|
HC BILI DUCT DILITATION PERC
|
Facility
|
IP
|
$2,208.00
|
|
|
Service Code
|
CPT 74363
|
| Hospital Charge Code |
909001856
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$441.60 |
| Max. Negotiated Rate |
$1,987.20 |
| Rate for Payer: Adventist Health Commercial |
$441.60
|
| Rate for Payer: Cash Price |
$1,214.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,766.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$883.20
|
| Rate for Payer: EPIC Health Plan Senior |
$883.20
|
| Rate for Payer: Galaxy Health WC |
$1,876.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,324.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,987.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,472.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$841.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,366.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$441.60
|
| Rate for Payer: Multiplan Commercial |
$1,656.00
|
| Rate for Payer: Networks By Design Commercial |
$1,435.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,876.80
|
|
|
HC BILI DUCT DILITATION PERC
|
Facility
|
OP
|
$2,208.00
|
|
|
Service Code
|
CPT 74363
|
| Hospital Charge Code |
909001856
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$227.33 |
| Max. Negotiated Rate |
$1,987.20 |
| Rate for Payer: Adventist Health Commercial |
$441.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,340.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,876.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,214.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,656.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,263.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$256.33
|
| Rate for Payer: Blue Shield of California Commercial |
$1,340.26
|
| Rate for Payer: Blue Shield of California EPN |
$876.58
|
| Rate for Payer: Cash Price |
$1,214.40
|
| Rate for Payer: Cash Price |
$1,214.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,766.40
|
| Rate for Payer: Cigna of CA HMO |
$1,413.12
|
| Rate for Payer: Cigna of CA PPO |
$1,633.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,876.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,876.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,876.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$883.20
|
| Rate for Payer: EPIC Health Plan Senior |
$883.20
|
| Rate for Payer: Galaxy Health WC |
$1,876.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,324.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,987.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$227.33
|
| Rate for Payer: InnovAge PACE Commercial |
$1,104.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,472.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$251.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,366.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$441.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,545.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,545.60
|
| Rate for Payer: Multiplan Commercial |
$1,656.00
|
| Rate for Payer: Networks By Design Commercial |
$1,435.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,876.80
|
| Rate for Payer: Riverside University Health System MISP |
$883.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,324.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,324.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,104.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,104.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,104.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,104.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,876.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,876.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,876.80
|
|
|
HC BILIRUBIN DIRECT
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
CPT 82248
|
| Hospital Charge Code |
900910504
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.07 |
| Max. Negotiated Rate |
$36.39 |
| Rate for Payer: Adventist Health Commercial |
$6.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$20.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$36.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.39
|
| Rate for Payer: Blue Shield of California Commercial |
$20.64
|
| Rate for Payer: Blue Shield of California EPN |
$13.50
|
| Rate for Payer: Cash Price |
$18.70
|
| Rate for Payer: Cash Price |
$18.70
|
| Rate for Payer: Central Health Plan Commercial |
$27.20
|
| Rate for Payer: Cigna of CA HMO |
$21.76
|
| Rate for Payer: Cigna of CA PPO |
$25.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.78
|
| Rate for Payer: EPIC Health Plan Senior |
$5.02
|
| Rate for Payer: Galaxy Health WC |
$28.90
|
| Rate for Payer: Global Benefits Group Commercial |
$20.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.02
|
| Rate for Payer: InnovAge PACE Commercial |
$7.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.73
|
| Rate for Payer: Multiplan Commercial |
$25.50
|
| Rate for Payer: Networks By Design Commercial |
$22.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.02
|
| Rate for Payer: Prime Health Services Commercial |
$28.90
|
| Rate for Payer: Prime Health Services Medicare |
$5.32
|
| Rate for Payer: Riverside University Health System MISP |
$5.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.07
|
| Rate for Payer: United Healthcare All Other HMO |
$4.07
|
| Rate for Payer: United Healthcare HMO Rider |
$4.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.07
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.52
|
| Rate for Payer: Vantage Medical Group Senior |
$5.02
|
|
|
HC BILIRUBIN DIRECT
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
CPT 82248
|
| Hospital Charge Code |
900910504
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Adventist Health Commercial |
$6.80
|
| Rate for Payer: Cash Price |
$18.70
|
| Rate for Payer: Central Health Plan Commercial |
$27.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.60
|
| Rate for Payer: EPIC Health Plan Senior |
$13.60
|
| Rate for Payer: Galaxy Health WC |
$28.90
|
| Rate for Payer: Global Benefits Group Commercial |
$20.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.80
|
| Rate for Payer: Multiplan Commercial |
$25.50
|
| Rate for Payer: Networks By Design Commercial |
$22.10
|
| Rate for Payer: Prime Health Services Commercial |
$28.90
|
|
|
HC BILIRUBIN ICTOTEST
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
900910181
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$2.82 |
| Max. Negotiated Rate |
$68.40 |
| Rate for Payer: Adventist Health Commercial |
$15.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$3.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$46.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.51
|
| Rate for Payer: Blue Shield of California Commercial |
$46.13
|
| Rate for Payer: Blue Shield of California EPN |
$30.17
|
| Rate for Payer: Cash Price |
$41.80
|
| Rate for Payer: Cash Price |
$41.80
|
| Rate for Payer: Central Health Plan Commercial |
$60.80
|
| Rate for Payer: Cigna of CA HMO |
$48.64
|
| Rate for Payer: Cigna of CA PPO |
$56.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.70
|
| Rate for Payer: EPIC Health Plan Senior |
$3.48
|
| Rate for Payer: Galaxy Health WC |
$64.60
|
| Rate for Payer: Global Benefits Group Commercial |
$45.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$68.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.48
|
| Rate for Payer: InnovAge PACE Commercial |
$5.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.66
|
| Rate for Payer: Multiplan Commercial |
$57.00
|
| Rate for Payer: Networks By Design Commercial |
$49.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3.48
|
| Rate for Payer: Prime Health Services Commercial |
$64.60
|
| Rate for Payer: Prime Health Services Medicare |
$3.69
|
| Rate for Payer: Riverside University Health System MISP |
$3.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.82
|
| Rate for Payer: United Healthcare All Other HMO |
$2.82
|
| Rate for Payer: United Healthcare HMO Rider |
$2.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.82
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.83
|
| Rate for Payer: Vantage Medical Group Senior |
$3.48
|
|
|
HC BILIRUBIN ICTOTEST
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
900910181
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$15.20 |
| Max. Negotiated Rate |
$68.40 |
| Rate for Payer: Adventist Health Commercial |
$15.20
|
| Rate for Payer: Cash Price |
$41.80
|
| Rate for Payer: Central Health Plan Commercial |
$60.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.40
|
| Rate for Payer: EPIC Health Plan Senior |
$30.40
|
| Rate for Payer: Galaxy Health WC |
$64.60
|
| Rate for Payer: Global Benefits Group Commercial |
$45.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$68.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.20
|
| Rate for Payer: Multiplan Commercial |
$57.00
|
| Rate for Payer: Networks By Design Commercial |
$49.40
|
| Rate for Payer: Prime Health Services Commercial |
$64.60
|
|
|
HC BILIRUBIN TOTAL
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
900910273
|
|
Hospital Revenue Code
|
301
|
| 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 BILIRUBIN TOTAL
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
900910273
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.07 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$36.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.39
|
| 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 |
$7.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.78
|
| Rate for Payer: EPIC Health Plan Senior |
$5.02
|
| 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 |
$8.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.02
|
| Rate for Payer: InnovAge PACE Commercial |
$7.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.73
|
| 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 |
$5.02
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Prime Health Services Medicare |
$5.32
|
| Rate for Payer: Riverside University Health System MISP |
$5.52
|
| 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 |
$4.07
|
| Rate for Payer: United Healthcare All Other HMO |
$4.07
|
| Rate for Payer: United Healthcare HMO Rider |
$4.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.07
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.52
|
| Rate for Payer: Vantage Medical Group Senior |
$5.02
|
|
|
HC BILIRUBIN TRANSCUTANEOUS
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
CPT 88720
|
| Hospital Charge Code |
900912154
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$18.90 |
| Rate for Payer: Adventist Health Commercial |
$4.20
|
| Rate for Payer: Cash Price |
$11.55
|
| Rate for Payer: Central Health Plan Commercial |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.40
|
| Rate for Payer: EPIC Health Plan Senior |
$8.40
|
| Rate for Payer: Galaxy Health WC |
$17.85
|
| Rate for Payer: Global Benefits Group Commercial |
$12.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.20
|
| Rate for Payer: Multiplan Commercial |
$15.75
|
| Rate for Payer: Networks By Design Commercial |
$13.65
|
| Rate for Payer: Prime Health Services Commercial |
$17.85
|
|
|
HC BILIRUBIN TRANSCUTANEOUS
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
CPT 88720
|
| Hospital Charge Code |
900912154
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.07 |
| Max. Negotiated Rate |
$36.44 |
| Rate for Payer: Adventist Health Commercial |
$4.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$36.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.40
|
| Rate for Payer: Blue Shield of California Commercial |
$12.75
|
| Rate for Payer: Blue Shield of California EPN |
$8.34
|
| Rate for Payer: Cash Price |
$11.55
|
| Rate for Payer: Cash Price |
$11.55
|
| Rate for Payer: Central Health Plan Commercial |
$16.80
|
| Rate for Payer: Cigna of CA HMO |
$13.44
|
| Rate for Payer: Cigna of CA PPO |
$15.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.78
|
| Rate for Payer: EPIC Health Plan Senior |
$5.02
|
| Rate for Payer: Galaxy Health WC |
$17.85
|
| Rate for Payer: Global Benefits Group Commercial |
$12.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.02
|
| Rate for Payer: InnovAge PACE Commercial |
$7.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.73
|
| Rate for Payer: Multiplan Commercial |
$15.75
|
| Rate for Payer: Networks By Design Commercial |
$13.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.02
|
| Rate for Payer: Prime Health Services Commercial |
$17.85
|
| Rate for Payer: Prime Health Services Medicare |
$5.32
|
| Rate for Payer: Riverside University Health System MISP |
$5.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.07
|
| Rate for Payer: United Healthcare All Other HMO |
$4.07
|
| Rate for Payer: United Healthcare HMO Rider |
$4.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.07
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.52
|
| Rate for Payer: Vantage Medical Group Senior |
$5.02
|
|
|
HC BIL STNT PLCMNT NEW ACC W CATH
|
Facility
|
IP
|
$27,853.00
|
|
|
Service Code
|
CPT 47540
|
| Hospital Charge Code |
909047540
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,570.60 |
| Max. Negotiated Rate |
$25,067.70 |
| Rate for Payer: Adventist Health Commercial |
$5,570.60
|
| Rate for Payer: Cash Price |
$15,319.15
|
| Rate for Payer: Central Health Plan Commercial |
$22,282.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,141.20
|
| Rate for Payer: EPIC Health Plan Senior |
$11,141.20
|
| Rate for Payer: Galaxy Health WC |
$23,675.05
|
| Rate for Payer: Global Benefits Group Commercial |
$16,711.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$25,067.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,577.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,611.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,241.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,570.60
|
| Rate for Payer: Multiplan Commercial |
$20,889.75
|
| Rate for Payer: Networks By Design Commercial |
$18,104.45
|
| Rate for Payer: Prime Health Services Commercial |
$23,675.05
|
|
|
HC BIL STNT PLCMNT NEW ACC W CATH
|
Facility
|
OP
|
$27,853.00
|
|
|
Service Code
|
CPT 47540
|
| Hospital Charge Code |
909047540
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,165.61 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$5,570.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$7,413.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,119.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,154.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,413.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,764.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$11,811.52
|
| Rate for Payer: Blue Shield of California Commercial |
$4,851.77
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$15,319.15
|
| Rate for Payer: Cash Price |
$15,319.15
|
| Rate for Payer: Cash Price |
$15,319.15
|
| Rate for Payer: Central Health Plan Commercial |
$22,282.40
|
| Rate for Payer: Cigna of CA HMO |
$17,825.92
|
| Rate for Payer: Cigna of CA PPO |
$20,611.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,119.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,154.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,413.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,007.74
|
| Rate for Payer: EPIC Health Plan Senior |
$7,413.14
|
| Rate for Payer: Galaxy Health WC |
$23,675.05
|
| Rate for Payer: Global Benefits Group Commercial |
$16,711.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$25,067.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12,157.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8,163.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,413.14
|
| Rate for Payer: InnovAge PACE Commercial |
$11,119.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,577.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,018.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,413.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,570.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,933.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,933.61
|
| Rate for Payer: Multiplan Commercial |
$20,889.75
|
| Rate for Payer: Multiplan WC |
$11,811.52
|
| Rate for Payer: Networks By Design Commercial |
$18,104.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7,413.14
|
| Rate for Payer: Preferred Health Network WC |
$12,052.57
|
| Rate for Payer: Prime Health Services Commercial |
$23,675.05
|
| Rate for Payer: Prime Health Services Medicare |
$7,857.93
|
| Rate for Payer: Prime Health Services WC |
$11,690.99
|
| Rate for Payer: Riverside University Health System MISP |
$8,154.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16,711.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,413.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,119.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,154.45
|
| Rate for Payer: Vantage Medical Group Senior |
$7,413.14
|
|
|
HC BIL STNT PLCMT NEW ACC WO CATH
|
Facility
|
OP
|
$27,853.00
|
|
|
Service Code
|
CPT 47539
|
| Hospital Charge Code |
909047539
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,165.61 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$5,570.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$7,413.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,119.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,154.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,413.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,764.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$11,811.52
|
| Rate for Payer: Blue Shield of California Commercial |
$4,851.77
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$15,319.15
|
| Rate for Payer: Cash Price |
$15,319.15
|
| Rate for Payer: Cash Price |
$15,319.15
|
| Rate for Payer: Central Health Plan Commercial |
$22,282.40
|
| Rate for Payer: Cigna of CA HMO |
$17,825.92
|
| Rate for Payer: Cigna of CA PPO |
$20,611.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,119.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,154.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,413.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,007.74
|
| Rate for Payer: EPIC Health Plan Senior |
$7,413.14
|
| Rate for Payer: Galaxy Health WC |
$23,675.05
|
| Rate for Payer: Global Benefits Group Commercial |
$16,711.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$25,067.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12,157.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7,861.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,413.14
|
| Rate for Payer: InnovAge PACE Commercial |
$11,119.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,577.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,684.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,413.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,570.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,933.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,933.61
|
| Rate for Payer: Multiplan Commercial |
$20,889.75
|
| Rate for Payer: Multiplan WC |
$11,811.52
|
| Rate for Payer: Networks By Design Commercial |
$18,104.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7,413.14
|
| Rate for Payer: Preferred Health Network WC |
$12,052.57
|
| Rate for Payer: Prime Health Services Commercial |
$23,675.05
|
| Rate for Payer: Prime Health Services Medicare |
$7,857.93
|
| Rate for Payer: Prime Health Services WC |
$11,690.99
|
| Rate for Payer: Riverside University Health System MISP |
$8,154.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16,711.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,413.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,119.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,154.45
|
| Rate for Payer: Vantage Medical Group Senior |
$7,413.14
|
|
|
HC BIL STNT PLCMT NEW ACC WO CATH
|
Facility
|
IP
|
$27,853.00
|
|
|
Service Code
|
CPT 47539
|
| Hospital Charge Code |
909047539
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,570.60 |
| Max. Negotiated Rate |
$25,067.70 |
| Rate for Payer: Adventist Health Commercial |
$5,570.60
|
| Rate for Payer: Cash Price |
$15,319.15
|
| Rate for Payer: Central Health Plan Commercial |
$22,282.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,141.20
|
| Rate for Payer: EPIC Health Plan Senior |
$11,141.20
|
| Rate for Payer: Galaxy Health WC |
$23,675.05
|
| Rate for Payer: Global Benefits Group Commercial |
$16,711.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$25,067.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,577.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,611.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,241.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,570.60
|
| Rate for Payer: Multiplan Commercial |
$20,889.75
|
| Rate for Payer: Networks By Design Commercial |
$18,104.45
|
| Rate for Payer: Prime Health Services Commercial |
$23,675.05
|
|
|
HC BINDER ABD 9IN TRI-PANEL S/M
|
Facility
|
OP
|
$152.00
|
|
| Hospital Charge Code |
901698665
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$30.40 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$92.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$129.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$114.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$73.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$89.27
|
| Rate for Payer: Blue Shield of California Commercial |
$92.87
|
| Rate for Payer: Blue Shield of California EPN |
$60.65
|
| Rate for Payer: Cash Price |
$83.60
|
| Rate for Payer: Central Health Plan Commercial |
$121.60
|
| Rate for Payer: Cigna of CA HMO |
$97.28
|
| Rate for Payer: Cigna of CA PPO |
$112.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$129.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$129.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$129.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.80
|
| Rate for Payer: EPIC Health Plan Senior |
$60.80
|
| Rate for Payer: Galaxy Health WC |
$129.20
|
| Rate for Payer: Global Benefits Group Commercial |
$91.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$136.80
|
| Rate for Payer: InnovAge PACE Commercial |
$76.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$101.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$94.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$106.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$106.40
|
| Rate for Payer: Multiplan Commercial |
$114.00
|
| Rate for Payer: Networks By Design Commercial |
$98.80
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
| Rate for Payer: Riverside University Health System MISP |
$60.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$91.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$91.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$76.00
|
| Rate for Payer: United Healthcare All Other HMO |
$76.00
|
| Rate for Payer: United Healthcare HMO Rider |
$76.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$76.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$129.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$129.20
|
| Rate for Payer: Vantage Medical Group Senior |
$129.20
|
|
|
HC BINDER ABD 9IN TRI-PANEL S/M
|
Facility
|
IP
|
$152.00
|
|
| Hospital Charge Code |
901698665
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$30.40 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Cash Price |
$83.60
|
| Rate for Payer: Central Health Plan Commercial |
$121.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.80
|
| Rate for Payer: EPIC Health Plan Senior |
$60.80
|
| Rate for Payer: Galaxy Health WC |
$129.20
|
| Rate for Payer: Global Benefits Group Commercial |
$91.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$136.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$101.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$94.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.40
|
| Rate for Payer: Multiplan Commercial |
$114.00
|
| Rate for Payer: Networks By Design Commercial |
$98.80
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
|
|
HC BIOBAG LARVAE 10X10CM
|
Facility
|
IP
|
$713.00
|
|
| Hospital Charge Code |
901698179
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$142.60 |
| Max. Negotiated Rate |
$641.70 |
| Rate for Payer: Adventist Health Commercial |
$142.60
|
| Rate for Payer: Cash Price |
$392.15
|
| Rate for Payer: Central Health Plan Commercial |
$570.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$285.20
|
| Rate for Payer: EPIC Health Plan Senior |
$285.20
|
| Rate for Payer: Galaxy Health WC |
$606.05
|
| Rate for Payer: Global Benefits Group Commercial |
$427.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$641.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$475.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$271.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$441.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$142.60
|
| Rate for Payer: Multiplan Commercial |
$534.75
|
| Rate for Payer: Networks By Design Commercial |
$463.45
|
| Rate for Payer: Prime Health Services Commercial |
$606.05
|
|
|
HC BIOBAG LARVAE 10X10CM
|
Facility
|
OP
|
$713.00
|
|
| Hospital Charge Code |
901698179
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$142.60 |
| Max. Negotiated Rate |
$641.70 |
| Rate for Payer: Adventist Health Commercial |
$142.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$433.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$606.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$392.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$534.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$345.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$418.74
|
| Rate for Payer: Blue Shield of California Commercial |
$435.64
|
| Rate for Payer: Blue Shield of California EPN |
$284.49
|
| Rate for Payer: Cash Price |
$392.15
|
| Rate for Payer: Central Health Plan Commercial |
$570.40
|
| Rate for Payer: Cigna of CA HMO |
$456.32
|
| Rate for Payer: Cigna of CA PPO |
$527.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$606.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$606.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$606.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$285.20
|
| Rate for Payer: EPIC Health Plan Senior |
$285.20
|
| Rate for Payer: Galaxy Health WC |
$606.05
|
| Rate for Payer: Global Benefits Group Commercial |
$427.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$641.70
|
| Rate for Payer: InnovAge PACE Commercial |
$356.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$475.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$271.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$441.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$142.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$499.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$499.10
|
| Rate for Payer: Multiplan Commercial |
$534.75
|
| Rate for Payer: Networks By Design Commercial |
$463.45
|
| Rate for Payer: Prime Health Services Commercial |
$606.05
|
| Rate for Payer: Riverside University Health System MISP |
$285.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$427.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$427.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$356.50
|
| Rate for Payer: United Healthcare All Other HMO |
$356.50
|
| Rate for Payer: United Healthcare HMO Rider |
$356.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$356.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$606.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$606.05
|
| Rate for Payer: Vantage Medical Group Senior |
$606.05
|
|
|
HC BIOBAG LARVAE 12X6CM
|
Facility
|
OP
|
$2,001.00
|
|
| Hospital Charge Code |
901698178
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$400.20 |
| Max. Negotiated Rate |
$1,800.90 |
| Rate for Payer: Adventist Health Commercial |
$400.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,215.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,700.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,100.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,500.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$968.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,175.19
|
| Rate for Payer: Blue Shield of California Commercial |
$1,222.61
|
| Rate for Payer: Blue Shield of California EPN |
$798.40
|
| Rate for Payer: Cash Price |
$1,100.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,600.80
|
| Rate for Payer: Cigna of CA HMO |
$1,280.64
|
| Rate for Payer: Cigna of CA PPO |
$1,480.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,700.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,700.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,700.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$800.40
|
| Rate for Payer: EPIC Health Plan Senior |
$800.40
|
| Rate for Payer: Galaxy Health WC |
$1,700.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,200.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,800.90
|
| Rate for Payer: InnovAge PACE Commercial |
$1,000.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,334.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$762.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,238.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$400.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,400.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,400.70
|
| Rate for Payer: Multiplan Commercial |
$1,500.75
|
| Rate for Payer: Networks By Design Commercial |
$1,300.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,700.85
|
| Rate for Payer: Riverside University Health System MISP |
$800.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,200.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,200.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,000.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,000.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,000.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,700.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,700.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,700.85
|
|
|
HC BIOBAG LARVAE 12X6CM
|
Facility
|
IP
|
$2,001.00
|
|
| Hospital Charge Code |
901698178
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$400.20 |
| Max. Negotiated Rate |
$1,800.90 |
| Rate for Payer: Adventist Health Commercial |
$400.20
|
| Rate for Payer: Cash Price |
$1,100.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,600.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$800.40
|
| Rate for Payer: EPIC Health Plan Senior |
$800.40
|
| Rate for Payer: Galaxy Health WC |
$1,700.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,200.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,800.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,334.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$762.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,238.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$400.20
|
| Rate for Payer: Multiplan Commercial |
$1,500.75
|
| Rate for Payer: Networks By Design Commercial |
$1,300.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,700.85
|
|
|
HC BIOBAG LARVAE 2.5 X 4CM
|
Facility
|
OP
|
$1,817.00
|
|
| Hospital Charge Code |
901698175
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$363.40 |
| Max. Negotiated Rate |
$1,635.30 |
| Rate for Payer: Adventist Health Commercial |
$363.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,103.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,544.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$999.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,362.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$879.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,067.12
|
| Rate for Payer: Blue Shield of California Commercial |
$1,110.19
|
| Rate for Payer: Blue Shield of California EPN |
$724.98
|
| Rate for Payer: Cash Price |
$999.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,453.60
|
| Rate for Payer: Cigna of CA HMO |
$1,162.88
|
| Rate for Payer: Cigna of CA PPO |
$1,344.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,544.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,544.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,544.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$726.80
|
| Rate for Payer: EPIC Health Plan Senior |
$726.80
|
| Rate for Payer: Galaxy Health WC |
$1,544.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,090.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,635.30
|
| Rate for Payer: InnovAge PACE Commercial |
$908.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,211.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$692.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,124.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$363.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,271.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,271.90
|
| Rate for Payer: Multiplan Commercial |
$1,362.75
|
| Rate for Payer: Networks By Design Commercial |
$1,181.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,544.45
|
| Rate for Payer: Riverside University Health System MISP |
$726.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,090.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,090.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$908.50
|
| Rate for Payer: United Healthcare All Other HMO |
$908.50
|
| Rate for Payer: United Healthcare HMO Rider |
$908.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$908.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,544.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,544.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1,544.45
|
|
|
HC BIOBAG LARVAE 2.5 X 4CM
|
Facility
|
IP
|
$1,817.00
|
|
| Hospital Charge Code |
901698175
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$363.40 |
| Max. Negotiated Rate |
$1,635.30 |
| Rate for Payer: Adventist Health Commercial |
$363.40
|
| Rate for Payer: Cash Price |
$999.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,453.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$726.80
|
| Rate for Payer: EPIC Health Plan Senior |
$726.80
|
| Rate for Payer: Galaxy Health WC |
$1,544.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,090.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,635.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,211.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$692.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,124.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$363.40
|
| Rate for Payer: Multiplan Commercial |
$1,362.75
|
| Rate for Payer: Networks By Design Commercial |
$1,181.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,544.45
|
|
|
HC BIOBAG LARVAE 5X4CM
|
Facility
|
IP
|
$1,863.00
|
|
| Hospital Charge Code |
901698176
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$372.60 |
| Max. Negotiated Rate |
$1,676.70 |
| Rate for Payer: Adventist Health Commercial |
$372.60
|
| Rate for Payer: Cash Price |
$1,024.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,490.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$745.20
|
| Rate for Payer: EPIC Health Plan Senior |
$745.20
|
| Rate for Payer: Galaxy Health WC |
$1,583.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,117.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,676.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,242.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$709.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,153.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$372.60
|
| Rate for Payer: Multiplan Commercial |
$1,397.25
|
| Rate for Payer: Networks By Design Commercial |
$1,210.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,583.55
|
|
|
HC BIOBAG LARVAE 5X4CM
|
Facility
|
OP
|
$1,863.00
|
|
| Hospital Charge Code |
901698176
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$372.60 |
| Max. Negotiated Rate |
$1,676.70 |
| Rate for Payer: Adventist Health Commercial |
$372.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,131.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,583.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,024.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,397.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$902.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,094.14
|
| Rate for Payer: Blue Shield of California Commercial |
$1,138.29
|
| Rate for Payer: Blue Shield of California EPN |
$743.34
|
| Rate for Payer: Cash Price |
$1,024.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,490.40
|
| Rate for Payer: Cigna of CA HMO |
$1,192.32
|
| Rate for Payer: Cigna of CA PPO |
$1,378.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,583.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,583.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,583.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$745.20
|
| Rate for Payer: EPIC Health Plan Senior |
$745.20
|
| Rate for Payer: Galaxy Health WC |
$1,583.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,117.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,676.70
|
| Rate for Payer: InnovAge PACE Commercial |
$931.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,242.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$709.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,153.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$372.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,304.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,304.10
|
| Rate for Payer: Multiplan Commercial |
$1,397.25
|
| Rate for Payer: Networks By Design Commercial |
$1,210.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,583.55
|
| Rate for Payer: Riverside University Health System MISP |
$745.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,117.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,117.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$931.50
|
| Rate for Payer: United Healthcare All Other HMO |
$931.50
|
| Rate for Payer: United Healthcare HMO Rider |
$931.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$931.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,583.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,583.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,583.55
|
|
|
HC BIOBAG LARVAE 6X5CM
|
Facility
|
IP
|
$1,909.00
|
|
| Hospital Charge Code |
901698177
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$381.80 |
| Max. Negotiated Rate |
$1,718.10 |
| Rate for Payer: Adventist Health Commercial |
$381.80
|
| Rate for Payer: Cash Price |
$1,049.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,527.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$763.60
|
| Rate for Payer: EPIC Health Plan Senior |
$763.60
|
| Rate for Payer: Galaxy Health WC |
$1,622.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,145.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,718.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,273.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$727.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,181.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$381.80
|
| Rate for Payer: Multiplan Commercial |
$1,431.75
|
| Rate for Payer: Networks By Design Commercial |
$1,240.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,622.65
|
|
