|
HC CATH WHISTLE TIP 14-16FR
|
Facility
|
IP
|
$11.73
|
|
| Hospital Charge Code |
901601348
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$10.56 |
| Rate for Payer: Adventist Health Commercial |
$2.35
|
| Rate for Payer: Cash Price |
$6.45
|
| Rate for Payer: Central Health Plan Commercial |
$9.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.69
|
| Rate for Payer: EPIC Health Plan Senior |
$4.69
|
| Rate for Payer: Galaxy Health WC |
$9.97
|
| Rate for Payer: Global Benefits Group Commercial |
$7.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.35
|
| Rate for Payer: Multiplan Commercial |
$8.80
|
| Rate for Payer: Networks By Design Commercial |
$7.62
|
| Rate for Payer: Prime Health Services Commercial |
$9.97
|
|
|
HC CATH WHISTLE TIP 8FR
|
Facility
|
OP
|
$11.73
|
|
| Hospital Charge Code |
901601473
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$10.56 |
| Rate for Payer: Adventist Health Commercial |
$2.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.89
|
| Rate for Payer: Blue Shield of California Commercial |
$7.17
|
| Rate for Payer: Blue Shield of California EPN |
$4.68
|
| Rate for Payer: Cash Price |
$6.45
|
| Rate for Payer: Central Health Plan Commercial |
$9.38
|
| Rate for Payer: Cigna of CA HMO |
$7.51
|
| Rate for Payer: Cigna of CA PPO |
$8.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.69
|
| Rate for Payer: EPIC Health Plan Senior |
$4.69
|
| Rate for Payer: Galaxy Health WC |
$9.97
|
| Rate for Payer: Global Benefits Group Commercial |
$7.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.56
|
| Rate for Payer: InnovAge PACE Commercial |
$5.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.21
|
| Rate for Payer: Multiplan Commercial |
$8.80
|
| Rate for Payer: Networks By Design Commercial |
$7.62
|
| Rate for Payer: Prime Health Services Commercial |
$9.97
|
| Rate for Payer: Riverside University Health System MISP |
$4.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.87
|
| Rate for Payer: United Healthcare All Other HMO |
$5.87
|
| Rate for Payer: United Healthcare HMO Rider |
$5.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.97
|
| Rate for Payer: Vantage Medical Group Senior |
$9.97
|
|
|
HC CATH WHISTLE TIP 8FR
|
Facility
|
IP
|
$11.73
|
|
| Hospital Charge Code |
901601473
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$10.56 |
| Rate for Payer: Adventist Health Commercial |
$2.35
|
| Rate for Payer: Cash Price |
$6.45
|
| Rate for Payer: Central Health Plan Commercial |
$9.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.69
|
| Rate for Payer: EPIC Health Plan Senior |
$4.69
|
| Rate for Payer: Galaxy Health WC |
$9.97
|
| Rate for Payer: Global Benefits Group Commercial |
$7.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.35
|
| Rate for Payer: Multiplan Commercial |
$8.80
|
| Rate for Payer: Networks By Design Commercial |
$7.62
|
| Rate for Payer: Prime Health Services Commercial |
$9.97
|
|
|
HC CATH WINGMAN CROSSING
|
Facility
|
OP
|
$3,881.00
|
|
|
Service Code
|
CPT C1714
|
| Hospital Charge Code |
909000020
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$776.20 |
| Max. Negotiated Rate |
$3,492.90 |
| Rate for Payer: Adventist Health Commercial |
$776.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,356.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,298.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,134.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,910.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,879.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,279.31
|
| Rate for Payer: Blue Shield of California Commercial |
$2,371.29
|
| Rate for Payer: Blue Shield of California EPN |
$1,548.52
|
| Rate for Payer: Cash Price |
$2,134.55
|
| Rate for Payer: Central Health Plan Commercial |
$3,104.80
|
| Rate for Payer: Cigna of CA HMO |
$2,483.84
|
| Rate for Payer: Cigna of CA PPO |
$2,871.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,298.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,298.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,298.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,552.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,552.40
|
| Rate for Payer: Galaxy Health WC |
$3,298.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,328.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,492.90
|
| Rate for Payer: InnovAge PACE Commercial |
$1,940.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,588.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,478.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,402.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$776.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,716.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,716.70
|
| Rate for Payer: Multiplan Commercial |
$2,910.75
|
| Rate for Payer: Networks By Design Commercial |
$2,522.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,298.85
|
| Rate for Payer: Riverside University Health System MISP |
$1,552.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,328.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,328.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,940.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,940.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,940.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,940.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,298.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,298.85
|
| Rate for Payer: Vantage Medical Group Senior |
$3,298.85
|
|
|
HC CATH WINGMAN CROSSING
|
Facility
|
IP
|
$3,881.00
|
|
|
Service Code
|
CPT C1714
|
| Hospital Charge Code |
909000020
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$776.20 |
| Max. Negotiated Rate |
$3,492.90 |
| Rate for Payer: Adventist Health Commercial |
$776.20
|
| Rate for Payer: Cash Price |
$2,134.55
|
| Rate for Payer: Central Health Plan Commercial |
$3,104.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,552.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,552.40
|
| Rate for Payer: Galaxy Health WC |
$3,298.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,328.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,492.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,588.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,478.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,402.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$776.20
|
| Rate for Payer: Multiplan Commercial |
$2,910.75
|
| Rate for Payer: Networks By Design Commercial |
$2,522.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,298.85
|
|
|
HC CAUTERY COVIDIEN BLADE
|
Facility
|
OP
|
$26.00
|
|
| Hospital Charge Code |
906812611
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$23.40 |
| Rate for Payer: Adventist Health Commercial |
$5.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.27
|
| Rate for Payer: Blue Shield of California Commercial |
$15.89
|
| Rate for Payer: Blue Shield of California EPN |
$10.37
|
| Rate for Payer: Cash Price |
$14.30
|
| Rate for Payer: Central Health Plan Commercial |
$20.80
|
| Rate for Payer: Cigna of CA HMO |
$16.64
|
| Rate for Payer: Cigna of CA PPO |
$19.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.40
|
| Rate for Payer: EPIC Health Plan Senior |
$10.40
|
| Rate for Payer: Galaxy Health WC |
$22.10
|
| Rate for Payer: Global Benefits Group Commercial |
$15.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.40
|
| Rate for Payer: InnovAge PACE Commercial |
$13.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.20
|
| Rate for Payer: Multiplan Commercial |
$19.50
|
| Rate for Payer: Networks By Design Commercial |
$16.90
|
| Rate for Payer: Prime Health Services Commercial |
$22.10
|
| Rate for Payer: Riverside University Health System MISP |
$10.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.00
|
| Rate for Payer: United Healthcare All Other HMO |
$13.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.10
|
| Rate for Payer: Vantage Medical Group Senior |
$22.10
|
|
|
HC CAUTERY COVIDIEN BLADE
|
Facility
|
IP
|
$26.00
|
|
| Hospital Charge Code |
906812611
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$23.40 |
| Rate for Payer: Adventist Health Commercial |
$5.20
|
| Rate for Payer: Cash Price |
$14.30
|
| Rate for Payer: Central Health Plan Commercial |
$20.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.40
|
| Rate for Payer: EPIC Health Plan Senior |
$10.40
|
| Rate for Payer: Galaxy Health WC |
$22.10
|
| Rate for Payer: Global Benefits Group Commercial |
$15.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.20
|
| Rate for Payer: Multiplan Commercial |
$19.50
|
| Rate for Payer: Networks By Design Commercial |
$16.90
|
| Rate for Payer: Prime Health Services Commercial |
$22.10
|
|
|
HC CAUTERY MED AQUAMANTYS SEALER
|
Facility
|
IP
|
$2,275.62
|
|
| Hospital Charge Code |
906812613
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$455.12 |
| Max. Negotiated Rate |
$2,048.06 |
| Rate for Payer: Adventist Health Commercial |
$455.12
|
| Rate for Payer: Cash Price |
$1,251.59
|
| Rate for Payer: Central Health Plan Commercial |
$1,820.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$910.25
|
| Rate for Payer: EPIC Health Plan Senior |
$910.25
|
| Rate for Payer: Galaxy Health WC |
$1,934.28
|
| Rate for Payer: Global Benefits Group Commercial |
$1,365.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,048.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,517.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$867.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,408.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$455.12
|
| Rate for Payer: Multiplan Commercial |
$1,706.71
|
| Rate for Payer: Networks By Design Commercial |
$1,479.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,934.28
|
|
|
HC CAUTERY MED AQUAMANTYS SEALER
|
Facility
|
OP
|
$2,275.62
|
|
| Hospital Charge Code |
906812613
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$455.12 |
| Max. Negotiated Rate |
$2,048.06 |
| Rate for Payer: Adventist Health Commercial |
$455.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,381.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,934.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,251.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,706.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,101.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,336.47
|
| Rate for Payer: Blue Shield of California Commercial |
$1,390.40
|
| Rate for Payer: Blue Shield of California EPN |
$907.97
|
| Rate for Payer: Cash Price |
$1,251.59
|
| Rate for Payer: Central Health Plan Commercial |
$1,820.50
|
| Rate for Payer: Cigna of CA HMO |
$1,456.40
|
| Rate for Payer: Cigna of CA PPO |
$1,683.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,934.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,934.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,934.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$910.25
|
| Rate for Payer: EPIC Health Plan Senior |
$910.25
|
| Rate for Payer: Galaxy Health WC |
$1,934.28
|
| Rate for Payer: Global Benefits Group Commercial |
$1,365.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,048.06
|
| Rate for Payer: InnovAge PACE Commercial |
$1,137.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,517.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$867.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,408.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$455.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,592.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,592.93
|
| Rate for Payer: Multiplan Commercial |
$1,706.71
|
| Rate for Payer: Networks By Design Commercial |
$1,479.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,934.28
|
| Rate for Payer: Riverside University Health System MISP |
$910.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,365.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,365.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,137.81
|
| Rate for Payer: United Healthcare All Other HMO |
$1,137.81
|
| Rate for Payer: United Healthcare HMO Rider |
$1,137.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,137.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,934.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,934.28
|
| Rate for Payer: Vantage Medical Group Senior |
$1,934.28
|
|
|
HC CAUTERY MED PLASMA BLADE
|
Facility
|
OP
|
$1,374.00
|
|
| Hospital Charge Code |
906812612
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$274.80 |
| Max. Negotiated Rate |
$1,236.60 |
| Rate for Payer: Adventist Health Commercial |
$274.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$834.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$755.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,030.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$665.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$806.95
|
| Rate for Payer: Blue Shield of California Commercial |
$839.51
|
| Rate for Payer: Blue Shield of California EPN |
$548.23
|
| Rate for Payer: Cash Price |
$755.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,099.20
|
| Rate for Payer: Cigna of CA HMO |
$879.36
|
| Rate for Payer: Cigna of CA PPO |
$1,016.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,167.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,167.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$549.60
|
| Rate for Payer: EPIC Health Plan Senior |
$549.60
|
| Rate for Payer: Galaxy Health WC |
$1,167.90
|
| Rate for Payer: Global Benefits Group Commercial |
$824.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,236.60
|
| Rate for Payer: InnovAge PACE Commercial |
$687.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$916.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$523.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$850.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$274.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$961.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$961.80
|
| Rate for Payer: Multiplan Commercial |
$1,030.50
|
| Rate for Payer: Networks By Design Commercial |
$893.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,167.90
|
| Rate for Payer: Riverside University Health System MISP |
$549.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$824.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$824.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$687.00
|
| Rate for Payer: United Healthcare All Other HMO |
$687.00
|
| Rate for Payer: United Healthcare HMO Rider |
$687.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$687.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,167.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,167.90
|
|
|
HC CAUTERY MED PLASMA BLADE
|
Facility
|
IP
|
$1,374.00
|
|
| Hospital Charge Code |
906812612
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$274.80 |
| Max. Negotiated Rate |
$1,236.60 |
| Rate for Payer: Adventist Health Commercial |
$274.80
|
| Rate for Payer: Cash Price |
$755.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,099.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$549.60
|
| Rate for Payer: EPIC Health Plan Senior |
$549.60
|
| Rate for Payer: Galaxy Health WC |
$1,167.90
|
| Rate for Payer: Global Benefits Group Commercial |
$824.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,236.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$916.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$523.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$850.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$274.80
|
| Rate for Payer: Multiplan Commercial |
$1,030.50
|
| Rate for Payer: Networks By Design Commercial |
$893.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,167.90
|
|
|
HC CAVERNOSGRAPHY INJECTION
|
Facility
|
OP
|
$469.00
|
|
|
Service Code
|
CPT 54230
|
| Hospital Charge Code |
909080039
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$93.80 |
| Max. Negotiated Rate |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$93.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$398.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$257.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$351.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$227.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$275.44
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$257.95
|
| Rate for Payer: Cash Price |
$257.95
|
| Rate for Payer: Cash Price |
$257.95
|
| Rate for Payer: Central Health Plan Commercial |
$375.20
|
| Rate for Payer: Cigna of CA HMO |
$300.16
|
| Rate for Payer: Cigna of CA PPO |
$347.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$398.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$398.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$398.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$187.60
|
| Rate for Payer: EPIC Health Plan Senior |
$187.60
|
| Rate for Payer: Galaxy Health WC |
$398.65
|
| Rate for Payer: Global Benefits Group Commercial |
$281.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$422.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$105.66
|
| Rate for Payer: InnovAge PACE Commercial |
$234.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$312.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$290.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$328.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$328.30
|
| Rate for Payer: Multiplan Commercial |
$351.75
|
| Rate for Payer: Networks By Design Commercial |
$304.85
|
| Rate for Payer: Prime Health Services Commercial |
$398.65
|
| Rate for Payer: Riverside University Health System MISP |
$187.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$281.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$398.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$398.65
|
| Rate for Payer: Vantage Medical Group Senior |
$398.65
|
|
|
HC CAVERNOSGRAPHY INJECTION
|
Facility
|
IP
|
$469.00
|
|
|
Service Code
|
CPT 54230
|
| Hospital Charge Code |
909080039
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$93.80 |
| Max. Negotiated Rate |
$422.10 |
| Rate for Payer: Adventist Health Commercial |
$93.80
|
| Rate for Payer: Cash Price |
$257.95
|
| Rate for Payer: Central Health Plan Commercial |
$375.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$187.60
|
| Rate for Payer: EPIC Health Plan Senior |
$187.60
|
| Rate for Payer: Galaxy Health WC |
$398.65
|
| Rate for Payer: Global Benefits Group Commercial |
$281.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$422.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$312.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$178.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$290.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.80
|
| Rate for Payer: Multiplan Commercial |
$351.75
|
| Rate for Payer: Networks By Design Commercial |
$304.85
|
| Rate for Payer: Prime Health Services Commercial |
$398.65
|
|
|
HC CAVILON BARRIER WAND 1ML
|
Facility
|
OP
|
$5.90
|
|
|
Service Code
|
CPT A6250
|
| Hospital Charge Code |
901698609
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$5.31 |
| Rate for Payer: Adventist Health Commercial |
$1.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.47
|
| Rate for Payer: Blue Shield of California Commercial |
$3.60
|
| Rate for Payer: Blue Shield of California EPN |
$2.35
|
| Rate for Payer: Cash Price |
$3.25
|
| Rate for Payer: Central Health Plan Commercial |
$4.72
|
| Rate for Payer: Cigna of CA HMO |
$3.78
|
| Rate for Payer: Cigna of CA PPO |
$4.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.36
|
| Rate for Payer: EPIC Health Plan Senior |
$2.36
|
| Rate for Payer: Galaxy Health WC |
$5.01
|
| Rate for Payer: Global Benefits Group Commercial |
$3.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.31
|
| Rate for Payer: InnovAge PACE Commercial |
$2.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.13
|
| Rate for Payer: Multiplan Commercial |
$4.42
|
| Rate for Payer: Networks By Design Commercial |
$3.83
|
| Rate for Payer: Prime Health Services Commercial |
$5.01
|
| Rate for Payer: Riverside University Health System MISP |
$2.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.95
|
| Rate for Payer: United Healthcare All Other HMO |
$2.95
|
| Rate for Payer: United Healthcare HMO Rider |
$2.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.01
|
| Rate for Payer: Vantage Medical Group Senior |
$5.01
|
|
|
HC CAVILON BARRIER WAND 1ML
|
Facility
|
IP
|
$5.90
|
|
|
Service Code
|
CPT A6250
|
| Hospital Charge Code |
901698609
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$5.31 |
| Rate for Payer: Adventist Health Commercial |
$1.18
|
| Rate for Payer: Cash Price |
$3.25
|
| Rate for Payer: Central Health Plan Commercial |
$4.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.36
|
| Rate for Payer: EPIC Health Plan Senior |
$2.36
|
| Rate for Payer: Galaxy Health WC |
$5.01
|
| Rate for Payer: Global Benefits Group Commercial |
$3.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.18
|
| Rate for Payer: Multiplan Commercial |
$4.42
|
| Rate for Payer: Networks By Design Commercial |
$3.83
|
| Rate for Payer: Prime Health Services Commercial |
$5.01
|
|
|
HC CBC W DIFFERENTIAL
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
900910093
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$46.80 |
| Rate for Payer: Adventist Health Commercial |
$10.40
|
| Rate for Payer: Cash Price |
$28.60
|
| Rate for Payer: Central Health Plan Commercial |
$41.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.80
|
| Rate for Payer: EPIC Health Plan Senior |
$20.80
|
| Rate for Payer: Galaxy Health WC |
$44.20
|
| Rate for Payer: Global Benefits Group Commercial |
$31.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$46.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.40
|
| Rate for Payer: Multiplan Commercial |
$39.00
|
| Rate for Payer: Networks By Design Commercial |
$33.80
|
| Rate for Payer: Prime Health Services Commercial |
$44.20
|
|
|
HC CBC W DIFFERENTIAL
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
900910093
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.24 |
| Max. Negotiated Rate |
$47.07 |
| Rate for Payer: Adventist Health Commercial |
$10.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$6.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$47.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.55
|
| Rate for Payer: Blue Shield of California Commercial |
$31.56
|
| Rate for Payer: Blue Shield of California EPN |
$20.64
|
| Rate for Payer: Cash Price |
$28.60
|
| Rate for Payer: Cash Price |
$28.60
|
| Rate for Payer: Central Health Plan Commercial |
$41.60
|
| Rate for Payer: Cigna of CA HMO |
$33.28
|
| Rate for Payer: Cigna of CA PPO |
$38.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.73
|
| Rate for Payer: EPIC Health Plan Senior |
$6.47
|
| Rate for Payer: Galaxy Health WC |
$44.20
|
| Rate for Payer: Global Benefits Group Commercial |
$31.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$46.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.47
|
| Rate for Payer: InnovAge PACE Commercial |
$9.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.67
|
| Rate for Payer: Multiplan Commercial |
$39.00
|
| Rate for Payer: Networks By Design Commercial |
$33.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6.47
|
| Rate for Payer: Prime Health Services Commercial |
$44.20
|
| Rate for Payer: Prime Health Services Medicare |
$6.86
|
| Rate for Payer: Riverside University Health System MISP |
$7.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.24
|
| Rate for Payer: United Healthcare All Other HMO |
$5.24
|
| Rate for Payer: United Healthcare HMO Rider |
$5.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Vantage Medical Group Senior |
$6.47
|
|
|
HC CBC WITHOUT DIFFERENTIAL
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
900912020
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.24 |
| Max. Negotiated Rate |
$47.07 |
| Rate for Payer: Adventist Health Commercial |
$10.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$6.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$47.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.55
|
| Rate for Payer: Blue Shield of California Commercial |
$31.56
|
| Rate for Payer: Blue Shield of California EPN |
$20.64
|
| Rate for Payer: Cash Price |
$28.60
|
| Rate for Payer: Cash Price |
$28.60
|
| Rate for Payer: Central Health Plan Commercial |
$41.60
|
| Rate for Payer: Cigna of CA HMO |
$33.28
|
| Rate for Payer: Cigna of CA PPO |
$38.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.73
|
| Rate for Payer: EPIC Health Plan Senior |
$6.47
|
| Rate for Payer: Galaxy Health WC |
$44.20
|
| Rate for Payer: Global Benefits Group Commercial |
$31.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$46.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.47
|
| Rate for Payer: InnovAge PACE Commercial |
$9.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.67
|
| Rate for Payer: Multiplan Commercial |
$39.00
|
| Rate for Payer: Networks By Design Commercial |
$33.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6.47
|
| Rate for Payer: Prime Health Services Commercial |
$44.20
|
| Rate for Payer: Prime Health Services Medicare |
$6.86
|
| Rate for Payer: Riverside University Health System MISP |
$7.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.24
|
| Rate for Payer: United Healthcare All Other HMO |
$5.24
|
| Rate for Payer: United Healthcare HMO Rider |
$5.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Vantage Medical Group Senior |
$6.47
|
|
|
HC CBC WITHOUT DIFFERENTIAL
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
900912020
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$46.80 |
| Rate for Payer: Adventist Health Commercial |
$10.40
|
| Rate for Payer: Cash Price |
$28.60
|
| Rate for Payer: Central Health Plan Commercial |
$41.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.80
|
| Rate for Payer: EPIC Health Plan Senior |
$20.80
|
| Rate for Payer: Galaxy Health WC |
$44.20
|
| Rate for Payer: Global Benefits Group Commercial |
$31.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$46.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.40
|
| Rate for Payer: Multiplan Commercial |
$39.00
|
| Rate for Payer: Networks By Design Commercial |
$33.80
|
| Rate for Payer: Prime Health Services Commercial |
$44.20
|
|
|
HC CBC WO DIFFERENTIAL
|
Facility
|
IP
|
$37.04
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
900910086
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.41 |
| Max. Negotiated Rate |
$33.34 |
| Rate for Payer: Adventist Health Commercial |
$7.41
|
| Rate for Payer: Cash Price |
$20.37
|
| Rate for Payer: Central Health Plan Commercial |
$29.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.82
|
| Rate for Payer: EPIC Health Plan Senior |
$14.82
|
| Rate for Payer: Galaxy Health WC |
$31.48
|
| Rate for Payer: Global Benefits Group Commercial |
$22.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.41
|
| Rate for Payer: Multiplan Commercial |
$27.78
|
| Rate for Payer: Networks By Design Commercial |
$24.08
|
| Rate for Payer: Prime Health Services Commercial |
$31.48
|
|
|
HC CBC WO DIFFERENTIAL
|
Facility
|
OP
|
$37.04
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
900910086
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.24 |
| Max. Negotiated Rate |
$47.07 |
| Rate for Payer: Adventist Health Commercial |
$7.41
|
| Rate for Payer: Adventist Health Medi-Cal |
$6.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$47.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.55
|
| Rate for Payer: Blue Shield of California Commercial |
$22.48
|
| Rate for Payer: Blue Shield of California EPN |
$14.70
|
| Rate for Payer: Cash Price |
$20.37
|
| Rate for Payer: Cash Price |
$20.37
|
| Rate for Payer: Central Health Plan Commercial |
$29.63
|
| Rate for Payer: Cigna of CA HMO |
$23.71
|
| Rate for Payer: Cigna of CA PPO |
$27.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.73
|
| Rate for Payer: EPIC Health Plan Senior |
$6.47
|
| Rate for Payer: Galaxy Health WC |
$31.48
|
| Rate for Payer: Global Benefits Group Commercial |
$22.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.34
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.47
|
| Rate for Payer: InnovAge PACE Commercial |
$9.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.67
|
| Rate for Payer: Multiplan Commercial |
$27.78
|
| Rate for Payer: Networks By Design Commercial |
$24.08
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6.47
|
| Rate for Payer: Prime Health Services Commercial |
$31.48
|
| Rate for Payer: Prime Health Services Medicare |
$6.86
|
| Rate for Payer: Riverside University Health System MISP |
$7.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.24
|
| Rate for Payer: United Healthcare All Other HMO |
$5.24
|
| Rate for Payer: United Healthcare HMO Rider |
$5.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Vantage Medical Group Senior |
$6.47
|
|
|
HC CBC W WBC AUTO DIFF
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
CPT 85025
|
| Hospital Charge Code |
900910092
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$46.80 |
| Rate for Payer: Adventist Health Commercial |
$10.40
|
| Rate for Payer: Cash Price |
$28.60
|
| Rate for Payer: Central Health Plan Commercial |
$41.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.80
|
| Rate for Payer: EPIC Health Plan Senior |
$20.80
|
| Rate for Payer: Galaxy Health WC |
$44.20
|
| Rate for Payer: Global Benefits Group Commercial |
$31.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$46.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.40
|
| Rate for Payer: Multiplan Commercial |
$39.00
|
| Rate for Payer: Networks By Design Commercial |
$33.80
|
| Rate for Payer: Prime Health Services Commercial |
$44.20
|
|
|
HC CBC W WBC AUTO DIFF
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT 85025
|
| Hospital Charge Code |
900910092
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.29 |
| Max. Negotiated Rate |
$56.57 |
| Rate for Payer: Adventist Health Commercial |
$10.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$7.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$56.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.48
|
| Rate for Payer: Blue Shield of California Commercial |
$31.56
|
| Rate for Payer: Blue Shield of California EPN |
$20.64
|
| Rate for Payer: Cash Price |
$28.60
|
| Rate for Payer: Cash Price |
$28.60
|
| Rate for Payer: Central Health Plan Commercial |
$41.60
|
| Rate for Payer: Cigna of CA HMO |
$33.28
|
| Rate for Payer: Cigna of CA PPO |
$38.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.49
|
| Rate for Payer: EPIC Health Plan Senior |
$7.77
|
| Rate for Payer: Galaxy Health WC |
$44.20
|
| Rate for Payer: Global Benefits Group Commercial |
$31.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$46.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.77
|
| Rate for Payer: InnovAge PACE Commercial |
$11.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.41
|
| Rate for Payer: Multiplan Commercial |
$39.00
|
| Rate for Payer: Networks By Design Commercial |
$33.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7.77
|
| Rate for Payer: Prime Health Services Commercial |
$44.20
|
| Rate for Payer: Prime Health Services Medicare |
$8.24
|
| Rate for Payer: Riverside University Health System MISP |
$8.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.29
|
| Rate for Payer: United Healthcare All Other HMO |
$6.29
|
| Rate for Payer: United Healthcare HMO Rider |
$6.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.29
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.55
|
| Rate for Payer: Vantage Medical Group Senior |
$7.77
|
|
|
HC CBC W WBC AUTO DIFFERENTIAL INDIV
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT 85025
|
| Hospital Charge Code |
900912018
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.29 |
| Max. Negotiated Rate |
$56.57 |
| Rate for Payer: Adventist Health Commercial |
$10.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$7.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$56.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.48
|
| Rate for Payer: Blue Shield of California Commercial |
$31.56
|
| Rate for Payer: Blue Shield of California EPN |
$20.64
|
| Rate for Payer: Cash Price |
$28.60
|
| Rate for Payer: Cash Price |
$28.60
|
| Rate for Payer: Central Health Plan Commercial |
$41.60
|
| Rate for Payer: Cigna of CA HMO |
$33.28
|
| Rate for Payer: Cigna of CA PPO |
$38.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.49
|
| Rate for Payer: EPIC Health Plan Senior |
$7.77
|
| Rate for Payer: Galaxy Health WC |
$44.20
|
| Rate for Payer: Global Benefits Group Commercial |
$31.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$46.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.77
|
| Rate for Payer: InnovAge PACE Commercial |
$11.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.41
|
| Rate for Payer: Multiplan Commercial |
$39.00
|
| Rate for Payer: Networks By Design Commercial |
$33.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7.77
|
| Rate for Payer: Prime Health Services Commercial |
$44.20
|
| Rate for Payer: Prime Health Services Medicare |
$8.24
|
| Rate for Payer: Riverside University Health System MISP |
$8.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.29
|
| Rate for Payer: United Healthcare All Other HMO |
$6.29
|
| Rate for Payer: United Healthcare HMO Rider |
$6.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.29
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.55
|
| Rate for Payer: Vantage Medical Group Senior |
$7.77
|
|
|
HC CBC W WBC AUTO DIFFERENTIAL INDIV
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
CPT 85025
|
| Hospital Charge Code |
900912018
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$46.80 |
| Rate for Payer: Adventist Health Commercial |
$10.40
|
| Rate for Payer: Cash Price |
$28.60
|
| Rate for Payer: Central Health Plan Commercial |
$41.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.80
|
| Rate for Payer: EPIC Health Plan Senior |
$20.80
|
| Rate for Payer: Galaxy Health WC |
$44.20
|
| Rate for Payer: Global Benefits Group Commercial |
$31.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$46.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.40
|
| Rate for Payer: Multiplan Commercial |
$39.00
|
| Rate for Payer: Networks By Design Commercial |
$33.80
|
| Rate for Payer: Prime Health Services Commercial |
$44.20
|
|
