|
HC DRVVT CONFIRM
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT 85613
|
| Hospital Charge Code |
900912009
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$35.60 |
| Max. Negotiated Rate |
$160.20 |
| Rate for Payer: Adventist Health Commercial |
$35.60
|
| Rate for Payer: Cash Price |
$80.10
|
| Rate for Payer: Central Health Plan Commercial |
$142.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.20
|
| Rate for Payer: EPIC Health Plan Senior |
$71.20
|
| Rate for Payer: Galaxy Health WC |
$151.30
|
| Rate for Payer: Global Benefits Group Commercial |
$106.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$160.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$118.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$110.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.60
|
| Rate for Payer: Multiplan Commercial |
$133.50
|
| Rate for Payer: Networks By Design Commercial |
$115.70
|
| Rate for Payer: Prime Health Services Commercial |
$151.30
|
|
|
HC DSCHG RCP EDU TRAINING EA 30MN
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
CPT 98960
|
| Hospital Charge Code |
900898960
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$100.80 |
| Rate for Payer: Adventist Health Commercial |
$22.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Central Health Plan Commercial |
$89.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.80
|
| Rate for Payer: EPIC Health Plan Senior |
$44.80
|
| Rate for Payer: Galaxy Health WC |
$95.20
|
| Rate for Payer: Global Benefits Group Commercial |
$67.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$100.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$74.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$69.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.40
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
| Rate for Payer: Networks By Design Commercial |
$72.80
|
| Rate for Payer: Prime Health Services Commercial |
$95.20
|
|
|
HC DSCHG RCP EDU TRAINING EA 30MN
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
CPT 98960
|
| Hospital Charge Code |
900898960
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$536.00 |
| Rate for Payer: Adventist Health Commercial |
$22.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$95.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$61.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$84.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Central Health Plan Commercial |
$89.60
|
| Rate for Payer: Cigna of CA HMO |
$71.68
|
| Rate for Payer: Cigna of CA PPO |
$82.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$95.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$95.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$95.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.80
|
| Rate for Payer: EPIC Health Plan Senior |
$44.80
|
| Rate for Payer: Galaxy Health WC |
$95.20
|
| Rate for Payer: Global Benefits Group Commercial |
$67.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$100.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$47.37
|
| Rate for Payer: InnovAge PACE Commercial |
$56.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$74.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$69.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$78.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$78.40
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
| Rate for Payer: Networks By Design Commercial |
$72.80
|
| Rate for Payer: Prime Health Services Commercial |
$95.20
|
| Rate for Payer: Riverside University Health System MISP |
$44.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$95.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$95.20
|
| Rate for Payer: Vantage Medical Group Senior |
$95.20
|
|
|
HC D-STAT HEMOSTAT
|
Facility
|
OP
|
$483.00
|
|
| Hospital Charge Code |
906812352
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$96.60 |
| Max. Negotiated Rate |
$434.70 |
| Rate for Payer: Adventist Health Commercial |
$96.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$293.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$410.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$265.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$362.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$233.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$283.67
|
| Rate for Payer: Blue Shield of California Commercial |
$295.11
|
| Rate for Payer: Blue Shield of California EPN |
$192.72
|
| Rate for Payer: Cash Price |
$217.35
|
| Rate for Payer: Central Health Plan Commercial |
$386.40
|
| Rate for Payer: Cigna of CA HMO |
$309.12
|
| Rate for Payer: Cigna of CA PPO |
$357.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$410.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$410.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$410.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$193.20
|
| Rate for Payer: EPIC Health Plan Senior |
$193.20
|
| Rate for Payer: Galaxy Health WC |
$410.55
|
| Rate for Payer: Global Benefits Group Commercial |
$289.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$434.70
|
| Rate for Payer: InnovAge PACE Commercial |
$241.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$322.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$184.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$298.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$338.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.10
|
| Rate for Payer: Multiplan Commercial |
$362.25
|
| Rate for Payer: Networks By Design Commercial |
$313.95
|
| Rate for Payer: Prime Health Services Commercial |
$410.55
|
| Rate for Payer: Riverside University Health System MISP |
$193.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$289.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$289.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$241.50
|
| Rate for Payer: United Healthcare All Other HMO |
$241.50
|
| Rate for Payer: United Healthcare HMO Rider |
$241.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$241.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$410.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$410.55
|
| Rate for Payer: Vantage Medical Group Senior |
$410.55
|
|
|
HC D-STAT HEMOSTAT
|
Facility
|
IP
|
$483.00
|
|
| Hospital Charge Code |
906812352
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$96.60 |
| Max. Negotiated Rate |
$434.70 |
| Rate for Payer: Adventist Health Commercial |
$96.60
|
| Rate for Payer: Cash Price |
$217.35
|
| Rate for Payer: Central Health Plan Commercial |
$386.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$193.20
|
| Rate for Payer: EPIC Health Plan Senior |
$193.20
|
| Rate for Payer: Galaxy Health WC |
$410.55
|
| Rate for Payer: Global Benefits Group Commercial |
$289.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$434.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$322.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$184.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$298.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.60
|
| Rate for Payer: Multiplan Commercial |
$362.25
|
| Rate for Payer: Networks By Design Commercial |
$313.95
|
| Rate for Payer: Prime Health Services Commercial |
$410.55
|
|
|
HC DTAP ADMINISTRATION
|
Facility
|
IP
|
$22.00
|
|
| Hospital Charge Code |
902890234
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$19.80 |
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Central Health Plan Commercial |
$17.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.80
|
| Rate for Payer: EPIC Health Plan Senior |
$8.80
|
| Rate for Payer: Galaxy Health WC |
$18.70
|
| Rate for Payer: Global Benefits Group Commercial |
$13.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.40
|
| Rate for Payer: Multiplan Commercial |
$16.50
|
| Rate for Payer: Networks By Design Commercial |
$14.30
|
| Rate for Payer: Prime Health Services Commercial |
$18.70
|
|
|
HC DTAP ADMINISTRATION
|
Facility
|
OP
|
$22.00
|
|
| Hospital Charge Code |
902890234
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$1,833.00 |
| Rate for Payer: Adventist Health Commercial |
$9.02
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.92
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Central Health Plan Commercial |
$17.60
|
| Rate for Payer: Cigna of CA HMO |
$14.08
|
| Rate for Payer: Cigna of CA PPO |
$16.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.80
|
| Rate for Payer: EPIC Health Plan Senior |
$8.80
|
| Rate for Payer: Galaxy Health WC |
$18.70
|
| Rate for Payer: Global Benefits Group Commercial |
$13.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: InnovAge PACE Commercial |
$11.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.40
|
| Rate for Payer: Multiplan Commercial |
$16.50
|
| Rate for Payer: Networks By Design Commercial |
$14.30
|
| Rate for Payer: Prime Health Services Commercial |
$18.70
|
| Rate for Payer: Riverside University Health System MISP |
$8.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.70
|
| Rate for Payer: Vantage Medical Group Senior |
$18.70
|
|
|
HC D TEST
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
CPT 87184
|
| Hospital Charge Code |
900912427
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.06 |
| Max. Negotiated Rate |
$64.80 |
| Rate for Payer: Adventist Health Commercial |
$14.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$7.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$43.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$50.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.17
|
| Rate for Payer: Blue Shield of California Commercial |
$43.70
|
| Rate for Payer: Blue Shield of California EPN |
$28.58
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Central Health Plan Commercial |
$57.60
|
| Rate for Payer: Cigna of CA HMO |
$46.08
|
| Rate for Payer: Cigna of CA PPO |
$53.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.10
|
| Rate for Payer: EPIC Health Plan Senior |
$7.48
|
| Rate for Payer: Galaxy Health WC |
$61.20
|
| Rate for Payer: Global Benefits Group Commercial |
$43.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$64.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.48
|
| Rate for Payer: InnovAge PACE Commercial |
$11.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.02
|
| Rate for Payer: Multiplan Commercial |
$54.00
|
| Rate for Payer: Networks By Design Commercial |
$46.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7.48
|
| Rate for Payer: Prime Health Services Commercial |
$61.20
|
| Rate for Payer: Prime Health Services Medicare |
$7.93
|
| Rate for Payer: Riverside University Health System MISP |
$8.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$43.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.06
|
| Rate for Payer: United Healthcare All Other HMO |
$6.06
|
| Rate for Payer: United Healthcare HMO Rider |
$6.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.06
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.23
|
| Rate for Payer: Vantage Medical Group Senior |
$7.48
|
|
|
HC D TEST
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
CPT 87184
|
| Hospital Charge Code |
900912427
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$140.40 |
| Rate for Payer: Adventist Health Commercial |
$31.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Central Health Plan Commercial |
$124.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.40
|
| Rate for Payer: EPIC Health Plan Senior |
$62.40
|
| Rate for Payer: Galaxy Health WC |
$132.60
|
| Rate for Payer: Global Benefits Group Commercial |
$93.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$140.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$96.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.20
|
| Rate for Payer: Multiplan Commercial |
$117.00
|
| Rate for Payer: Networks By Design Commercial |
$101.40
|
| Rate for Payer: Prime Health Services Commercial |
$132.60
|
|
|
HC DTP-HIB COMBO ADMIN
|
Facility
|
IP
|
$24.00
|
|
| Hospital Charge Code |
902890231
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Central Health Plan Commercial |
$19.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
|
|
HC DTP-HIB COMBO ADMIN
|
Facility
|
OP
|
$24.00
|
|
| Hospital Charge Code |
902890231
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$1,833.00 |
| Rate for Payer: Adventist Health Commercial |
$9.84
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.10
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Central Health Plan Commercial |
$19.20
|
| Rate for Payer: Cigna of CA HMO |
$15.36
|
| Rate for Payer: Cigna of CA PPO |
$17.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: InnovAge PACE Commercial |
$12.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.80
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: Riverside University Health System MISP |
$9.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.40
|
| Rate for Payer: Vantage Medical Group Senior |
$20.40
|
|
|
HC DT TOXOIDS PEDS ADMIN
|
Facility
|
OP
|
$24.00
|
|
| Hospital Charge Code |
902890233
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$1,833.00 |
| Rate for Payer: Adventist Health Commercial |
$9.84
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.10
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Central Health Plan Commercial |
$19.20
|
| Rate for Payer: Cigna of CA HMO |
$15.36
|
| Rate for Payer: Cigna of CA PPO |
$17.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: InnovAge PACE Commercial |
$12.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.80
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: Riverside University Health System MISP |
$9.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.40
|
| Rate for Payer: Vantage Medical Group Senior |
$20.40
|
|
|
HC DT TOXOIDS PEDS ADMIN
|
Facility
|
IP
|
$24.00
|
|
| Hospital Charge Code |
902890233
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Central Health Plan Commercial |
$19.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
|
|
HC DT TOXOIDS PEDS ADMIN
|
Facility
|
OP
|
$41.00
|
|
| Hospital Charge Code |
908603028
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$36.90 |
| Rate for Payer: Adventist Health Commercial |
$8.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$19.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.08
|
| Rate for Payer: Blue Shield of California Commercial |
$25.05
|
| Rate for Payer: Blue Shield of California EPN |
$16.36
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Central Health Plan Commercial |
$32.80
|
| Rate for Payer: Cigna of CA HMO |
$26.24
|
| Rate for Payer: Cigna of CA PPO |
$30.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$34.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.40
|
| Rate for Payer: EPIC Health Plan Senior |
$16.40
|
| Rate for Payer: Galaxy Health WC |
$34.85
|
| Rate for Payer: Global Benefits Group Commercial |
$24.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.90
|
| Rate for Payer: InnovAge PACE Commercial |
$20.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.70
|
| Rate for Payer: Multiplan Commercial |
$30.75
|
| Rate for Payer: Networks By Design Commercial |
$26.65
|
| Rate for Payer: Prime Health Services Commercial |
$34.85
|
| Rate for Payer: Riverside University Health System MISP |
$16.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.50
|
| Rate for Payer: United Healthcare All Other HMO |
$20.50
|
| Rate for Payer: United Healthcare HMO Rider |
$20.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.85
|
| Rate for Payer: Vantage Medical Group Senior |
$34.85
|
|
|
HC DT TOXOIDS PEDS ADMIN
|
Facility
|
IP
|
$41.00
|
|
| Hospital Charge Code |
908603028
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$36.90 |
| Rate for Payer: Adventist Health Commercial |
$8.20
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Central Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.40
|
| Rate for Payer: EPIC Health Plan Senior |
$16.40
|
| Rate for Payer: Galaxy Health WC |
$34.85
|
| Rate for Payer: Global Benefits Group Commercial |
$24.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.20
|
| Rate for Payer: Multiplan Commercial |
$30.75
|
| Rate for Payer: Networks By Design Commercial |
$26.65
|
| Rate for Payer: Prime Health Services Commercial |
$34.85
|
|
|
HC DT VACCINE IM LT 7 YRS
|
Facility
|
OP
|
$53.00
|
|
|
Service Code
|
CPT 90702
|
| Hospital Charge Code |
900501449
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.60 |
| Max. Negotiated Rate |
$144.79 |
| Rate for Payer: Adventist Health Commercial |
$10.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$45.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$39.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$144.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.44
|
| Rate for Payer: Blue Shield of California Commercial |
$32.38
|
| Rate for Payer: Blue Shield of California EPN |
$21.15
|
| Rate for Payer: Cash Price |
$23.85
|
| Rate for Payer: Cash Price |
$23.85
|
| Rate for Payer: Central Health Plan Commercial |
$42.40
|
| Rate for Payer: Cigna of CA HMO |
$33.92
|
| Rate for Payer: Cigna of CA PPO |
$39.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$45.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.20
|
| Rate for Payer: EPIC Health Plan Senior |
$21.20
|
| Rate for Payer: Galaxy Health WC |
$45.05
|
| Rate for Payer: Global Benefits Group Commercial |
$31.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$47.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$118.77
|
| Rate for Payer: InnovAge PACE Commercial |
$26.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$131.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37.10
|
| Rate for Payer: Multiplan Commercial |
$39.75
|
| Rate for Payer: Networks By Design Commercial |
$34.45
|
| Rate for Payer: Prime Health Services Commercial |
$45.05
|
| Rate for Payer: Riverside University Health System MISP |
$21.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.50
|
| Rate for Payer: United Healthcare All Other HMO |
$26.50
|
| Rate for Payer: United Healthcare HMO Rider |
$26.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$45.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.05
|
| Rate for Payer: Vantage Medical Group Senior |
$45.05
|
|
|
HC DT VACCINE IM LT 7 YRS
|
Facility
|
IP
|
$53.00
|
|
|
Service Code
|
CPT 90702
|
| Hospital Charge Code |
900501449
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.60 |
| Max. Negotiated Rate |
$47.70 |
| Rate for Payer: Adventist Health Commercial |
$10.60
|
| Rate for Payer: Blue Shield of California Commercial |
$40.97
|
| Rate for Payer: Blue Shield of California EPN |
$26.71
|
| Rate for Payer: Cash Price |
$23.85
|
| Rate for Payer: Central Health Plan Commercial |
$42.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.20
|
| Rate for Payer: EPIC Health Plan Senior |
$21.20
|
| Rate for Payer: Galaxy Health WC |
$45.05
|
| Rate for Payer: Global Benefits Group Commercial |
$31.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$47.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.60
|
| Rate for Payer: Multiplan Commercial |
$39.75
|
| Rate for Payer: Networks By Design Commercial |
$34.45
|
| Rate for Payer: Prime Health Services Commercial |
$45.05
|
|
|
HC DUCTOGRAM/ASPIRATION-2 OR MORE
|
Facility
|
IP
|
$1,134.00
|
|
|
Service Code
|
CPT 77054
|
| Hospital Charge Code |
909001446
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$226.80 |
| Max. Negotiated Rate |
$1,020.60 |
| Rate for Payer: Adventist Health Commercial |
$226.80
|
| Rate for Payer: Cash Price |
$510.30
|
| Rate for Payer: Central Health Plan Commercial |
$907.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$453.60
|
| Rate for Payer: EPIC Health Plan Senior |
$453.60
|
| Rate for Payer: Galaxy Health WC |
$963.90
|
| Rate for Payer: Global Benefits Group Commercial |
$680.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,020.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$756.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$432.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$701.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.80
|
| Rate for Payer: Multiplan Commercial |
$850.50
|
| Rate for Payer: Networks By Design Commercial |
$737.10
|
| Rate for Payer: Prime Health Services Commercial |
$963.90
|
|
|
HC DUCTOGRAM/ASPIRATION-2 OR MORE
|
Facility
|
OP
|
$1,134.00
|
|
|
Service Code
|
CPT 77054
|
| Hospital Charge Code |
909001446
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$109.67 |
| Max. Negotiated Rate |
$1,020.60 |
| Rate for Payer: Adventist Health Commercial |
$226.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$307.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$688.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$762.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$154.73
|
| Rate for Payer: Blue Shield of California Commercial |
$688.34
|
| Rate for Payer: Blue Shield of California EPN |
$450.20
|
| Rate for Payer: Cash Price |
$510.30
|
| Rate for Payer: Cash Price |
$510.30
|
| Rate for Payer: Central Health Plan Commercial |
$907.20
|
| Rate for Payer: Cigna of CA HMO |
$725.76
|
| Rate for Payer: Cigna of CA PPO |
$839.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.63
|
| Rate for Payer: EPIC Health Plan Senior |
$307.13
|
| Rate for Payer: Galaxy Health WC |
$963.90
|
| Rate for Payer: Global Benefits Group Commercial |
$680.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,020.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$109.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: InnovAge PACE Commercial |
$460.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$756.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$121.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$411.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.55
|
| Rate for Payer: Multiplan Commercial |
$850.50
|
| Rate for Payer: Networks By Design Commercial |
$737.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$307.13
|
| Rate for Payer: Prime Health Services Commercial |
$963.90
|
| Rate for Payer: Prime Health Services Medicare |
$325.56
|
| Rate for Payer: Riverside University Health System MISP |
$337.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$680.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$680.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$605.23
|
| Rate for Payer: United Healthcare All Other HMO |
$605.23
|
| Rate for Payer: United Healthcare HMO Rider |
$605.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$307.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC DUCTOGRAM/ASPIRATION- SINGLE
|
Facility
|
IP
|
$1,034.00
|
|
|
Service Code
|
CPT 77053
|
| Hospital Charge Code |
909001433
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$206.80 |
| Max. Negotiated Rate |
$930.60 |
| Rate for Payer: Adventist Health Commercial |
$206.80
|
| Rate for Payer: Cash Price |
$465.30
|
| Rate for Payer: Central Health Plan Commercial |
$827.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$413.60
|
| Rate for Payer: EPIC Health Plan Senior |
$413.60
|
| Rate for Payer: Galaxy Health WC |
$878.90
|
| Rate for Payer: Global Benefits Group Commercial |
$620.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$930.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$689.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$393.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$640.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.80
|
| Rate for Payer: Multiplan Commercial |
$775.50
|
| Rate for Payer: Networks By Design Commercial |
$672.10
|
| Rate for Payer: Prime Health Services Commercial |
$878.90
|
|
|
HC DUCTOGRAM/ASPIRATION- SINGLE
|
Facility
|
OP
|
$1,034.00
|
|
|
Service Code
|
CPT 77053
|
| Hospital Charge Code |
909001433
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$84.83 |
| Max. Negotiated Rate |
$930.60 |
| Rate for Payer: Adventist Health Commercial |
$206.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$307.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$627.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$547.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$111.19
|
| Rate for Payer: Blue Shield of California Commercial |
$627.64
|
| Rate for Payer: Blue Shield of California EPN |
$410.50
|
| Rate for Payer: Cash Price |
$465.30
|
| Rate for Payer: Cash Price |
$465.30
|
| Rate for Payer: Central Health Plan Commercial |
$827.20
|
| Rate for Payer: Cigna of CA HMO |
$661.76
|
| Rate for Payer: Cigna of CA PPO |
$765.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.63
|
| Rate for Payer: EPIC Health Plan Senior |
$307.13
|
| Rate for Payer: Galaxy Health WC |
$878.90
|
| Rate for Payer: Global Benefits Group Commercial |
$620.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$930.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$84.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: InnovAge PACE Commercial |
$460.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$689.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$411.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.55
|
| Rate for Payer: Multiplan Commercial |
$775.50
|
| Rate for Payer: Networks By Design Commercial |
$672.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$307.13
|
| Rate for Payer: Prime Health Services Commercial |
$878.90
|
| Rate for Payer: Prime Health Services Medicare |
$325.56
|
| Rate for Payer: Riverside University Health System MISP |
$337.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$620.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$620.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$605.23
|
| Rate for Payer: United Healthcare All Other HMO |
$605.23
|
| Rate for Payer: United Healthcare HMO Rider |
$605.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$307.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC DUODNL INT ASP DIAG INCL IG; COLL MUL SPCMNS INCL DRUG ADM
|
Facility
|
IP
|
$3,119.00
|
|
|
Service Code
|
CPT 43757
|
| Hospital Charge Code |
906743757
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$623.80 |
| Max. Negotiated Rate |
$2,807.10 |
| Rate for Payer: Adventist Health Commercial |
$623.80
|
| Rate for Payer: Cash Price |
$1,403.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,495.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,247.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,247.60
|
| Rate for Payer: Galaxy Health WC |
$2,651.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,871.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,807.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,080.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,188.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,930.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$623.80
|
| Rate for Payer: Multiplan Commercial |
$2,339.25
|
| Rate for Payer: Networks By Design Commercial |
$2,027.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,651.15
|
|
|
HC DUODNL INT ASP DIAG INCL IG; COLL MUL SPCMNS INCL DRUG ADM
|
Facility
|
OP
|
$3,119.00
|
|
|
Service Code
|
CPT 43757
|
| Hospital Charge Code |
906743757
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$110.79 |
| Max. Negotiated Rate |
$7,378.00 |
| Rate for Payer: Adventist Health Commercial |
$623.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,191.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,510.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,831.79
|
| Rate for Payer: Blue Shield of California Commercial |
$979.68
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$1,403.55
|
| Rate for Payer: Cash Price |
$1,403.55
|
| Rate for Payer: Cash Price |
$1,403.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,495.20
|
| Rate for Payer: Cigna of CA HMO |
$1,996.16
|
| Rate for Payer: Cigna of CA PPO |
$2,308.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,310.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,191.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,608.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,191.26
|
| Rate for Payer: Galaxy Health WC |
$2,651.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,871.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,807.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,953.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$110.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: InnovAge PACE Commercial |
$1,786.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,080.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$122.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,191.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$623.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,596.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,596.29
|
| Rate for Payer: Multiplan Commercial |
$2,339.25
|
| Rate for Payer: Networks By Design Commercial |
$2,027.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Prime Health Services Commercial |
$2,651.15
|
| Rate for Payer: Prime Health Services Medicare |
$1,262.74
|
| Rate for Payer: Riverside University Health System MISP |
$1,310.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,871.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,429.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,191.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1,191.26
|
|
|
HC DUPLEX ABD PELVIS SCROTAL CONTENTS AND OR RETROPERI ORGANS LIMITED
|
Facility
|
OP
|
$2,152.00
|
|
|
Service Code
|
CPT 93976
|
| Hospital Charge Code |
906601559
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$135.12 |
| Max. Negotiated Rate |
$1,936.80 |
| Rate for Payer: Adventist Health Commercial |
$430.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$135.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,306.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$848.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,263.87
|
| Rate for Payer: Blue Shield of California Commercial |
$1,306.26
|
| Rate for Payer: Blue Shield of California EPN |
$854.34
|
| Rate for Payer: Cash Price |
$968.40
|
| Rate for Payer: Cash Price |
$968.40
|
| Rate for Payer: Cash Price |
$968.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,721.60
|
| Rate for Payer: Cigna of CA HMO |
$1,377.28
|
| Rate for Payer: Cigna of CA PPO |
$1,592.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$1,829.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,291.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,936.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$266.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: InnovAge PACE Commercial |
$202.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,435.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$293.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$430.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$181.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$1,614.00
|
| Rate for Payer: Networks By Design Commercial |
$1,398.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$135.12
|
| Rate for Payer: Prime Health Services Commercial |
$1,829.20
|
| Rate for Payer: Prime Health Services Medicare |
$143.23
|
| Rate for Payer: Riverside University Health System MISP |
$148.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,291.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,291.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,588.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,289.00
|
| Rate for Payer: United Healthcare HMO Rider |
$978.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$895.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC DUPLEX ABD PELVIS SCROTAL CONTENTS AND OR RETROPERI ORGANS LIMITED
|
Facility
|
IP
|
$2,152.00
|
|
|
Service Code
|
CPT 93976
|
| Hospital Charge Code |
906601559
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$430.40 |
| Max. Negotiated Rate |
$1,936.80 |
| Rate for Payer: Adventist Health Commercial |
$430.40
|
| Rate for Payer: Cash Price |
$968.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,721.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$860.80
|
| Rate for Payer: EPIC Health Plan Senior |
$860.80
|
| Rate for Payer: Galaxy Health WC |
$1,829.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,291.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,936.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,435.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$819.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,332.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$430.40
|
| Rate for Payer: Multiplan Commercial |
$1,614.00
|
| Rate for Payer: Networks By Design Commercial |
$1,398.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,829.20
|
|
