|
|
|
HC B ABORTUS AB
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
CPT 86000
|
| Hospital Charge Code |
900911585
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$23.40 |
| Rate for Payer: Adventist Health Commercial |
$5.20
|
| Rate for Payer: Cash Price |
$14.30
|
| Rate for Payer: Central Health Plan Commercial |
$20.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.40
|
| Rate for Payer: EPIC Health Plan Senior |
$10.40
|
| Rate for Payer: Galaxy Health WC |
$22.10
|
| Rate for Payer: Global Benefits Group Commercial |
$15.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.20
|
| Rate for Payer: Multiplan Commercial |
$19.50
|
| Rate for Payer: Networks By Design Commercial |
$16.90
|
| Rate for Payer: Prime Health Services Commercial |
$22.10
|
|
|
HC BACTERIAL ANTIGEN
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
CPT 86403
|
| Hospital Charge Code |
900912496
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$100.80 |
| Rate for Payer: Adventist Health Commercial |
$22.40
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Central Health Plan Commercial |
$89.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.80
|
| Rate for Payer: EPIC Health Plan Senior |
$44.80
|
| Rate for Payer: Galaxy Health WC |
$95.20
|
| Rate for Payer: Global Benefits Group Commercial |
$67.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$100.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$74.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$69.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.40
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
| Rate for Payer: Networks By Design Commercial |
$72.80
|
| Rate for Payer: Prime Health Services Commercial |
$95.20
|
|
|
HC BACTERIAL ANTIGEN
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
CPT 86403
|
| Hospital Charge Code |
900912496
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.35 |
| Max. Negotiated Rate |
$100.80 |
| Rate for Payer: Adventist Health Commercial |
$22.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$11.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$72.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.61
|
| Rate for Payer: Blue Shield of California Commercial |
$67.98
|
| Rate for Payer: Blue Shield of California EPN |
$44.46
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Central Health Plan Commercial |
$89.60
|
| Rate for Payer: Cigna of CA HMO |
$71.68
|
| Rate for Payer: Cigna of CA PPO |
$82.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.58
|
| Rate for Payer: EPIC Health Plan Senior |
$11.54
|
| Rate for Payer: Galaxy Health WC |
$95.20
|
| Rate for Payer: Global Benefits Group Commercial |
$67.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$100.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$15.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.54
|
| Rate for Payer: InnovAge PACE Commercial |
$17.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$74.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.46
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
| Rate for Payer: Networks By Design Commercial |
$72.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11.54
|
| Rate for Payer: Prime Health Services Commercial |
$95.20
|
| Rate for Payer: Prime Health Services Medicare |
$12.23
|
| Rate for Payer: Riverside University Health System MISP |
$12.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.35
|
| Rate for Payer: United Healthcare All Other HMO |
$9.35
|
| Rate for Payer: United Healthcare HMO Rider |
$9.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.35
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.69
|
| Rate for Payer: Vantage Medical Group Senior |
$11.54
|
|
|
HC BACTERIAL ANTIGEN DETECTION LLUH
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
900913679
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
|
|
HC BACTERIAL ANTIGEN DETECTION LLUH
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
900913679
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.19 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.91
|
| Rate for Payer: Blue Shield of California Commercial |
$30.35
|
| Rate for Payer: Blue Shield of California EPN |
$19.85
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: Cigna of CA HMO |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.99
|
| Rate for Payer: EPIC Health Plan Senior |
$5.18
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: InnovAge PACE Commercial |
$7.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.94
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.18
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Prime Health Services Medicare |
$5.49
|
| Rate for Payer: Riverside University Health System MISP |
$5.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.19
|
| Rate for Payer: United Healthcare All Other HMO |
$4.19
|
| Rate for Payer: United Healthcare HMO Rider |
$4.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.19
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
|
|
HC BAG ACCUDRAIN CSF 700ML
|
Facility
|
IP
|
$741.24
|
|
| Hospital Charge Code |
901605661
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$148.25 |
| Max. Negotiated Rate |
$667.12 |
| Rate for Payer: Adventist Health Commercial |
$148.25
|
| Rate for Payer: Cash Price |
$407.68
|
| Rate for Payer: Central Health Plan Commercial |
$592.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$296.50
|
| Rate for Payer: EPIC Health Plan Senior |
$296.50
|
| Rate for Payer: Galaxy Health WC |
$630.05
|
| Rate for Payer: Global Benefits Group Commercial |
$444.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$667.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$494.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$282.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$458.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.25
|
| Rate for Payer: Multiplan Commercial |
$555.93
|
| Rate for Payer: Networks By Design Commercial |
$481.81
|
| Rate for Payer: Prime Health Services Commercial |
$630.05
|
|
|
HC BAG ACCUDRAIN CSF 700ML
|
Facility
|
OP
|
$741.24
|
|
| Hospital Charge Code |
901605661
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$148.25 |
| Max. Negotiated Rate |
$667.12 |
| Rate for Payer: Adventist Health Commercial |
$148.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$450.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$630.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$407.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$555.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$358.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$435.33
|
| Rate for Payer: Blue Shield of California Commercial |
$452.90
|
| Rate for Payer: Blue Shield of California EPN |
$295.75
|
| Rate for Payer: Cash Price |
$407.68
|
| Rate for Payer: Central Health Plan Commercial |
$592.99
|
| Rate for Payer: Cigna of CA HMO |
$474.39
|
| Rate for Payer: Cigna of CA PPO |
$548.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$630.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$630.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$630.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$296.50
|
| Rate for Payer: EPIC Health Plan Senior |
$296.50
|
| Rate for Payer: Galaxy Health WC |
$630.05
|
| Rate for Payer: Global Benefits Group Commercial |
$444.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$667.12
|
| Rate for Payer: InnovAge PACE Commercial |
$370.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$494.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$282.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$458.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$518.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$518.87
|
| Rate for Payer: Multiplan Commercial |
$555.93
|
| Rate for Payer: Networks By Design Commercial |
$481.81
|
| Rate for Payer: Prime Health Services Commercial |
$630.05
|
| Rate for Payer: Riverside University Health System MISP |
$296.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$444.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$444.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$370.62
|
| Rate for Payer: United Healthcare All Other HMO |
$370.62
|
| Rate for Payer: United Healthcare HMO Rider |
$370.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$370.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$630.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$630.05
|
| Rate for Payer: Vantage Medical Group Senior |
$630.05
|
|
|
HC BAG BILE DISP
|
Facility
|
IP
|
$65.68
|
|
| Hospital Charge Code |
901600101
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.14 |
| Max. Negotiated Rate |
$59.11 |
| Rate for Payer: Adventist Health Commercial |
$13.14
|
| Rate for Payer: Cash Price |
$36.12
|
| Rate for Payer: Central Health Plan Commercial |
$52.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.27
|
| Rate for Payer: EPIC Health Plan Senior |
$26.27
|
| Rate for Payer: Galaxy Health WC |
$55.83
|
| Rate for Payer: Global Benefits Group Commercial |
$39.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$59.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.14
|
| Rate for Payer: Multiplan Commercial |
$49.26
|
| Rate for Payer: Networks By Design Commercial |
$42.69
|
| Rate for Payer: Prime Health Services Commercial |
$55.83
|
|
|
HC BAG BILE DISP
|
Facility
|
OP
|
$65.68
|
|
| Hospital Charge Code |
901600101
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.14 |
| Max. Negotiated Rate |
$59.11 |
| Rate for Payer: Adventist Health Commercial |
$13.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$39.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$36.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$49.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.57
|
| Rate for Payer: Blue Shield of California Commercial |
$40.13
|
| Rate for Payer: Blue Shield of California EPN |
$26.21
|
| Rate for Payer: Cash Price |
$36.12
|
| Rate for Payer: Central Health Plan Commercial |
$52.54
|
| Rate for Payer: Cigna of CA HMO |
$42.04
|
| Rate for Payer: Cigna of CA PPO |
$48.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$55.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$55.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.27
|
| Rate for Payer: EPIC Health Plan Senior |
$26.27
|
| Rate for Payer: Galaxy Health WC |
$55.83
|
| Rate for Payer: Global Benefits Group Commercial |
$39.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$59.11
|
| Rate for Payer: InnovAge PACE Commercial |
$32.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$45.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$45.98
|
| Rate for Payer: Multiplan Commercial |
$49.26
|
| Rate for Payer: Networks By Design Commercial |
$42.69
|
| Rate for Payer: Prime Health Services Commercial |
$55.83
|
| Rate for Payer: Riverside University Health System MISP |
$26.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.84
|
| Rate for Payer: United Healthcare All Other HMO |
$32.84
|
| Rate for Payer: United Healthcare HMO Rider |
$32.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$55.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$55.83
|
| Rate for Payer: Vantage Medical Group Senior |
$55.83
|
|
|
HC BAG BILE DRAINAGE
|
Facility
|
OP
|
$10.60
|
|
| Hospital Charge Code |
909001075
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.12 |
| Max. Negotiated Rate |
$9.54 |
| Rate for Payer: Adventist Health Commercial |
$2.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.23
|
| Rate for Payer: Blue Shield of California Commercial |
$6.48
|
| Rate for Payer: Blue Shield of California EPN |
$4.23
|
| Rate for Payer: Cash Price |
$5.83
|
| Rate for Payer: Central Health Plan Commercial |
$8.48
|
| Rate for Payer: Cigna of CA HMO |
$6.78
|
| Rate for Payer: Cigna of CA PPO |
$7.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.24
|
| Rate for Payer: EPIC Health Plan Senior |
$4.24
|
| Rate for Payer: Galaxy Health WC |
$9.01
|
| Rate for Payer: Global Benefits Group Commercial |
$6.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.54
|
| Rate for Payer: InnovAge PACE Commercial |
$5.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.42
|
| Rate for Payer: Multiplan Commercial |
$7.95
|
| Rate for Payer: Networks By Design Commercial |
$6.89
|
| Rate for Payer: Prime Health Services Commercial |
$9.01
|
| Rate for Payer: Riverside University Health System MISP |
$4.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.30
|
| Rate for Payer: United Healthcare All Other HMO |
$5.30
|
| Rate for Payer: United Healthcare HMO Rider |
$5.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.01
|
| Rate for Payer: Vantage Medical Group Senior |
$9.01
|
|
|
HC BAG BILE DRAINAGE
|
Facility
|
IP
|
$10.60
|
|
| Hospital Charge Code |
909001075
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.12 |
| Max. Negotiated Rate |
$9.54 |
| Rate for Payer: Adventist Health Commercial |
$2.12
|
| Rate for Payer: Cash Price |
$5.83
|
| Rate for Payer: Central Health Plan Commercial |
$8.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.24
|
| Rate for Payer: EPIC Health Plan Senior |
$4.24
|
| Rate for Payer: Galaxy Health WC |
$9.01
|
| Rate for Payer: Global Benefits Group Commercial |
$6.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.12
|
| Rate for Payer: Multiplan Commercial |
$7.95
|
| Rate for Payer: Networks By Design Commercial |
$6.89
|
| Rate for Payer: Prime Health Services Commercial |
$9.01
|
|
|
HC BAG DRAINAGE 4L A/R TWR LL
|
Facility
|
IP
|
$25.34
|
|
| Hospital Charge Code |
901607520
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$22.81 |
| Rate for Payer: Adventist Health Commercial |
$5.07
|
| Rate for Payer: Cash Price |
$13.94
|
| Rate for Payer: Central Health Plan Commercial |
$20.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.14
|
| Rate for Payer: EPIC Health Plan Senior |
$10.14
|
| Rate for Payer: Galaxy Health WC |
$21.54
|
| Rate for Payer: Global Benefits Group Commercial |
$15.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.07
|
| Rate for Payer: Multiplan Commercial |
$19.00
|
| Rate for Payer: Networks By Design Commercial |
$16.47
|
| Rate for Payer: Prime Health Services Commercial |
$21.54
|
|
|
HC BAG DRAINAGE 4L A/R TWR LL
|
Facility
|
OP
|
$25.34
|
|
| Hospital Charge Code |
901607520
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$22.81 |
| Rate for Payer: Adventist Health Commercial |
$5.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.88
|
| Rate for Payer: Blue Shield of California Commercial |
$15.48
|
| Rate for Payer: Blue Shield of California EPN |
$10.11
|
| Rate for Payer: Cash Price |
$13.94
|
| Rate for Payer: Central Health Plan Commercial |
$20.27
|
| Rate for Payer: Cigna of CA HMO |
$16.22
|
| Rate for Payer: Cigna of CA PPO |
$18.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.14
|
| Rate for Payer: EPIC Health Plan Senior |
$10.14
|
| Rate for Payer: Galaxy Health WC |
$21.54
|
| Rate for Payer: Global Benefits Group Commercial |
$15.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.81
|
| Rate for Payer: InnovAge PACE Commercial |
$12.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.74
|
| Rate for Payer: Multiplan Commercial |
$19.00
|
| Rate for Payer: Networks By Design Commercial |
$16.47
|
| Rate for Payer: Prime Health Services Commercial |
$21.54
|
| Rate for Payer: Riverside University Health System MISP |
$10.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.67
|
| Rate for Payer: United Healthcare All Other HMO |
$12.67
|
| Rate for Payer: United Healthcare HMO Rider |
$12.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.54
|
| Rate for Payer: Vantage Medical Group Senior |
$21.54
|
|
|
HC BAG DRAINAGE URESIL GRAVITY
|
Facility
|
IP
|
$69.00
|
|
| Hospital Charge Code |
909001098
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.80 |
| Max. Negotiated Rate |
$62.10 |
| Rate for Payer: Adventist Health Commercial |
$13.80
|
| Rate for Payer: Cash Price |
$37.95
|
| Rate for Payer: Central Health Plan Commercial |
$55.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.60
|
| Rate for Payer: EPIC Health Plan Senior |
$27.60
|
| Rate for Payer: Galaxy Health WC |
$58.65
|
| Rate for Payer: Global Benefits Group Commercial |
$41.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$62.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$42.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.80
|
| Rate for Payer: Multiplan Commercial |
$51.75
|
| Rate for Payer: Networks By Design Commercial |
$44.85
|
| Rate for Payer: Prime Health Services Commercial |
$58.65
|
|
|
HC BAG DRAINAGE URESIL GRAVITY
|
Facility
|
OP
|
$69.00
|
|
| Hospital Charge Code |
909001098
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.80 |
| Max. Negotiated Rate |
$62.10 |
| Rate for Payer: Adventist Health Commercial |
$13.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$41.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$58.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$37.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$33.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.52
|
| Rate for Payer: Blue Shield of California Commercial |
$42.16
|
| Rate for Payer: Blue Shield of California EPN |
$27.53
|
| Rate for Payer: Cash Price |
$37.95
|
| Rate for Payer: Central Health Plan Commercial |
$55.20
|
| Rate for Payer: Cigna of CA HMO |
$44.16
|
| Rate for Payer: Cigna of CA PPO |
$51.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$58.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$58.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$58.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.60
|
| Rate for Payer: EPIC Health Plan Senior |
$27.60
|
| Rate for Payer: Galaxy Health WC |
$58.65
|
| Rate for Payer: Global Benefits Group Commercial |
$41.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$62.10
|
| Rate for Payer: InnovAge PACE Commercial |
$34.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$42.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$48.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$48.30
|
| Rate for Payer: Multiplan Commercial |
$51.75
|
| Rate for Payer: Networks By Design Commercial |
$44.85
|
| Rate for Payer: Prime Health Services Commercial |
$58.65
|
| Rate for Payer: Riverside University Health System MISP |
$27.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$41.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$41.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.50
|
| Rate for Payer: United Healthcare All Other HMO |
$34.50
|
| Rate for Payer: United Healthcare HMO Rider |
$34.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$58.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$58.65
|
| Rate for Payer: Vantage Medical Group Senior |
$58.65
|
|
|
HC BAG DRAINAGE URESIL SUCTION
|
Facility
|
IP
|
$88.00
|
|
| Hospital Charge Code |
909002002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.60 |
| Max. Negotiated Rate |
$79.20 |
| Rate for Payer: Adventist Health Commercial |
$17.60
|
| Rate for Payer: Cash Price |
$48.40
|
| Rate for Payer: Central Health Plan Commercial |
$70.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.20
|
| Rate for Payer: EPIC Health Plan Senior |
$35.20
|
| Rate for Payer: Galaxy Health WC |
$74.80
|
| Rate for Payer: Global Benefits Group Commercial |
$52.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$79.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$54.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.60
|
| Rate for Payer: Multiplan Commercial |
$66.00
|
| Rate for Payer: Networks By Design Commercial |
$57.20
|
| Rate for Payer: Prime Health Services Commercial |
$74.80
|
|
|
HC BAG DRAINAGE URESIL SUCTION
|
Facility
|
OP
|
$88.00
|
|
| Hospital Charge Code |
909002002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.60 |
| Max. Negotiated Rate |
$79.20 |
| Rate for Payer: Adventist Health Commercial |
$17.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$74.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$48.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$66.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$42.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.68
|
| Rate for Payer: Blue Shield of California Commercial |
$53.77
|
| Rate for Payer: Blue Shield of California EPN |
$35.11
|
| Rate for Payer: Cash Price |
$48.40
|
| Rate for Payer: Central Health Plan Commercial |
$70.40
|
| Rate for Payer: Cigna of CA HMO |
$56.32
|
| Rate for Payer: Cigna of CA PPO |
$65.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$74.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$74.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.20
|
| Rate for Payer: EPIC Health Plan Senior |
$35.20
|
| Rate for Payer: Galaxy Health WC |
$74.80
|
| Rate for Payer: Global Benefits Group Commercial |
$52.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$79.20
|
| Rate for Payer: InnovAge PACE Commercial |
$44.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$54.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$61.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$61.60
|
| Rate for Payer: Multiplan Commercial |
$66.00
|
| Rate for Payer: Networks By Design Commercial |
$57.20
|
| Rate for Payer: Prime Health Services Commercial |
$74.80
|
| Rate for Payer: Riverside University Health System MISP |
$35.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$44.00
|
| Rate for Payer: United Healthcare All Other HMO |
$44.00
|
| Rate for Payer: United Healthcare HMO Rider |
$44.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$44.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$74.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.80
|
| Rate for Payer: Vantage Medical Group Senior |
$74.80
|
|
|
HC BAG DRAIN ANTI REFLX L/F 2000ML
|
Facility
|
OP
|
$19.68
|
|
| Hospital Charge Code |
901607521
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.94 |
| Max. Negotiated Rate |
$17.71 |
| Rate for Payer: Adventist Health Commercial |
$3.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.76
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.56
|
| Rate for Payer: Blue Shield of California Commercial |
$12.02
|
| Rate for Payer: Blue Shield of California EPN |
$7.85
|
| Rate for Payer: Cash Price |
$10.82
|
| Rate for Payer: Central Health Plan Commercial |
$15.74
|
| Rate for Payer: Cigna of CA HMO |
$12.60
|
| Rate for Payer: Cigna of CA PPO |
$14.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.87
|
| Rate for Payer: EPIC Health Plan Senior |
$7.87
|
| Rate for Payer: Galaxy Health WC |
$16.73
|
| Rate for Payer: Global Benefits Group Commercial |
$11.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.71
|
| Rate for Payer: InnovAge PACE Commercial |
$9.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.78
|
| Rate for Payer: Multiplan Commercial |
$14.76
|
| Rate for Payer: Networks By Design Commercial |
$12.79
|
| Rate for Payer: Prime Health Services Commercial |
$16.73
|
| Rate for Payer: Riverside University Health System MISP |
$7.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.84
|
| Rate for Payer: United Healthcare All Other HMO |
$9.84
|
| Rate for Payer: United Healthcare HMO Rider |
$9.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.73
|
| Rate for Payer: Vantage Medical Group Senior |
$16.73
|
|
|
HC BAG DRAIN ANTI REFLX L/F 2000ML
|
Facility
|
IP
|
$19.68
|
|
| Hospital Charge Code |
901607521
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.94 |
| Max. Negotiated Rate |
$17.71 |
| Rate for Payer: Adventist Health Commercial |
$3.94
|
| Rate for Payer: Cash Price |
$10.82
|
| Rate for Payer: Central Health Plan Commercial |
$15.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.87
|
| Rate for Payer: EPIC Health Plan Senior |
$7.87
|
| Rate for Payer: Galaxy Health WC |
$16.73
|
| Rate for Payer: Global Benefits Group Commercial |
$11.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.94
|
| Rate for Payer: Multiplan Commercial |
$14.76
|
| Rate for Payer: Networks By Design Commercial |
$12.79
|
| Rate for Payer: Prime Health Services Commercial |
$16.73
|
|
