|
HC B/S EMBLEM 3501
|
Facility
|
OP
|
$12,500.00
|
|
|
Service Code
|
CPT C1896
|
| Hospital Charge Code |
906813815
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,500.00 |
| Max. Negotiated Rate |
$11,250.00 |
| Rate for Payer: Adventist Health Commercial |
$2,500.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,625.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,875.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,375.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,052.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,341.25
|
| Rate for Payer: Blue Shield of California Commercial |
$9,662.50
|
| Rate for Payer: Blue Shield of California EPN |
$6,300.00
|
| Rate for Payer: Cash Price |
$6,875.00
|
| Rate for Payer: Central Health Plan Commercial |
$10,000.00
|
| Rate for Payer: Cigna of CA HMO |
$8,750.00
|
| Rate for Payer: Cigna of CA PPO |
$8,750.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,625.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,625.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,625.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,000.00
|
| Rate for Payer: Galaxy Health WC |
$10,625.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,500.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,250.00
|
| Rate for Payer: InnovAge PACE Commercial |
$6,250.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,337.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,737.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,500.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,750.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,750.00
|
| Rate for Payer: Multiplan Commercial |
$9,375.00
|
| Rate for Payer: Networks By Design Commercial |
$6,250.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,625.00
|
| Rate for Payer: Riverside University Health System MISP |
$5,000.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,500.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,500.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,691.25
|
| Rate for Payer: United Healthcare All Other HMO |
$4,566.25
|
| Rate for Payer: United Healthcare HMO Rider |
$4,467.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,093.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,625.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,625.00
|
| Rate for Payer: Vantage Medical Group Senior |
$10,625.00
|
|
|
HC BTTN MINI 1 12FRX0.8CM BLLN LP
|
Facility
|
OP
|
$939.27
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901696291
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$187.85 |
| Max. Negotiated Rate |
$845.34 |
| Rate for Payer: Adventist Health Commercial |
$187.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$570.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$798.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$516.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$704.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$454.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$551.63
|
| Rate for Payer: Blue Shield of California Commercial |
$573.89
|
| Rate for Payer: Blue Shield of California EPN |
$374.77
|
| Rate for Payer: Cash Price |
$516.60
|
| Rate for Payer: Central Health Plan Commercial |
$751.42
|
| Rate for Payer: Cigna of CA HMO |
$601.13
|
| Rate for Payer: Cigna of CA PPO |
$695.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$798.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$798.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$798.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$375.71
|
| Rate for Payer: EPIC Health Plan Senior |
$375.71
|
| Rate for Payer: Galaxy Health WC |
$798.38
|
| Rate for Payer: Global Benefits Group Commercial |
$563.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$845.34
|
| Rate for Payer: InnovAge PACE Commercial |
$469.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$626.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$357.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$581.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$657.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$657.49
|
| Rate for Payer: Multiplan Commercial |
$704.45
|
| Rate for Payer: Networks By Design Commercial |
$610.53
|
| Rate for Payer: Prime Health Services Commercial |
$798.38
|
| Rate for Payer: Riverside University Health System MISP |
$375.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$563.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$563.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$469.63
|
| Rate for Payer: United Healthcare All Other HMO |
$469.63
|
| Rate for Payer: United Healthcare HMO Rider |
$469.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$469.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$798.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$798.38
|
| Rate for Payer: Vantage Medical Group Senior |
$798.38
|
|
|
HC BTTN MINI 1 12FRX0.8CM BLLN LP
|
Facility
|
IP
|
$939.27
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901696291
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$187.85 |
| Max. Negotiated Rate |
$845.34 |
| Rate for Payer: Adventist Health Commercial |
$187.85
|
| Rate for Payer: Cash Price |
$516.60
|
| Rate for Payer: Central Health Plan Commercial |
$751.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$375.71
|
| Rate for Payer: EPIC Health Plan Senior |
$375.71
|
| Rate for Payer: Galaxy Health WC |
$798.38
|
| Rate for Payer: Global Benefits Group Commercial |
$563.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$845.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$626.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$357.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$581.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.85
|
| Rate for Payer: Multiplan Commercial |
$704.45
|
| Rate for Payer: Networks By Design Commercial |
$610.53
|
| Rate for Payer: Prime Health Services Commercial |
$798.38
|
|
|
HC BTTN MINI 1 12FRX1.0CM BLLN LP
|
Facility
|
OP
|
$939.27
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901696292
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$187.85 |
| Max. Negotiated Rate |
$845.34 |
| Rate for Payer: Adventist Health Commercial |
$187.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$570.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$798.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$516.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$704.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$454.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$551.63
|
| Rate for Payer: Blue Shield of California Commercial |
$573.89
|
| Rate for Payer: Blue Shield of California EPN |
$374.77
|
| Rate for Payer: Cash Price |
$516.60
|
| Rate for Payer: Central Health Plan Commercial |
$751.42
|
| Rate for Payer: Cigna of CA HMO |
$601.13
|
| Rate for Payer: Cigna of CA PPO |
$695.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$798.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$798.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$798.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$375.71
|
| Rate for Payer: EPIC Health Plan Senior |
$375.71
|
| Rate for Payer: Galaxy Health WC |
$798.38
|
| Rate for Payer: Global Benefits Group Commercial |
$563.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$845.34
|
| Rate for Payer: InnovAge PACE Commercial |
$469.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$626.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$357.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$581.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$657.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$657.49
|
| Rate for Payer: Multiplan Commercial |
$704.45
|
| Rate for Payer: Networks By Design Commercial |
$610.53
|
| Rate for Payer: Prime Health Services Commercial |
$798.38
|
| Rate for Payer: Riverside University Health System MISP |
$375.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$563.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$563.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$469.63
|
| Rate for Payer: United Healthcare All Other HMO |
$469.63
|
| Rate for Payer: United Healthcare HMO Rider |
$469.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$469.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$798.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$798.38
|
| Rate for Payer: Vantage Medical Group Senior |
$798.38
|
|
|
HC BTTN MINI 1 12FRX1.0CM BLLN LP
|
Facility
|
IP
|
$939.27
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901696292
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$187.85 |
| Max. Negotiated Rate |
$845.34 |
| Rate for Payer: Adventist Health Commercial |
$187.85
|
| Rate for Payer: Cash Price |
$516.60
|
| Rate for Payer: Central Health Plan Commercial |
$751.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$375.71
|
| Rate for Payer: EPIC Health Plan Senior |
$375.71
|
| Rate for Payer: Galaxy Health WC |
$798.38
|
| Rate for Payer: Global Benefits Group Commercial |
$563.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$845.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$626.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$357.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$581.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.85
|
| Rate for Payer: Multiplan Commercial |
$704.45
|
| Rate for Payer: Networks By Design Commercial |
$610.53
|
| Rate for Payer: Prime Health Services Commercial |
$798.38
|
|
|
HC BTTN MINI 1 14FRX1.0CM BLLN LP
|
Facility
|
OP
|
$246.96
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901696293
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.39 |
| Max. Negotiated Rate |
$222.26 |
| Rate for Payer: Adventist Health Commercial |
$49.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$149.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$209.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$135.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$185.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$119.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$145.04
|
| Rate for Payer: Blue Shield of California Commercial |
$150.89
|
| Rate for Payer: Blue Shield of California EPN |
$98.54
|
| Rate for Payer: Cash Price |
$135.83
|
| Rate for Payer: Central Health Plan Commercial |
$197.57
|
| Rate for Payer: Cigna of CA HMO |
$158.05
|
| Rate for Payer: Cigna of CA PPO |
$182.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$209.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$209.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$209.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.78
|
| Rate for Payer: EPIC Health Plan Senior |
$98.78
|
| Rate for Payer: Galaxy Health WC |
$209.92
|
| Rate for Payer: Global Benefits Group Commercial |
$148.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$222.26
|
| Rate for Payer: InnovAge PACE Commercial |
$123.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$164.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$152.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$172.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$172.87
|
| Rate for Payer: Multiplan Commercial |
$185.22
|
| Rate for Payer: Networks By Design Commercial |
$160.52
|
| Rate for Payer: Prime Health Services Commercial |
$209.92
|
| Rate for Payer: Riverside University Health System MISP |
$98.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$148.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$148.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.48
|
| Rate for Payer: United Healthcare All Other HMO |
$123.48
|
| Rate for Payer: United Healthcare HMO Rider |
$123.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$209.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$209.92
|
| Rate for Payer: Vantage Medical Group Senior |
$209.92
|
|
|
HC BTTN MINI 1 14FRX1.0CM BLLN LP
|
Facility
|
IP
|
$246.96
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901696293
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.39 |
| Max. Negotiated Rate |
$222.26 |
| Rate for Payer: Adventist Health Commercial |
$49.39
|
| Rate for Payer: Cash Price |
$135.83
|
| Rate for Payer: Central Health Plan Commercial |
$197.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.78
|
| Rate for Payer: EPIC Health Plan Senior |
$98.78
|
| Rate for Payer: Galaxy Health WC |
$209.92
|
| Rate for Payer: Global Benefits Group Commercial |
$148.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$222.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$164.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$152.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.39
|
| Rate for Payer: Multiplan Commercial |
$185.22
|
| Rate for Payer: Networks By Design Commercial |
$160.52
|
| Rate for Payer: Prime Health Services Commercial |
$209.92
|
|
|
HC BTTN MINI 1 14FRX1.2CM BLLN LP
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901696294
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$352.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$280.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$340.63
|
| Rate for Payer: Blue Shield of California Commercial |
$354.38
|
| Rate for Payer: Blue Shield of California EPN |
$231.42
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Cigna of CA HMO |
$371.20
|
| Rate for Payer: Cigna of CA PPO |
$429.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$493.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: InnovAge PACE Commercial |
$290.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$406.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Riverside University Health System MISP |
$232.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$290.00
|
| Rate for Payer: United Healthcare All Other HMO |
$290.00
|
| Rate for Payer: United Healthcare HMO Rider |
$290.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC BTTN MINI 1 14FRX1.2CM BLLN LP
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901696294
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
|
|
HC BTTN MINI 1 14FRX1.7CM BLLN LP
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901696296
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
|
|
HC BTTN MINI 1 14FRX1.7CM BLLN LP
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901696296
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$352.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$280.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$340.63
|
| Rate for Payer: Blue Shield of California Commercial |
$354.38
|
| Rate for Payer: Blue Shield of California EPN |
$231.42
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Cigna of CA HMO |
$371.20
|
| Rate for Payer: Cigna of CA PPO |
$429.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$493.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: InnovAge PACE Commercial |
$290.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$406.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Riverside University Health System MISP |
$232.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$290.00
|
| Rate for Payer: United Healthcare All Other HMO |
$290.00
|
| Rate for Payer: United Healthcare HMO Rider |
$290.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC BTTN MINI 1 14FRX2.0CM BLLN LP
|
Facility
|
IP
|
$643.45
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901696297
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$128.69 |
| Max. Negotiated Rate |
$579.11 |
| Rate for Payer: Adventist Health Commercial |
$128.69
|
| Rate for Payer: Cash Price |
$353.90
|
| Rate for Payer: Central Health Plan Commercial |
$514.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$257.38
|
| Rate for Payer: EPIC Health Plan Senior |
$257.38
|
| Rate for Payer: Galaxy Health WC |
$546.93
|
| Rate for Payer: Global Benefits Group Commercial |
$386.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$579.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$429.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$245.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$398.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.69
|
| Rate for Payer: Multiplan Commercial |
$482.59
|
| Rate for Payer: Networks By Design Commercial |
$418.24
|
| Rate for Payer: Prime Health Services Commercial |
$546.93
|
|
|
HC BTTN MINI 1 14FRX2.0CM BLLN LP
|
Facility
|
OP
|
$643.45
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901696297
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$128.69 |
| Max. Negotiated Rate |
$579.11 |
| Rate for Payer: Adventist Health Commercial |
$128.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$390.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$546.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$353.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$482.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$311.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$377.90
|
| Rate for Payer: Blue Shield of California Commercial |
$393.15
|
| Rate for Payer: Blue Shield of California EPN |
$256.74
|
| Rate for Payer: Cash Price |
$353.90
|
| Rate for Payer: Central Health Plan Commercial |
$514.76
|
| Rate for Payer: Cigna of CA HMO |
$411.81
|
| Rate for Payer: Cigna of CA PPO |
$476.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$546.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$546.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$546.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$257.38
|
| Rate for Payer: EPIC Health Plan Senior |
$257.38
|
| Rate for Payer: Galaxy Health WC |
$546.93
|
| Rate for Payer: Global Benefits Group Commercial |
$386.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$579.11
|
| Rate for Payer: InnovAge PACE Commercial |
$321.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$429.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$245.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$398.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$450.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$450.42
|
| Rate for Payer: Multiplan Commercial |
$482.59
|
| Rate for Payer: Networks By Design Commercial |
$418.24
|
| Rate for Payer: Prime Health Services Commercial |
$546.93
|
| Rate for Payer: Riverside University Health System MISP |
$257.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$386.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$386.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$321.73
|
| Rate for Payer: United Healthcare All Other HMO |
$321.73
|
| Rate for Payer: United Healthcare HMO Rider |
$321.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$321.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$546.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$546.93
|
| Rate for Payer: Vantage Medical Group Senior |
$546.93
|
|
|
HC BTTN MINI 14FRX1.5CM
|
Facility
|
IP
|
$512.60
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901696295
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$102.52 |
| Max. Negotiated Rate |
$461.34 |
| Rate for Payer: Adventist Health Commercial |
$102.52
|
| Rate for Payer: Cash Price |
$281.93
|
| Rate for Payer: Central Health Plan Commercial |
$410.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$205.04
|
| Rate for Payer: EPIC Health Plan Senior |
$205.04
|
| Rate for Payer: Galaxy Health WC |
$435.71
|
| Rate for Payer: Global Benefits Group Commercial |
$307.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$461.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$341.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$195.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$317.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.52
|
| Rate for Payer: Multiplan Commercial |
$384.45
|
| Rate for Payer: Networks By Design Commercial |
$333.19
|
| Rate for Payer: Prime Health Services Commercial |
$435.71
|
|
|
HC BTTN MINI 14FRX1.5CM
|
Facility
|
OP
|
$512.60
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901696295
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$102.52 |
| Max. Negotiated Rate |
$461.34 |
| Rate for Payer: Adventist Health Commercial |
$102.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$311.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$435.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$281.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$384.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$248.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$301.05
|
| Rate for Payer: Blue Shield of California Commercial |
$313.20
|
| Rate for Payer: Blue Shield of California EPN |
$204.53
|
| Rate for Payer: Cash Price |
$281.93
|
| Rate for Payer: Central Health Plan Commercial |
$410.08
|
| Rate for Payer: Cigna of CA HMO |
$328.06
|
| Rate for Payer: Cigna of CA PPO |
$379.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$435.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$435.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$435.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$205.04
|
| Rate for Payer: EPIC Health Plan Senior |
$205.04
|
| Rate for Payer: Galaxy Health WC |
$435.71
|
| Rate for Payer: Global Benefits Group Commercial |
$307.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$461.34
|
| Rate for Payer: InnovAge PACE Commercial |
$256.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$341.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$195.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$317.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$358.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$358.82
|
| Rate for Payer: Multiplan Commercial |
$384.45
|
| Rate for Payer: Networks By Design Commercial |
$333.19
|
| Rate for Payer: Prime Health Services Commercial |
$435.71
|
| Rate for Payer: Riverside University Health System MISP |
$205.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$307.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$307.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$256.30
|
| Rate for Payer: United Healthcare All Other HMO |
$256.30
|
| Rate for Payer: United Healthcare HMO Rider |
$256.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$256.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$435.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$435.71
|
| Rate for Payer: Vantage Medical Group Senior |
$435.71
|
|
|
HC BUFFY COAT EXAM
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
CPT 85009
|
| Hospital Charge Code |
900910196
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$27.04 |
| Rate for Payer: Adventist Health Commercial |
$2.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$27.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.49
|
| Rate for Payer: Blue Shield of California Commercial |
$8.50
|
| Rate for Payer: Blue Shield of California EPN |
$5.56
|
| Rate for Payer: Cash Price |
$7.70
|
| Rate for Payer: Cash Price |
$7.70
|
| Rate for Payer: Central Health Plan Commercial |
$11.20
|
| Rate for Payer: Cigna of CA HMO |
$8.96
|
| Rate for Payer: Cigna of CA PPO |
$10.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.84
|
| Rate for Payer: EPIC Health Plan Senior |
$5.07
|
| Rate for Payer: Galaxy Health WC |
$11.90
|
| Rate for Payer: Global Benefits Group Commercial |
$8.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.07
|
| Rate for Payer: InnovAge PACE Commercial |
$7.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.79
|
| Rate for Payer: Multiplan Commercial |
$10.50
|
| Rate for Payer: Networks By Design Commercial |
$9.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.07
|
| Rate for Payer: Prime Health Services Commercial |
$11.90
|
| Rate for Payer: Prime Health Services Medicare |
$5.37
|
| Rate for Payer: Riverside University Health System MISP |
$5.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.10
|
| Rate for Payer: United Healthcare All Other HMO |
$4.10
|
| Rate for Payer: United Healthcare HMO Rider |
$4.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.10
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.58
|
| Rate for Payer: Vantage Medical Group Senior |
$5.07
|
|
|
HC BUFFY COAT EXAM
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
CPT 85009
|
| Hospital Charge Code |
900910196
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$12.60 |
| Rate for Payer: Adventist Health Commercial |
$2.80
|
| Rate for Payer: Cash Price |
$7.70
|
| Rate for Payer: Central Health Plan Commercial |
$11.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.60
|
| Rate for Payer: EPIC Health Plan Senior |
$5.60
|
| Rate for Payer: Galaxy Health WC |
$11.90
|
| Rate for Payer: Global Benefits Group Commercial |
$8.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.80
|
| Rate for Payer: Multiplan Commercial |
$10.50
|
| Rate for Payer: Networks By Design Commercial |
$9.10
|
| Rate for Payer: Prime Health Services Commercial |
$11.90
|
|
|
HC BULB RESERVOIR JACKSON PRATT
|
Facility
|
IP
|
$44.77
|
|
| Hospital Charge Code |
901604267
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.95 |
| Max. Negotiated Rate |
$40.29 |
| Rate for Payer: Adventist Health Commercial |
$8.95
|
| Rate for Payer: Cash Price |
$24.62
|
| Rate for Payer: Central Health Plan Commercial |
$35.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.91
|
| Rate for Payer: EPIC Health Plan Senior |
$17.91
|
| Rate for Payer: Galaxy Health WC |
$38.05
|
| Rate for Payer: Global Benefits Group Commercial |
$26.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.95
|
| Rate for Payer: Multiplan Commercial |
$33.58
|
| Rate for Payer: Networks By Design Commercial |
$29.10
|
| Rate for Payer: Prime Health Services Commercial |
$38.05
|
|
|
HC BULB RESERVOIR JACKSON PRATT
|
Facility
|
OP
|
$44.77
|
|
| Hospital Charge Code |
901604267
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.95 |
| Max. Negotiated Rate |
$40.29 |
| Rate for Payer: Adventist Health Commercial |
$8.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.29
|
| Rate for Payer: Blue Shield of California Commercial |
$27.35
|
| Rate for Payer: Blue Shield of California EPN |
$17.86
|
| Rate for Payer: Cash Price |
$24.62
|
| Rate for Payer: Central Health Plan Commercial |
$35.82
|
| Rate for Payer: Cigna of CA HMO |
$28.65
|
| Rate for Payer: Cigna of CA PPO |
$33.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$38.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.91
|
| Rate for Payer: EPIC Health Plan Senior |
$17.91
|
| Rate for Payer: Galaxy Health WC |
$38.05
|
| Rate for Payer: Global Benefits Group Commercial |
$26.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.29
|
| Rate for Payer: InnovAge PACE Commercial |
$22.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31.34
|
| Rate for Payer: Multiplan Commercial |
$33.58
|
| Rate for Payer: Networks By Design Commercial |
$29.10
|
| Rate for Payer: Prime Health Services Commercial |
$38.05
|
| Rate for Payer: Riverside University Health System MISP |
$17.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.39
|
| Rate for Payer: United Healthcare All Other HMO |
$22.39
|
| Rate for Payer: United Healthcare HMO Rider |
$22.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.05
|
| Rate for Payer: Vantage Medical Group Senior |
$38.05
|
|
|
HC BUN
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
900910253
|
|
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 BUN
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
900910253
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Adventist Health Commercial |
$6.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$3.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$20.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$28.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.82
|
| 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 |
$5.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.33
|
| Rate for Payer: EPIC Health Plan Senior |
$3.95
|
| 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 |
$6.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.95
|
| Rate for Payer: InnovAge PACE Commercial |
$5.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.29
|
| 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 |
$3.95
|
| Rate for Payer: Prime Health Services Commercial |
$28.90
|
| Rate for Payer: Prime Health Services Medicare |
$4.19
|
| Rate for Payer: Riverside University Health System MISP |
$4.34
|
| 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 |
$3.20
|
| Rate for Payer: United Healthcare All Other HMO |
$3.20
|
| Rate for Payer: United Healthcare HMO Rider |
$3.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.20
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.34
|
| Rate for Payer: Vantage Medical Group Senior |
$3.95
|
|
|
HC BUN BODY FLUID
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
900912241
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$34.20 |
| Rate for Payer: Adventist Health Commercial |
$7.60
|
| Rate for Payer: Cash Price |
$20.90
|
| Rate for Payer: Central Health Plan Commercial |
$30.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.20
|
| Rate for Payer: EPIC Health Plan Senior |
$15.20
|
| Rate for Payer: Galaxy Health WC |
$32.30
|
| Rate for Payer: Global Benefits Group Commercial |
$22.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.60
|
| Rate for Payer: Multiplan Commercial |
$28.50
|
| Rate for Payer: Networks By Design Commercial |
$24.70
|
| Rate for Payer: Prime Health Services Commercial |
$32.30
|
|
|
HC BUN BODY FLUID
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
900912241
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$34.20 |
| Rate for Payer: Adventist Health Commercial |
$7.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$3.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$28.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.82
|
| Rate for Payer: Blue Shield of California Commercial |
$23.07
|
| Rate for Payer: Blue Shield of California EPN |
$15.09
|
| Rate for Payer: Cash Price |
$20.90
|
| Rate for Payer: Cash Price |
$20.90
|
| Rate for Payer: Central Health Plan Commercial |
$30.40
|
| Rate for Payer: Cigna of CA HMO |
$24.32
|
| Rate for Payer: Cigna of CA PPO |
$28.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.33
|
| Rate for Payer: EPIC Health Plan Senior |
$3.95
|
| Rate for Payer: Galaxy Health WC |
$32.30
|
| Rate for Payer: Global Benefits Group Commercial |
$22.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.95
|
| Rate for Payer: InnovAge PACE Commercial |
$5.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.29
|
| Rate for Payer: Multiplan Commercial |
$28.50
|
| Rate for Payer: Networks By Design Commercial |
$24.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3.95
|
| Rate for Payer: Prime Health Services Commercial |
$32.30
|
| Rate for Payer: Prime Health Services Medicare |
$4.19
|
| Rate for Payer: Riverside University Health System MISP |
$4.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.20
|
| Rate for Payer: United Healthcare All Other HMO |
$3.20
|
| Rate for Payer: United Healthcare HMO Rider |
$3.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.20
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.34
|
| Rate for Payer: Vantage Medical Group Senior |
$3.95
|
|
|
HC BURR HOLES/ICP
|
Facility
|
IP
|
$1,393.00
|
|
|
Service Code
|
CPT 61105
|
| Hospital Charge Code |
988161105
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$278.60 |
| Max. Negotiated Rate |
$1,253.70 |
| Rate for Payer: Adventist Health Commercial |
$278.60
|
| Rate for Payer: Cash Price |
$766.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,114.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$557.20
|
| Rate for Payer: EPIC Health Plan Senior |
$557.20
|
| Rate for Payer: Galaxy Health WC |
$1,184.05
|
| Rate for Payer: Global Benefits Group Commercial |
$835.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,253.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$929.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$530.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$862.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$278.60
|
| Rate for Payer: Multiplan Commercial |
$1,044.75
|
| Rate for Payer: Networks By Design Commercial |
$905.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,184.05
|
|
|
HC BURR HOLES/ICP
|
Facility
|
OP
|
$1,393.00
|
|
|
Service Code
|
CPT 61105
|
| Hospital Charge Code |
988161105
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$278.60 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$278.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,184.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$766.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,044.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$766.15
|
| Rate for Payer: Cash Price |
$766.15
|
| Rate for Payer: Cash Price |
$766.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,114.40
|
| Rate for Payer: Cigna of CA HMO |
$891.52
|
| Rate for Payer: Cigna of CA PPO |
$1,030.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,184.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,184.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,184.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$557.20
|
| Rate for Payer: EPIC Health Plan Senior |
$557.20
|
| Rate for Payer: Galaxy Health WC |
$1,184.05
|
| Rate for Payer: Global Benefits Group Commercial |
$835.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,253.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$507.80
|
| Rate for Payer: InnovAge PACE Commercial |
$696.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$929.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$560.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$862.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$278.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$975.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$975.10
|
| Rate for Payer: Multiplan Commercial |
$1,044.75
|
| Rate for Payer: Networks By Design Commercial |
$905.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,184.05
|
| Rate for Payer: Riverside University Health System MISP |
$557.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$835.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,184.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,184.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1,184.05
|
|
