|
HC FA STAIN PARAINFLUENZA
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
CPT 87279
|
| Hospital Charge Code |
900911783
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$66.40 |
| Max. Negotiated Rate |
$298.80 |
| Rate for Payer: Adventist Health Commercial |
$66.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Central Health Plan Commercial |
$265.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$132.80
|
| Rate for Payer: EPIC Health Plan Senior |
$132.80
|
| Rate for Payer: Galaxy Health WC |
$282.20
|
| Rate for Payer: Global Benefits Group Commercial |
$199.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$298.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$221.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$126.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$205.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.40
|
| Rate for Payer: Multiplan Commercial |
$249.00
|
| Rate for Payer: Networks By Design Commercial |
$215.80
|
| Rate for Payer: Prime Health Services Commercial |
$282.20
|
|
|
HC FA STAIN PARAINFLUENZA
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
CPT 87279
|
| Hospital Charge Code |
900911783
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$67.54 |
| Rate for Payer: Adventist Health Commercial |
$7.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$16.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$67.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.71
|
| Rate for Payer: Blue Shield of California Commercial |
$23.07
|
| Rate for Payer: Blue Shield of California EPN |
$15.09
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Central Health Plan Commercial |
$30.40
|
| Rate for Payer: Cigna of CA HMO |
$24.32
|
| Rate for Payer: Cigna of CA PPO |
$28.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.18
|
| Rate for Payer: EPIC Health Plan Senior |
$16.43
|
| Rate for Payer: Galaxy Health WC |
$32.30
|
| Rate for Payer: Global Benefits Group Commercial |
$22.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$26.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.43
|
| Rate for Payer: InnovAge PACE Commercial |
$24.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.02
|
| Rate for Payer: Multiplan Commercial |
$28.50
|
| Rate for Payer: Networks By Design Commercial |
$24.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16.43
|
| Rate for Payer: Prime Health Services Commercial |
$32.30
|
| Rate for Payer: Prime Health Services Medicare |
$17.42
|
| Rate for Payer: Riverside University Health System MISP |
$18.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.31
|
| Rate for Payer: United Healthcare All Other HMO |
$13.31
|
| Rate for Payer: United Healthcare HMO Rider |
$13.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.31
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.07
|
| Rate for Payer: Vantage Medical Group Senior |
$16.43
|
|
|
HC FEEDER HABERMAN MINI
|
Facility
|
IP
|
$84.82
|
|
| Hospital Charge Code |
901603839
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.96 |
| Max. Negotiated Rate |
$76.34 |
| Rate for Payer: Adventist Health Commercial |
$16.96
|
| Rate for Payer: Cash Price |
$38.17
|
| Rate for Payer: Central Health Plan Commercial |
$67.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.93
|
| Rate for Payer: EPIC Health Plan Senior |
$33.93
|
| Rate for Payer: Galaxy Health WC |
$72.10
|
| Rate for Payer: Global Benefits Group Commercial |
$50.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$76.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$52.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.96
|
| Rate for Payer: Multiplan Commercial |
$63.62
|
| Rate for Payer: Networks By Design Commercial |
$55.13
|
| Rate for Payer: Prime Health Services Commercial |
$72.10
|
|
|
HC FEEDER HABERMAN MINI
|
Facility
|
OP
|
$84.82
|
|
| Hospital Charge Code |
901603839
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.96 |
| Max. Negotiated Rate |
$76.34 |
| Rate for Payer: Adventist Health Commercial |
$16.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$51.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$46.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$63.62
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$41.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.81
|
| Rate for Payer: Blue Shield of California Commercial |
$51.83
|
| Rate for Payer: Blue Shield of California EPN |
$33.84
|
| Rate for Payer: Cash Price |
$38.17
|
| Rate for Payer: Central Health Plan Commercial |
$67.86
|
| Rate for Payer: Cigna of CA HMO |
$54.28
|
| Rate for Payer: Cigna of CA PPO |
$62.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$72.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$72.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.93
|
| Rate for Payer: EPIC Health Plan Senior |
$33.93
|
| Rate for Payer: Galaxy Health WC |
$72.10
|
| Rate for Payer: Global Benefits Group Commercial |
$50.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$76.34
|
| Rate for Payer: InnovAge PACE Commercial |
$42.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$52.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$59.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$59.37
|
| Rate for Payer: Multiplan Commercial |
$63.62
|
| Rate for Payer: Networks By Design Commercial |
$55.13
|
| Rate for Payer: Prime Health Services Commercial |
$72.10
|
| Rate for Payer: Riverside University Health System MISP |
$33.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$50.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$50.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$42.41
|
| Rate for Payer: United Healthcare All Other HMO |
$42.41
|
| Rate for Payer: United Healthcare HMO Rider |
$42.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$42.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$72.10
|
| Rate for Payer: Vantage Medical Group Senior |
$72.10
|
|
|
HC FEEDER HABERMAN REGULAR
|
Facility
|
IP
|
$82.00
|
|
| Hospital Charge Code |
901603250
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
|
|
HC FEEDER HABERMAN REGULAR
|
Facility
|
OP
|
$82.00
|
|
| Hospital Charge Code |
901603250
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$39.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.16
|
| Rate for Payer: Blue Shield of California Commercial |
$50.10
|
| Rate for Payer: Blue Shield of California EPN |
$32.72
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$69.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: InnovAge PACE Commercial |
$41.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Riverside University Health System MISP |
$32.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.00
|
| Rate for Payer: United Healthcare All Other HMO |
$41.00
|
| Rate for Payer: United Healthcare HMO Rider |
$41.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.70
|
| Rate for Payer: Vantage Medical Group Senior |
$69.70
|
|
|
HC FEET BOTH 1 VIEW
|
Facility
|
IP
|
$852.00
|
|
|
Service Code
|
CPT 73620 50
|
| Hospital Charge Code |
909001641
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$170.40 |
| Max. Negotiated Rate |
$766.80 |
| Rate for Payer: Adventist Health Commercial |
$170.40
|
| Rate for Payer: Cash Price |
$383.40
|
| Rate for Payer: Central Health Plan Commercial |
$681.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.80
|
| Rate for Payer: EPIC Health Plan Senior |
$340.80
|
| Rate for Payer: Galaxy Health WC |
$724.20
|
| Rate for Payer: Global Benefits Group Commercial |
$511.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$766.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$568.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$324.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$527.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.40
|
| Rate for Payer: Multiplan Commercial |
$639.00
|
| Rate for Payer: Networks By Design Commercial |
$553.80
|
| Rate for Payer: Prime Health Services Commercial |
$724.20
|
|
|
HC FEET BOTH 1 VIEW
|
Facility
|
OP
|
$852.00
|
|
|
Service Code
|
CPT 73620 50
|
| Hospital Charge Code |
909001641
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$20.83 |
| Max. Negotiated Rate |
$766.80 |
| Rate for Payer: Adventist Health Commercial |
$170.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$517.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$724.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$468.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$639.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$102.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.83
|
| Rate for Payer: Blue Shield of California Commercial |
$517.16
|
| Rate for Payer: Blue Shield of California EPN |
$338.24
|
| Rate for Payer: Cash Price |
$383.40
|
| Rate for Payer: Cash Price |
$383.40
|
| Rate for Payer: Central Health Plan Commercial |
$681.60
|
| Rate for Payer: Cigna of CA HMO |
$545.28
|
| Rate for Payer: Cigna of CA PPO |
$630.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$724.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$724.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$724.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.80
|
| Rate for Payer: EPIC Health Plan Senior |
$340.80
|
| Rate for Payer: Galaxy Health WC |
$724.20
|
| Rate for Payer: Global Benefits Group Commercial |
$511.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$766.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$29.76
|
| Rate for Payer: InnovAge PACE Commercial |
$426.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$568.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$527.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$596.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$596.40
|
| Rate for Payer: Multiplan Commercial |
$639.00
|
| Rate for Payer: Networks By Design Commercial |
$553.80
|
| Rate for Payer: Prime Health Services Commercial |
$724.20
|
| Rate for Payer: Riverside University Health System MISP |
$340.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$511.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$511.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$724.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$724.20
|
| Rate for Payer: Vantage Medical Group Senior |
$724.20
|
|
|
HC FEMALE GENITAL SYTM PROC UNLST
|
Facility
|
IP
|
$1,615.00
|
|
|
Service Code
|
CPT 58999
|
| Hospital Charge Code |
900501441
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$323.00 |
| Max. Negotiated Rate |
$1,453.50 |
| Rate for Payer: Adventist Health Commercial |
$323.00
|
| Rate for Payer: Cash Price |
$726.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,292.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$646.00
|
| Rate for Payer: EPIC Health Plan Senior |
$646.00
|
| Rate for Payer: Galaxy Health WC |
$1,372.75
|
| Rate for Payer: Global Benefits Group Commercial |
$969.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,453.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,077.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$615.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$999.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$323.00
|
| Rate for Payer: Multiplan Commercial |
$1,211.25
|
| Rate for Payer: Networks By Design Commercial |
$1,049.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,372.75
|
|
|
HC FEMALE GENITAL SYTM PROC UNLST
|
Facility
|
OP
|
$1,615.00
|
|
|
Service Code
|
CPT 58999
|
| Hospital Charge Code |
900501441
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$255.61 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$323.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$383.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$281.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$255.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$407.27
|
| Rate for Payer: Cash Price |
$726.75
|
| Rate for Payer: Cash Price |
$726.75
|
| Rate for Payer: Cash Price |
$726.75
|
| Rate for Payer: Cash Price |
$726.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,292.00
|
| Rate for Payer: Cigna of CA HMO |
$1,033.60
|
| Rate for Payer: Cigna of CA PPO |
$1,195.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$383.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$281.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$255.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$345.07
|
| Rate for Payer: EPIC Health Plan Senior |
$255.61
|
| Rate for Payer: Galaxy Health WC |
$1,372.75
|
| Rate for Payer: Global Benefits Group Commercial |
$969.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,453.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$419.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$255.61
|
| Rate for Payer: InnovAge PACE Commercial |
$383.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,077.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$255.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$323.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$342.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$342.52
|
| Rate for Payer: Multiplan Commercial |
$1,211.25
|
| Rate for Payer: Multiplan WC |
$407.27
|
| Rate for Payer: Networks By Design Commercial |
$1,049.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$255.61
|
| Rate for Payer: Preferred Health Network WC |
$415.58
|
| Rate for Payer: Prime Health Services Commercial |
$1,372.75
|
| Rate for Payer: Prime Health Services Medicare |
$270.95
|
| Rate for Payer: Prime Health Services WC |
$403.11
|
| Rate for Payer: Riverside University Health System MISP |
$281.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$969.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$807.50
|
| Rate for Payer: United Healthcare All Other HMO |
$807.50
|
| Rate for Payer: United Healthcare HMO Rider |
$807.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$807.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$255.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$383.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$281.17
|
| Rate for Payer: Vantage Medical Group Senior |
$255.61
|
|
|
HC FEMALE GENITAL SYTM PROC UNLST
|
Facility
|
IP
|
$1,615.00
|
|
|
Service Code
|
CPT 58999
|
| Hospital Charge Code |
900501441
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$323.00 |
| Max. Negotiated Rate |
$1,453.50 |
| Rate for Payer: Adventist Health Commercial |
$323.00
|
| Rate for Payer: Cash Price |
$726.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,292.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$646.00
|
| Rate for Payer: EPIC Health Plan Senior |
$646.00
|
| Rate for Payer: Galaxy Health WC |
$1,372.75
|
| Rate for Payer: Global Benefits Group Commercial |
$969.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,453.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,077.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$615.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$999.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$323.00
|
| Rate for Payer: Multiplan Commercial |
$1,211.25
|
| Rate for Payer: Networks By Design Commercial |
$1,049.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,372.75
|
|
|
HC FEMALE GENITAL SYTM PROC UNLST
|
Facility
|
OP
|
$1,615.00
|
|
|
Service Code
|
CPT 58999
|
| Hospital Charge Code |
900501441
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$255.61 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$323.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$255.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$383.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$281.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$255.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$407.27
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$726.75
|
| Rate for Payer: Cash Price |
$726.75
|
| Rate for Payer: Cash Price |
$726.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,292.00
|
| Rate for Payer: Cigna of CA HMO |
$1,033.60
|
| Rate for Payer: Cigna of CA PPO |
$1,195.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$383.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$281.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$255.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$345.07
|
| Rate for Payer: EPIC Health Plan Senior |
$255.61
|
| Rate for Payer: Galaxy Health WC |
$1,372.75
|
| Rate for Payer: Global Benefits Group Commercial |
$969.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,453.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$419.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$255.61
|
| Rate for Payer: InnovAge PACE Commercial |
$383.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,077.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$255.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$323.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$342.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$342.52
|
| Rate for Payer: Multiplan Commercial |
$1,211.25
|
| Rate for Payer: Multiplan WC |
$407.27
|
| Rate for Payer: Networks By Design Commercial |
$1,049.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$255.61
|
| Rate for Payer: Preferred Health Network WC |
$415.58
|
| Rate for Payer: Prime Health Services Commercial |
$1,372.75
|
| Rate for Payer: Prime Health Services Medicare |
$270.95
|
| Rate for Payer: Prime Health Services WC |
$403.11
|
| Rate for Payer: Riverside University Health System MISP |
$281.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$969.00
|
| 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: Upland Medical Group Pediatric |
$255.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$383.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$281.17
|
| Rate for Payer: Vantage Medical Group Senior |
$255.61
|
|
|
HC FEMORAL LENGTH SOCK
|
Facility
|
OP
|
$224.00
|
|
|
Service Code
|
CPT L2850
|
| Hospital Charge Code |
905352850
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$42.38 |
| Max. Negotiated Rate |
$201.60 |
| Rate for Payer: Adventist Health Commercial |
$91.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$190.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$168.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$131.56
|
| Rate for Payer: Blue Shield of California Commercial |
$173.15
|
| Rate for Payer: Blue Shield of California EPN |
$112.90
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Central Health Plan Commercial |
$179.20
|
| Rate for Payer: Cigna of CA HMO |
$156.80
|
| Rate for Payer: Cigna of CA PPO |
$156.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$190.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$190.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$190.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.60
|
| Rate for Payer: EPIC Health Plan Senior |
$89.60
|
| Rate for Payer: Galaxy Health WC |
$190.40
|
| Rate for Payer: Global Benefits Group Commercial |
$134.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$201.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$42.38
|
| Rate for Payer: InnovAge PACE Commercial |
$112.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$149.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$138.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$156.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$156.80
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: Networks By Design Commercial |
$112.00
|
| Rate for Payer: Prime Health Services Commercial |
$190.40
|
| Rate for Payer: Riverside University Health System MISP |
$89.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$134.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$134.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$84.07
|
| Rate for Payer: United Healthcare All Other HMO |
$81.83
|
| Rate for Payer: United Healthcare HMO Rider |
$80.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$73.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$190.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$190.40
|
| Rate for Payer: Vantage Medical Group Senior |
$190.40
|
|
|
HC FEMORAL LENGTH SOCK
|
Facility
|
IP
|
$224.00
|
|
|
Service Code
|
CPT L2850
|
| Hospital Charge Code |
905352850
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$44.80 |
| Max. Negotiated Rate |
$201.60 |
| Rate for Payer: Adventist Health Commercial |
$44.80
|
| Rate for Payer: Blue Shield of California Commercial |
$173.15
|
| Rate for Payer: Blue Shield of California EPN |
$112.90
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Central Health Plan Commercial |
$179.20
|
| Rate for Payer: Cigna of CA HMO |
$156.80
|
| Rate for Payer: Cigna of CA PPO |
$156.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.60
|
| Rate for Payer: EPIC Health Plan Senior |
$89.60
|
| Rate for Payer: Galaxy Health WC |
$190.40
|
| Rate for Payer: Global Benefits Group Commercial |
$134.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$201.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$149.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$138.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.80
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: Networks By Design Commercial |
$145.60
|
| Rate for Payer: Prime Health Services Commercial |
$190.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$84.07
|
| Rate for Payer: United Healthcare All Other HMO |
$81.83
|
| Rate for Payer: United Healthcare HMO Rider |
$80.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$73.36
|
|
|
HC FEMORAL LENGTH SOCK
|
Facility
|
IP
|
$224.00
|
|
|
Service Code
|
CPT L2850
|
| Hospital Charge Code |
915352850
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$44.80 |
| Max. Negotiated Rate |
$201.60 |
| Rate for Payer: Adventist Health Commercial |
$44.80
|
| Rate for Payer: Blue Shield of California Commercial |
$173.15
|
| Rate for Payer: Blue Shield of California EPN |
$112.90
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Central Health Plan Commercial |
$179.20
|
| Rate for Payer: Cigna of CA HMO |
$156.80
|
| Rate for Payer: Cigna of CA PPO |
$156.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.60
|
| Rate for Payer: EPIC Health Plan Senior |
$89.60
|
| Rate for Payer: Galaxy Health WC |
$190.40
|
| Rate for Payer: Global Benefits Group Commercial |
$134.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$201.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$149.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$138.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.80
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: Networks By Design Commercial |
$145.60
|
| Rate for Payer: Prime Health Services Commercial |
$190.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$84.07
|
| Rate for Payer: United Healthcare All Other HMO |
$81.83
|
| Rate for Payer: United Healthcare HMO Rider |
$80.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$73.36
|
|
|
HC FEMORAL LENGTH SOCK
|
Facility
|
OP
|
$224.00
|
|
|
Service Code
|
CPT L2850
|
| Hospital Charge Code |
915352850
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$42.38 |
| Max. Negotiated Rate |
$201.60 |
| Rate for Payer: Adventist Health Commercial |
$91.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$190.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$168.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$131.56
|
| Rate for Payer: Blue Shield of California Commercial |
$173.15
|
| Rate for Payer: Blue Shield of California EPN |
$112.90
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Central Health Plan Commercial |
$179.20
|
| Rate for Payer: Cigna of CA HMO |
$156.80
|
| Rate for Payer: Cigna of CA PPO |
$156.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$190.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$190.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$190.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.60
|
| Rate for Payer: EPIC Health Plan Senior |
$89.60
|
| Rate for Payer: Galaxy Health WC |
$190.40
|
| Rate for Payer: Global Benefits Group Commercial |
$134.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$201.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$42.38
|
| Rate for Payer: InnovAge PACE Commercial |
$112.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$149.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$138.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$156.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$156.80
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: Networks By Design Commercial |
$112.00
|
| Rate for Payer: Prime Health Services Commercial |
$190.40
|
| Rate for Payer: Riverside University Health System MISP |
$89.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$134.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$134.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$84.07
|
| Rate for Payer: United Healthcare All Other HMO |
$81.83
|
| Rate for Payer: United Healthcare HMO Rider |
$80.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$73.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$190.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$190.40
|
| Rate for Payer: Vantage Medical Group Senior |
$190.40
|
|
|
HC FEMORAL NERVE BLOCK SINGLE
|
Facility
|
OP
|
$2,413.00
|
|
|
Service Code
|
CPT 64447
|
| Hospital Charge Code |
900501590
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$93.37 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Commercial |
$482.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.92
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,402.00
|
| Rate for Payer: Cash Price |
$1,085.85
|
| Rate for Payer: Cash Price |
$1,085.85
|
| Rate for Payer: Cash Price |
$1,085.85
|
| Rate for Payer: Cash Price |
$1,085.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,930.40
|
| Rate for Payer: Cigna of CA HMO |
$1,544.32
|
| Rate for Payer: Cigna of CA PPO |
$1,785.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$967.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$879.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,187.89
|
| Rate for Payer: EPIC Health Plan Senior |
$879.92
|
| Rate for Payer: Galaxy Health WC |
$2,051.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,447.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,171.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,443.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.92
|
| Rate for Payer: InnovAge PACE Commercial |
$1,319.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,609.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$482.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,179.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,179.09
|
| Rate for Payer: Multiplan Commercial |
$1,809.75
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: Networks By Design Commercial |
$1,568.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$879.92
|
| Rate for Payer: Preferred Health Network WC |
$1,430.61
|
| Rate for Payer: Prime Health Services Commercial |
$2,051.05
|
| Rate for Payer: Prime Health Services Medicare |
$932.72
|
| Rate for Payer: Prime Health Services WC |
$1,387.69
|
| Rate for Payer: Riverside University Health System MISP |
$967.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,447.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,206.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,206.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,206.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,206.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$879.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Vantage Medical Group Senior |
$879.92
|
|
|
HC FEMORAL NERVE BLOCK SINGLE
|
Facility
|
IP
|
$2,413.00
|
|
|
Service Code
|
CPT 64447
|
| Hospital Charge Code |
900501590
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$482.60 |
| Max. Negotiated Rate |
$2,171.70 |
| Rate for Payer: Adventist Health Commercial |
$482.60
|
| Rate for Payer: Cash Price |
$1,085.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,930.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$965.20
|
| Rate for Payer: EPIC Health Plan Senior |
$965.20
|
| Rate for Payer: Galaxy Health WC |
$2,051.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,447.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,171.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,609.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$919.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,493.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$482.60
|
| Rate for Payer: Multiplan Commercial |
$1,809.75
|
| Rate for Payer: Networks By Design Commercial |
$1,568.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,051.05
|
|
|
HC FEMOSTOP GOLD STJ HEMOSTASIS
|
Facility
|
IP
|
$483.00
|
|
| Hospital Charge Code |
906812584
|
|
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 FEMOSTOP GOLD STJ HEMOSTASIS
|
Facility
|
OP
|
$483.00
|
|
| Hospital Charge Code |
906812584
|
|
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 FERNING
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
900912032
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.72 |
| Max. Negotiated Rate |
$41.40 |
| Rate for Payer: Adventist Health Commercial |
$9.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.30
|
| Rate for Payer: Blue Shield of California Commercial |
$27.92
|
| Rate for Payer: Blue Shield of California EPN |
$18.26
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Central Health Plan Commercial |
$36.80
|
| Rate for Payer: Cigna of CA HMO |
$29.44
|
| Rate for Payer: Cigna of CA PPO |
$34.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.86
|
| Rate for Payer: EPIC Health Plan Senior |
$5.82
|
| Rate for Payer: Galaxy Health WC |
$39.10
|
| Rate for Payer: Global Benefits Group Commercial |
$27.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$41.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.82
|
| Rate for Payer: InnovAge PACE Commercial |
$8.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.80
|
| Rate for Payer: Multiplan Commercial |
$34.50
|
| Rate for Payer: Networks By Design Commercial |
$29.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.82
|
| Rate for Payer: Prime Health Services Commercial |
$39.10
|
| Rate for Payer: Prime Health Services Medicare |
$6.17
|
| Rate for Payer: Riverside University Health System MISP |
$6.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.72
|
| Rate for Payer: United Healthcare All Other HMO |
$4.72
|
| Rate for Payer: United Healthcare HMO Rider |
$4.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.72
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.40
|
| Rate for Payer: Vantage Medical Group Senior |
$5.82
|
|
|
HC FERNING
|
Facility
|
IP
|
$46.00
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
900912032
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.20 |
| Max. Negotiated Rate |
$41.40 |
| Rate for Payer: Adventist Health Commercial |
$9.20
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Central Health Plan Commercial |
$36.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.40
|
| Rate for Payer: EPIC Health Plan Senior |
$18.40
|
| Rate for Payer: Galaxy Health WC |
$39.10
|
| Rate for Payer: Global Benefits Group Commercial |
$27.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$41.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.20
|
| Rate for Payer: Multiplan Commercial |
$34.50
|
| Rate for Payer: Networks By Design Commercial |
$29.90
|
| Rate for Payer: Prime Health Services Commercial |
$39.10
|
|
|
HC FERRITIN
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
CPT 82728
|
| Hospital Charge Code |
900910819
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$54.00 |
| Max. Negotiated Rate |
$243.00 |
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Central Health Plan Commercial |
$216.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.00
|
| Rate for Payer: EPIC Health Plan Senior |
$108.00
|
| Rate for Payer: Galaxy Health WC |
$229.50
|
| Rate for Payer: Global Benefits Group Commercial |
$162.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$243.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$180.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$167.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.00
|
| Rate for Payer: Multiplan Commercial |
$202.50
|
| Rate for Payer: Networks By Design Commercial |
$175.50
|
| Rate for Payer: Prime Health Services Commercial |
$229.50
|
|
|
HC FERRITIN
|
Facility
|
OP
|
$132.47
|
|
|
Service Code
|
CPT 82728
|
| Hospital Charge Code |
900910819
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.04 |
| Max. Negotiated Rate |
$119.22 |
| Rate for Payer: Adventist Health Commercial |
$26.49
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$80.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$99.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.12
|
| Rate for Payer: Blue Shield of California Commercial |
$80.41
|
| Rate for Payer: Blue Shield of California EPN |
$52.59
|
| Rate for Payer: Cash Price |
$59.61
|
| Rate for Payer: Cash Price |
$59.61
|
| Rate for Payer: Central Health Plan Commercial |
$105.98
|
| Rate for Payer: Cigna of CA HMO |
$84.78
|
| Rate for Payer: Cigna of CA PPO |
$98.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.40
|
| Rate for Payer: EPIC Health Plan Senior |
$13.63
|
| Rate for Payer: Galaxy Health WC |
$112.60
|
| Rate for Payer: Global Benefits Group Commercial |
$79.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$119.22
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.63
|
| Rate for Payer: InnovAge PACE Commercial |
$20.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.26
|
| Rate for Payer: Multiplan Commercial |
$99.35
|
| Rate for Payer: Networks By Design Commercial |
$86.11
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.63
|
| Rate for Payer: Prime Health Services Commercial |
$112.60
|
| Rate for Payer: Prime Health Services Medicare |
$14.45
|
| Rate for Payer: Riverside University Health System MISP |
$14.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$79.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$79.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.04
|
| Rate for Payer: United Healthcare All Other HMO |
$11.04
|
| Rate for Payer: United Healthcare HMO Rider |
$11.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.04
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.99
|
| Rate for Payer: Vantage Medical Group Senior |
$13.63
|
|
|
HC FETAL BLEED SCREEN
|
Facility
|
OP
|
$296.00
|
|
|
Service Code
|
CPT 85461
|
| Hospital Charge Code |
900904562
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.17 |
| Max. Negotiated Rate |
$266.40 |
| Rate for Payer: Adventist Health Commercial |
$59.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$9.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$179.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$111.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.58
|
| Rate for Payer: Blue Shield of California Commercial |
$179.67
|
| Rate for Payer: Blue Shield of California EPN |
$117.51
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Central Health Plan Commercial |
$236.80
|
| Rate for Payer: Cigna of CA HMO |
$189.44
|
| Rate for Payer: Cigna of CA PPO |
$219.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.64
|
| Rate for Payer: EPIC Health Plan Senior |
$9.36
|
| Rate for Payer: Galaxy Health WC |
$251.60
|
| Rate for Payer: Global Benefits Group Commercial |
$177.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$266.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.36
|
| Rate for Payer: InnovAge PACE Commercial |
$14.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$197.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.54
|
| Rate for Payer: Multiplan Commercial |
$222.00
|
| Rate for Payer: Networks By Design Commercial |
$192.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9.36
|
| Rate for Payer: Prime Health Services Commercial |
$251.60
|
| Rate for Payer: Prime Health Services Medicare |
$9.92
|
| Rate for Payer: Riverside University Health System MISP |
$10.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$177.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$177.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.58
|
| Rate for Payer: United Healthcare All Other HMO |
$7.58
|
| Rate for Payer: United Healthcare HMO Rider |
$7.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.58
|
| Rate for Payer: Upland Medical Group Pediatric |
$9.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.30
|
| Rate for Payer: Vantage Medical Group Senior |
$9.36
|
|
