|
HC GDC SOFT
|
Facility
|
IP
|
$1,530.00
|
|
| Hospital Charge Code |
909081814
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$306.00 |
| Max. Negotiated Rate |
$1,377.00 |
| Rate for Payer: Adventist Health Commercial |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,182.69
|
| Rate for Payer: Blue Shield of California EPN |
$771.12
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,224.00
|
| Rate for Payer: Cigna of CA HMO |
$1,071.00
|
| Rate for Payer: Cigna of CA PPO |
$1,071.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.00
|
| Rate for Payer: EPIC Health Plan Senior |
$612.00
|
| Rate for Payer: Galaxy Health WC |
$1,300.50
|
| Rate for Payer: Global Benefits Group Commercial |
$918.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,377.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,020.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$582.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$947.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$306.00
|
| Rate for Payer: Multiplan Commercial |
$1,147.50
|
| Rate for Payer: Networks By Design Commercial |
$765.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,300.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$574.21
|
| Rate for Payer: United Healthcare All Other HMO |
$558.91
|
| Rate for Payer: United Healthcare HMO Rider |
$546.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$501.07
|
|
|
HC GDC STANDARD
|
Facility
|
OP
|
$4,347.50
|
|
| Hospital Charge Code |
909081815
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$869.50 |
| Max. Negotiated Rate |
$3,912.75 |
| Rate for Payer: Adventist Health Commercial |
$869.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,695.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,391.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,260.62
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,985.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,407.21
|
| Rate for Payer: Blue Shield of California Commercial |
$3,360.62
|
| Rate for Payer: Blue Shield of California EPN |
$2,191.14
|
| Rate for Payer: Cash Price |
$1,956.38
|
| Rate for Payer: Central Health Plan Commercial |
$3,478.00
|
| Rate for Payer: Cigna of CA HMO |
$3,043.25
|
| Rate for Payer: Cigna of CA PPO |
$3,043.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,695.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,695.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,695.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,739.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,739.00
|
| Rate for Payer: Galaxy Health WC |
$3,695.38
|
| Rate for Payer: Global Benefits Group Commercial |
$2,608.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,912.75
|
| Rate for Payer: InnovAge PACE Commercial |
$2,173.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,899.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,656.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,691.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$869.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,043.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,043.25
|
| Rate for Payer: Multiplan Commercial |
$3,260.62
|
| Rate for Payer: Networks By Design Commercial |
$2,173.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,695.38
|
| Rate for Payer: Riverside University Health System MISP |
$1,739.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,608.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,608.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,631.62
|
| Rate for Payer: United Healthcare All Other HMO |
$1,588.14
|
| Rate for Payer: United Healthcare HMO Rider |
$1,553.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,423.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,695.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,695.38
|
| Rate for Payer: Vantage Medical Group Senior |
$3,695.38
|
|
|
HC GDC STANDARD
|
Facility
|
IP
|
$4,347.50
|
|
| Hospital Charge Code |
909081815
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$869.50 |
| Max. Negotiated Rate |
$3,912.75 |
| Rate for Payer: Adventist Health Commercial |
$869.50
|
| Rate for Payer: Blue Shield of California Commercial |
$3,360.62
|
| Rate for Payer: Blue Shield of California EPN |
$2,191.14
|
| Rate for Payer: Cash Price |
$1,956.38
|
| Rate for Payer: Central Health Plan Commercial |
$3,478.00
|
| Rate for Payer: Cigna of CA HMO |
$3,043.25
|
| Rate for Payer: Cigna of CA PPO |
$3,043.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,739.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,739.00
|
| Rate for Payer: Galaxy Health WC |
$3,695.38
|
| Rate for Payer: Global Benefits Group Commercial |
$2,608.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,912.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,899.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,656.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,691.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$869.50
|
| Rate for Payer: Multiplan Commercial |
$3,260.62
|
| Rate for Payer: Networks By Design Commercial |
$2,173.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,695.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,631.62
|
| Rate for Payer: United Healthcare All Other HMO |
$1,588.14
|
| Rate for Payer: United Healthcare HMO Rider |
$1,553.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,423.81
|
|
|
HC GDC STRETCH RESISTANT
|
Facility
|
OP
|
$1,536.00
|
|
| Hospital Charge Code |
909081816
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$307.20 |
| Max. Negotiated Rate |
$1,382.40 |
| Rate for Payer: Adventist Health Commercial |
$307.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$932.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,305.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$844.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,152.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$743.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$902.09
|
| Rate for Payer: Blue Shield of California Commercial |
$938.50
|
| Rate for Payer: Blue Shield of California EPN |
$612.86
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,228.80
|
| Rate for Payer: Cigna of CA HMO |
$983.04
|
| Rate for Payer: Cigna of CA PPO |
$1,136.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,305.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,305.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,305.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$614.40
|
| Rate for Payer: EPIC Health Plan Senior |
$614.40
|
| Rate for Payer: Galaxy Health WC |
$1,305.60
|
| Rate for Payer: Global Benefits Group Commercial |
$921.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,382.40
|
| Rate for Payer: InnovAge PACE Commercial |
$768.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,024.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$585.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$950.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$307.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,075.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,075.20
|
| Rate for Payer: Multiplan Commercial |
$1,152.00
|
| Rate for Payer: Networks By Design Commercial |
$998.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,305.60
|
| Rate for Payer: Riverside University Health System MISP |
$614.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$921.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$921.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Other HMO |
$768.00
|
| Rate for Payer: United Healthcare HMO Rider |
$768.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$768.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,305.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,305.60
|
| Rate for Payer: Vantage Medical Group Senior |
$1,305.60
|
|
|
HC GDC STRETCH RESISTANT
|
Facility
|
IP
|
$1,536.00
|
|
| Hospital Charge Code |
909081816
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$307.20 |
| Max. Negotiated Rate |
$1,382.40 |
| Rate for Payer: Adventist Health Commercial |
$307.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,228.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$614.40
|
| Rate for Payer: EPIC Health Plan Senior |
$614.40
|
| Rate for Payer: Galaxy Health WC |
$1,305.60
|
| Rate for Payer: Global Benefits Group Commercial |
$921.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,382.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,024.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$585.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$950.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$307.20
|
| Rate for Payer: Multiplan Commercial |
$1,152.00
|
| Rate for Payer: Networks By Design Commercial |
$998.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,305.60
|
|
|
HC GECKO NASAL GEL PAD LARGE
|
Facility
|
IP
|
$97.36
|
|
|
Service Code
|
CPT A7032
|
| Hospital Charge Code |
901606818
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$19.47 |
| Max. Negotiated Rate |
$87.62 |
| Rate for Payer: Adventist Health Commercial |
$19.47
|
| Rate for Payer: Blue Shield of California Commercial |
$75.26
|
| Rate for Payer: Blue Shield of California EPN |
$49.07
|
| Rate for Payer: Cash Price |
$43.81
|
| Rate for Payer: Central Health Plan Commercial |
$77.89
|
| Rate for Payer: Cigna of CA HMO |
$68.15
|
| Rate for Payer: Cigna of CA PPO |
$68.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.94
|
| Rate for Payer: EPIC Health Plan Senior |
$38.94
|
| Rate for Payer: Galaxy Health WC |
$82.76
|
| Rate for Payer: Global Benefits Group Commercial |
$58.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$87.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$60.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.47
|
| Rate for Payer: Multiplan Commercial |
$73.02
|
| Rate for Payer: Networks By Design Commercial |
$63.28
|
| Rate for Payer: Prime Health Services Commercial |
$82.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.54
|
| Rate for Payer: United Healthcare All Other HMO |
$35.57
|
| Rate for Payer: United Healthcare HMO Rider |
$34.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.89
|
|
|
HC GECKO NASAL GEL PAD LARGE
|
Facility
|
OP
|
$97.36
|
|
|
Service Code
|
CPT A7032
|
| Hospital Charge Code |
901606818
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$31.89 |
| Max. Negotiated Rate |
$87.62 |
| Rate for Payer: Adventist Health Commercial |
$39.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$82.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$73.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.18
|
| Rate for Payer: Blue Shield of California Commercial |
$75.26
|
| Rate for Payer: Blue Shield of California EPN |
$49.07
|
| Rate for Payer: Cash Price |
$43.81
|
| Rate for Payer: Cash Price |
$43.81
|
| Rate for Payer: Central Health Plan Commercial |
$77.89
|
| Rate for Payer: Cigna of CA HMO |
$68.15
|
| Rate for Payer: Cigna of CA PPO |
$68.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$82.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$82.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$82.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.94
|
| Rate for Payer: EPIC Health Plan Senior |
$38.94
|
| Rate for Payer: Galaxy Health WC |
$82.76
|
| Rate for Payer: Global Benefits Group Commercial |
$58.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$87.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$52.99
|
| Rate for Payer: InnovAge PACE Commercial |
$48.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$60.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$68.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$68.15
|
| Rate for Payer: Multiplan Commercial |
$73.02
|
| Rate for Payer: Networks By Design Commercial |
$48.68
|
| Rate for Payer: Prime Health Services Commercial |
$82.76
|
| Rate for Payer: Riverside University Health System MISP |
$38.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.54
|
| Rate for Payer: United Healthcare All Other HMO |
$35.57
|
| Rate for Payer: United Healthcare HMO Rider |
$34.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$82.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$82.76
|
| Rate for Payer: Vantage Medical Group Senior |
$82.76
|
|
|
HC GECKO NASAL PAD SMALL
|
Facility
|
IP
|
$97.36
|
|
|
Service Code
|
CPT A7032
|
| Hospital Charge Code |
901606819
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$19.47 |
| Max. Negotiated Rate |
$87.62 |
| Rate for Payer: Adventist Health Commercial |
$19.47
|
| Rate for Payer: Blue Shield of California Commercial |
$75.26
|
| Rate for Payer: Blue Shield of California EPN |
$49.07
|
| Rate for Payer: Cash Price |
$43.81
|
| Rate for Payer: Central Health Plan Commercial |
$77.89
|
| Rate for Payer: Cigna of CA HMO |
$68.15
|
| Rate for Payer: Cigna of CA PPO |
$68.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.94
|
| Rate for Payer: EPIC Health Plan Senior |
$38.94
|
| Rate for Payer: Galaxy Health WC |
$82.76
|
| Rate for Payer: Global Benefits Group Commercial |
$58.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$87.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$60.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.47
|
| Rate for Payer: Multiplan Commercial |
$73.02
|
| Rate for Payer: Networks By Design Commercial |
$63.28
|
| Rate for Payer: Prime Health Services Commercial |
$82.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.54
|
| Rate for Payer: United Healthcare All Other HMO |
$35.57
|
| Rate for Payer: United Healthcare HMO Rider |
$34.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.89
|
|
|
HC GECKO NASAL PAD SMALL
|
Facility
|
OP
|
$97.36
|
|
|
Service Code
|
CPT A7032
|
| Hospital Charge Code |
901606819
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$31.89 |
| Max. Negotiated Rate |
$87.62 |
| Rate for Payer: Adventist Health Commercial |
$39.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$82.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$73.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.18
|
| Rate for Payer: Blue Shield of California Commercial |
$75.26
|
| Rate for Payer: Blue Shield of California EPN |
$49.07
|
| Rate for Payer: Cash Price |
$43.81
|
| Rate for Payer: Cash Price |
$43.81
|
| Rate for Payer: Central Health Plan Commercial |
$77.89
|
| Rate for Payer: Cigna of CA HMO |
$68.15
|
| Rate for Payer: Cigna of CA PPO |
$68.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$82.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$82.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$82.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.94
|
| Rate for Payer: EPIC Health Plan Senior |
$38.94
|
| Rate for Payer: Galaxy Health WC |
$82.76
|
| Rate for Payer: Global Benefits Group Commercial |
$58.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$87.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$52.99
|
| Rate for Payer: InnovAge PACE Commercial |
$48.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$60.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$68.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$68.15
|
| Rate for Payer: Multiplan Commercial |
$73.02
|
| Rate for Payer: Networks By Design Commercial |
$48.68
|
| Rate for Payer: Prime Health Services Commercial |
$82.76
|
| Rate for Payer: Riverside University Health System MISP |
$38.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.54
|
| Rate for Payer: United Healthcare All Other HMO |
$35.57
|
| Rate for Payer: United Healthcare HMO Rider |
$34.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$82.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$82.76
|
| Rate for Payer: Vantage Medical Group Senior |
$82.76
|
|
|
HC GEL PILLOW W/COVER 6" X 9"
|
Facility
|
IP
|
$98.50
|
|
| Hospital Charge Code |
901698550
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.70 |
| Max. Negotiated Rate |
$88.65 |
| Rate for Payer: Adventist Health Commercial |
$19.70
|
| Rate for Payer: Cash Price |
$44.33
|
| Rate for Payer: Central Health Plan Commercial |
$78.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.40
|
| Rate for Payer: EPIC Health Plan Senior |
$39.40
|
| Rate for Payer: Galaxy Health WC |
$83.72
|
| Rate for Payer: Global Benefits Group Commercial |
$59.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$88.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$60.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.70
|
| Rate for Payer: Multiplan Commercial |
$73.88
|
| Rate for Payer: Networks By Design Commercial |
$64.03
|
| Rate for Payer: Prime Health Services Commercial |
$83.72
|
|
|
HC GEL PILLOW W/COVER 6" X 9"
|
Facility
|
OP
|
$98.50
|
|
| Hospital Charge Code |
901698550
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.70 |
| Max. Negotiated Rate |
$88.65 |
| Rate for Payer: Adventist Health Commercial |
$19.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$83.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$54.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$73.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$47.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.85
|
| Rate for Payer: Blue Shield of California Commercial |
$60.18
|
| Rate for Payer: Blue Shield of California EPN |
$39.30
|
| Rate for Payer: Cash Price |
$44.33
|
| Rate for Payer: Central Health Plan Commercial |
$78.80
|
| Rate for Payer: Cigna of CA HMO |
$63.04
|
| Rate for Payer: Cigna of CA PPO |
$72.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$83.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$83.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.40
|
| Rate for Payer: EPIC Health Plan Senior |
$39.40
|
| Rate for Payer: Galaxy Health WC |
$83.72
|
| Rate for Payer: Global Benefits Group Commercial |
$59.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$88.65
|
| Rate for Payer: InnovAge PACE Commercial |
$49.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$60.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$68.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$68.95
|
| Rate for Payer: Multiplan Commercial |
$73.88
|
| Rate for Payer: Networks By Design Commercial |
$64.03
|
| Rate for Payer: Prime Health Services Commercial |
$83.72
|
| Rate for Payer: Riverside University Health System MISP |
$39.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$59.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$59.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.25
|
| Rate for Payer: United Healthcare All Other HMO |
$49.25
|
| Rate for Payer: United Healthcare HMO Rider |
$49.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$83.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.72
|
| Rate for Payer: Vantage Medical Group Senior |
$83.72
|
|
|
HC GENTAMICIN
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT 80170
|
| Hospital Charge Code |
900910406
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.60 |
| Max. Negotiated Rate |
$196.20 |
| Rate for Payer: Adventist Health Commercial |
$43.60
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Central Health Plan Commercial |
$174.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.20
|
| Rate for Payer: EPIC Health Plan Senior |
$87.20
|
| Rate for Payer: Galaxy Health WC |
$185.30
|
| Rate for Payer: Global Benefits Group Commercial |
$130.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$196.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$145.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$134.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.60
|
| Rate for Payer: Multiplan Commercial |
$163.50
|
| Rate for Payer: Networks By Design Commercial |
$141.70
|
| Rate for Payer: Prime Health Services Commercial |
$185.30
|
|
|
HC GENTAMICIN
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
CPT 80170
|
| Hospital Charge Code |
900910406
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$107.99 |
| Rate for Payer: Adventist Health Commercial |
$9.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$16.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$29.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$107.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.92
|
| Rate for Payer: Blue Shield of California Commercial |
$29.74
|
| Rate for Payer: Blue Shield of California EPN |
$19.45
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Central Health Plan Commercial |
$39.20
|
| Rate for Payer: Cigna of CA HMO |
$31.36
|
| Rate for Payer: Cigna of CA PPO |
$36.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.11
|
| Rate for Payer: EPIC Health Plan Senior |
$16.38
|
| Rate for Payer: Galaxy Health WC |
$41.65
|
| Rate for Payer: Global Benefits Group Commercial |
$29.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$26.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.38
|
| Rate for Payer: InnovAge PACE Commercial |
$24.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.95
|
| Rate for Payer: Multiplan Commercial |
$36.75
|
| Rate for Payer: Networks By Design Commercial |
$31.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16.38
|
| Rate for Payer: Prime Health Services Commercial |
$41.65
|
| Rate for Payer: Prime Health Services Medicare |
$17.36
|
| Rate for Payer: Riverside University Health System MISP |
$18.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.27
|
| Rate for Payer: United Healthcare All Other HMO |
$13.27
|
| Rate for Payer: United Healthcare HMO Rider |
$13.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.27
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.02
|
| Rate for Payer: Vantage Medical Group Senior |
$16.38
|
|
|
HC GI BLEED SCAN
|
Facility
|
OP
|
$3,571.00
|
|
|
Service Code
|
CPT 78278
|
| Hospital Charge Code |
909301360
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$223.26 |
| Max. Negotiated Rate |
$3,213.90 |
| Rate for Payer: Adventist Health Commercial |
$714.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$510.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,168.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,014.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,097.25
|
| Rate for Payer: Blue Shield of California Commercial |
$2,167.60
|
| Rate for Payer: Blue Shield of California EPN |
$1,417.69
|
| Rate for Payer: Cash Price |
$1,606.95
|
| Rate for Payer: Cash Price |
$1,606.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,856.80
|
| Rate for Payer: Cigna of CA HMO |
$2,285.44
|
| Rate for Payer: Cigna of CA PPO |
$2,642.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$510.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$689.27
|
| Rate for Payer: EPIC Health Plan Senior |
$510.57
|
| Rate for Payer: Galaxy Health WC |
$3,035.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,142.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,213.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$837.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$223.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.57
|
| Rate for Payer: InnovAge PACE Commercial |
$765.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,381.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$246.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$510.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$714.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$684.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$684.16
|
| Rate for Payer: Multiplan Commercial |
$2,678.25
|
| Rate for Payer: Networks By Design Commercial |
$2,321.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$510.57
|
| Rate for Payer: Prime Health Services Commercial |
$3,035.35
|
| Rate for Payer: Prime Health Services Medicare |
$541.20
|
| Rate for Payer: Riverside University Health System MISP |
$561.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,142.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,142.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$623.82
|
| Rate for Payer: United Healthcare All Other HMO |
$623.82
|
| Rate for Payer: United Healthcare HMO Rider |
$623.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$623.82
|
| Rate for Payer: Upland Medical Group Pediatric |
$510.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Vantage Medical Group Senior |
$510.57
|
|
|
HC GI BLEED SCAN
|
Facility
|
IP
|
$3,571.00
|
|
|
Service Code
|
CPT 78278
|
| Hospital Charge Code |
909301360
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$714.20 |
| Max. Negotiated Rate |
$3,213.90 |
| Rate for Payer: Adventist Health Commercial |
$714.20
|
| Rate for Payer: Cash Price |
$1,606.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,856.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,428.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,428.40
|
| Rate for Payer: Galaxy Health WC |
$3,035.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,142.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,213.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,381.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,360.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,210.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$714.20
|
| Rate for Payer: Multiplan Commercial |
$2,678.25
|
| Rate for Payer: Networks By Design Commercial |
$2,321.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,035.35
|
|
|
HC GI ENDOSCOPIC ULTRASOUND
|
Facility
|
IP
|
$1,355.00
|
|
|
Service Code
|
CPT 76975
|
| Hospital Charge Code |
906776975
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$271.00 |
| Max. Negotiated Rate |
$1,219.50 |
| Rate for Payer: Adventist Health Commercial |
$271.00
|
| Rate for Payer: Cash Price |
$609.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,084.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$542.00
|
| Rate for Payer: EPIC Health Plan Senior |
$542.00
|
| Rate for Payer: Galaxy Health WC |
$1,151.75
|
| Rate for Payer: Global Benefits Group Commercial |
$813.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,219.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$903.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$516.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$838.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$271.00
|
| Rate for Payer: Multiplan Commercial |
$1,016.25
|
| Rate for Payer: Networks By Design Commercial |
$880.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,151.75
|
|
|
HC GI ENDOSCOPIC ULTRASOUND
|
Facility
|
OP
|
$1,355.00
|
|
|
Service Code
|
CPT 76975
|
| Hospital Charge Code |
906776975
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$82.39 |
| Max. Negotiated Rate |
$1,219.50 |
| Rate for Payer: Adventist Health Commercial |
$271.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$307.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$822.89
|
| 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 |
$316.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$795.79
|
| Rate for Payer: Blue Shield of California Commercial |
$822.49
|
| Rate for Payer: Blue Shield of California EPN |
$537.93
|
| Rate for Payer: Cash Price |
$609.75
|
| Rate for Payer: Cash Price |
$609.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,084.00
|
| Rate for Payer: Cigna of CA HMO |
$867.20
|
| Rate for Payer: Cigna of CA PPO |
$1,002.70
|
| 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 |
$1,151.75
|
| Rate for Payer: Global Benefits Group Commercial |
$813.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,219.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$82.39
|
| 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 |
$903.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$91.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$271.00
|
| 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 |
$1,016.25
|
| Rate for Payer: Networks By Design Commercial |
$880.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$307.13
|
| Rate for Payer: Prime Health Services Commercial |
$1,151.75
|
| 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 |
$813.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$813.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$389.46
|
| Rate for Payer: United Healthcare All Other HMO |
$389.46
|
| Rate for Payer: United Healthcare HMO Rider |
$389.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$389.46
|
| 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 GI INJ TREATMENT NR
|
Facility
|
IP
|
$4,442.00
|
|
|
Service Code
|
CPT 64640
|
| Hospital Charge Code |
906764640
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$888.40 |
| Max. Negotiated Rate |
$3,997.80 |
| Rate for Payer: Adventist Health Commercial |
$888.40
|
| Rate for Payer: Cash Price |
$1,998.90
|
| Rate for Payer: Central Health Plan Commercial |
$3,553.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,776.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,776.80
|
| Rate for Payer: Galaxy Health WC |
$3,775.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,665.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,997.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,962.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,692.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,749.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$888.40
|
| Rate for Payer: Multiplan Commercial |
$3,331.50
|
| Rate for Payer: Networks By Design Commercial |
$2,887.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,775.70
|
|
|
HC GI INJ TREATMENT NR
|
Facility
|
OP
|
$1,961.00
|
|
|
Service Code
|
CPT 64640
|
| Hospital Charge Code |
906764640
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$215.81 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$392.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,131.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,131.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$882.45
|
| Rate for Payer: Cash Price |
$882.45
|
| Rate for Payer: Cash Price |
$882.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,568.80
|
| Rate for Payer: Cigna of CA HMO |
$1,255.04
|
| Rate for Payer: Cigna of CA PPO |
$1,451.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,244.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,131.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,527.12
|
| Rate for Payer: EPIC Health Plan Senior |
$1,131.20
|
| Rate for Payer: Galaxy Health WC |
$1,666.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,176.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,764.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,855.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$215.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,131.20
|
| Rate for Payer: InnovAge PACE Commercial |
$1,696.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,307.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$238.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,131.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$392.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,515.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,515.81
|
| Rate for Payer: Multiplan Commercial |
$1,470.75
|
| Rate for Payer: Networks By Design Commercial |
$1,274.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,131.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,666.85
|
| Rate for Payer: Prime Health Services Medicare |
$1,199.07
|
| Rate for Payer: Riverside University Health System MISP |
$1,244.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,176.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,357.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,131.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1,131.20
|
|
|
HC GI PROTEIN LOSS
|
Facility
|
OP
|
$1,233.00
|
|
|
Service Code
|
CPT 78282
|
| Hospital Charge Code |
909301367
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$89.29 |
| Max. Negotiated Rate |
$1,109.70 |
| Rate for Payer: Adventist Health Commercial |
$246.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$510.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$748.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$581.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$724.14
|
| Rate for Payer: Blue Shield of California Commercial |
$748.43
|
| Rate for Payer: Blue Shield of California EPN |
$489.50
|
| Rate for Payer: Cash Price |
$554.85
|
| Rate for Payer: Cash Price |
$554.85
|
| Rate for Payer: Central Health Plan Commercial |
$986.40
|
| Rate for Payer: Cigna of CA HMO |
$789.12
|
| Rate for Payer: Cigna of CA PPO |
$912.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$510.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$689.27
|
| Rate for Payer: EPIC Health Plan Senior |
$510.57
|
| Rate for Payer: Galaxy Health WC |
$1,048.05
|
| Rate for Payer: Global Benefits Group Commercial |
$739.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,109.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$837.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$89.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.57
|
| Rate for Payer: InnovAge PACE Commercial |
$765.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$822.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$510.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$684.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$684.16
|
| Rate for Payer: Multiplan Commercial |
$924.75
|
| Rate for Payer: Networks By Design Commercial |
$801.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$510.57
|
| Rate for Payer: Prime Health Services Commercial |
$1,048.05
|
| Rate for Payer: Prime Health Services Medicare |
$541.20
|
| Rate for Payer: Riverside University Health System MISP |
$561.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$739.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$739.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$623.82
|
| Rate for Payer: United Healthcare All Other HMO |
$623.82
|
| Rate for Payer: United Healthcare HMO Rider |
$623.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$623.82
|
| Rate for Payer: Upland Medical Group Pediatric |
$510.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Vantage Medical Group Senior |
$510.57
|
|
|
HC GI PROTEIN LOSS
|
Facility
|
IP
|
$1,233.00
|
|
|
Service Code
|
CPT 78282
|
| Hospital Charge Code |
909301367
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$246.60 |
| Max. Negotiated Rate |
$1,109.70 |
| Rate for Payer: Adventist Health Commercial |
$246.60
|
| Rate for Payer: Cash Price |
$554.85
|
| Rate for Payer: Central Health Plan Commercial |
$986.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$493.20
|
| Rate for Payer: EPIC Health Plan Senior |
$493.20
|
| Rate for Payer: Galaxy Health WC |
$1,048.05
|
| Rate for Payer: Global Benefits Group Commercial |
$739.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,109.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$822.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$469.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$763.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.60
|
| Rate for Payer: Multiplan Commercial |
$924.75
|
| Rate for Payer: Networks By Design Commercial |
$801.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,048.05
|
|
|
HC GI TRACT CAPSULE ENDO
|
Facility
|
OP
|
$2,539.00
|
|
|
Service Code
|
CPT 91110
|
| Hospital Charge Code |
906700355
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$507.80 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$507.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,191.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 |
$5,332.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,491.15
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$1,142.55
|
| Rate for Payer: Cash Price |
$1,142.55
|
| Rate for Payer: Cash Price |
$1,142.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,031.20
|
| Rate for Payer: Cigna of CA HMO |
$1,624.96
|
| Rate for Payer: Cigna of CA PPO |
$1,878.86
|
| 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 |
$2,158.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,523.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,285.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,953.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,383.38
|
| 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 |
$1,693.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,528.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,191.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$507.80
|
| 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 |
$1,904.25
|
| Rate for Payer: Networks By Design Commercial |
$1,650.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Prime Health Services Commercial |
$2,158.15
|
| 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 |
$1,523.40
|
| 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 GI TRACT CAPSULE ENDO
|
Facility
|
IP
|
$4,791.00
|
|
|
Service Code
|
CPT 91110
|
| Hospital Charge Code |
906700355
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$958.20 |
| Max. Negotiated Rate |
$4,311.90 |
| Rate for Payer: Adventist Health Commercial |
$958.20
|
| Rate for Payer: Cash Price |
$2,155.95
|
| Rate for Payer: Central Health Plan Commercial |
$3,832.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,916.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,916.40
|
| Rate for Payer: Galaxy Health WC |
$4,072.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,874.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,311.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,195.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,825.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,965.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$958.20
|
| Rate for Payer: Multiplan Commercial |
$3,593.25
|
| Rate for Payer: Networks By Design Commercial |
$3,114.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,072.35
|
|
|
HC GI TRANS & PRESS WRLS CAPSULE
|
Facility
|
IP
|
$2,221.00
|
|
|
Service Code
|
CPT 91112
|
| Hospital Charge Code |
906791112
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$444.20 |
| Max. Negotiated Rate |
$1,998.90 |
| Rate for Payer: Adventist Health Commercial |
$444.20
|
| Rate for Payer: Cash Price |
$999.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,776.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$888.40
|
| Rate for Payer: EPIC Health Plan Senior |
$888.40
|
| Rate for Payer: Galaxy Health WC |
$1,887.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,332.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,998.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,481.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$846.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,374.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$444.20
|
| Rate for Payer: Multiplan Commercial |
$1,665.75
|
| Rate for Payer: Networks By Design Commercial |
$1,443.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,887.85
|
|
|
HC GI TRANS & PRESS WRLS CAPSULE
|
Facility
|
OP
|
$980.00
|
|
|
Service Code
|
CPT 91112
|
| Hospital Charge Code |
906791112
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$196.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,191.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,245.30
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$441.00
|
| Rate for Payer: Cash Price |
$441.00
|
| Rate for Payer: Cash Price |
$441.00
|
| Rate for Payer: Central Health Plan Commercial |
$784.00
|
| Rate for Payer: Cigna of CA HMO |
$627.20
|
| Rate for Payer: Cigna of CA PPO |
$725.20
|
| 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 |
$833.00
|
| Rate for Payer: Global Benefits Group Commercial |
$588.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$882.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,953.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,859.44
|
| 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 |
$653.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,054.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,191.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.00
|
| 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 |
$735.00
|
| Rate for Payer: Networks By Design Commercial |
$637.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Prime Health Services Commercial |
$833.00
|
| 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 |
$588.00
|
| 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
|
|
