|
HC HYDRATION INFUSION INITIAL 31-90MIN
|
Facility
|
OP
|
$1,069.00
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
910196360
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$88.24 |
| Max. Negotiated Rate |
$962.10 |
| Rate for Payer: Adventist Health Commercial |
$213.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$273.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$363.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$410.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$300.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$273.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$517.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$621.84
|
| Rate for Payer: Blue Shield of California Commercial |
$677.75
|
| Rate for Payer: Blue Shield of California EPN |
$426.53
|
| Rate for Payer: Cash Price |
$481.05
|
| Rate for Payer: Cash Price |
$481.05
|
| Rate for Payer: Central Health Plan Commercial |
$855.20
|
| Rate for Payer: Cigna of CA HMO |
$684.16
|
| Rate for Payer: Cigna of CA PPO |
$791.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$410.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$300.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$273.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$748.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$451.39
|
| Rate for Payer: EPIC Health Plan Senior |
$300.93
|
| Rate for Payer: Galaxy Health WC |
$908.65
|
| Rate for Payer: Global Benefits Group Commercial |
$641.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$962.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$448.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$88.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$273.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$678.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$97.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$383.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$366.58
|
| Rate for Payer: Multiplan Commercial |
$801.75
|
| Rate for Payer: Networks By Design Commercial |
$694.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$273.57
|
| Rate for Payer: Prime Health Services Commercial |
$908.65
|
| Rate for Payer: Prime Health Services Medicare |
$289.98
|
| Rate for Payer: Riverside University Health System MISP |
$300.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$641.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$641.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$534.50
|
| Rate for Payer: United Healthcare All Other HMO |
$534.50
|
| Rate for Payer: United Healthcare HMO Rider |
$534.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$534.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$273.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$410.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$300.93
|
| Rate for Payer: Vantage Medical Group Senior |
$273.57
|
|
|
HC HYDRATION INFUSION INITIAL 31-90MIN
|
Facility
|
IP
|
$1,069.00
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
910196360
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$213.80 |
| Max. Negotiated Rate |
$962.10 |
| Rate for Payer: Adventist Health Commercial |
$213.80
|
| Rate for Payer: Cash Price |
$481.05
|
| Rate for Payer: Central Health Plan Commercial |
$855.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$748.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$427.60
|
| Rate for Payer: EPIC Health Plan Senior |
$427.60
|
| Rate for Payer: Galaxy Health WC |
$908.65
|
| Rate for Payer: Global Benefits Group Commercial |
$641.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$962.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$678.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$630.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.80
|
| Rate for Payer: Multiplan Commercial |
$801.75
|
| Rate for Payer: Networks By Design Commercial |
$694.85
|
| Rate for Payer: Prime Health Services Commercial |
$908.65
|
|
|
HC HYDRATION INFUSION INITIAL 31-90MIN
|
Facility
|
IP
|
$1,069.00
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
910196360
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$213.80 |
| Max. Negotiated Rate |
$962.10 |
| Rate for Payer: Adventist Health Commercial |
$213.80
|
| Rate for Payer: Cash Price |
$481.05
|
| Rate for Payer: Central Health Plan Commercial |
$855.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$748.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$427.60
|
| Rate for Payer: EPIC Health Plan Senior |
$427.60
|
| Rate for Payer: Galaxy Health WC |
$908.65
|
| Rate for Payer: Global Benefits Group Commercial |
$641.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$962.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$678.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$630.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.80
|
| Rate for Payer: Multiplan Commercial |
$801.75
|
| Rate for Payer: Networks By Design Commercial |
$694.85
|
| Rate for Payer: Prime Health Services Commercial |
$908.65
|
|
|
HC HYDRATION INFUSION INITIAL 31-90MIN
|
Facility
|
IP
|
$1,069.00
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
910196360
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$213.80 |
| Max. Negotiated Rate |
$962.10 |
| Rate for Payer: Adventist Health Commercial |
$213.80
|
| Rate for Payer: Cash Price |
$481.05
|
| Rate for Payer: Central Health Plan Commercial |
$855.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$748.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$427.60
|
| Rate for Payer: EPIC Health Plan Senior |
$427.60
|
| Rate for Payer: Galaxy Health WC |
$908.65
|
| Rate for Payer: Global Benefits Group Commercial |
$641.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$962.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$678.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$630.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.80
|
| Rate for Payer: Multiplan Commercial |
$801.75
|
| Rate for Payer: Networks By Design Commercial |
$694.85
|
| Rate for Payer: Prime Health Services Commercial |
$908.65
|
|
|
HC HYDRATION INFUSION INITIAL 31-90MIN
|
Facility
|
OP
|
$1,069.00
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
910196360
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$97.47 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Commercial |
$213.80
|
| 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 |
$410.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$300.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$273.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,685.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$426.54
|
| Rate for Payer: Cash Price |
$481.05
|
| Rate for Payer: Cash Price |
$481.05
|
| Rate for Payer: Cash Price |
$481.05
|
| Rate for Payer: Cash Price |
$481.05
|
| Rate for Payer: Central Health Plan Commercial |
$855.20
|
| Rate for Payer: Cigna of CA HMO |
$684.16
|
| Rate for Payer: Cigna of CA PPO |
$791.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$410.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$300.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$273.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$748.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$451.39
|
| Rate for Payer: EPIC Health Plan Senior |
$300.93
|
| Rate for Payer: Galaxy Health WC |
$908.65
|
| Rate for Payer: Global Benefits Group Commercial |
$641.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$962.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$448.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$273.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$678.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$97.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$294.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$366.58
|
| Rate for Payer: Multiplan Commercial |
$801.75
|
| Rate for Payer: Multiplan WC |
$426.54
|
| Rate for Payer: Networks By Design Commercial |
$694.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$273.57
|
| Rate for Payer: Preferred Health Network WC |
$435.24
|
| Rate for Payer: Prime Health Services Commercial |
$908.65
|
| Rate for Payer: Prime Health Services Medicare |
$289.98
|
| Rate for Payer: Prime Health Services WC |
$422.18
|
| Rate for Payer: Riverside University Health System MISP |
$300.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$641.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$534.50
|
| Rate for Payer: United Healthcare All Other HMO |
$534.50
|
| Rate for Payer: United Healthcare HMO Rider |
$534.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$534.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$273.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$410.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$300.93
|
| Rate for Payer: Vantage Medical Group Senior |
$273.57
|
|
|
HC HYDRAULIC SWING MINI HI ACTVTY
|
Facility
|
OP
|
$3,863.00
|
|
|
Service Code
|
CPT L5826
|
| Hospital Charge Code |
905355826
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,265.13 |
| Max. Negotiated Rate |
$3,476.70 |
| Rate for Payer: Adventist Health Commercial |
$1,583.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,283.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,124.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,897.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,247.11
|
| Rate for Payer: Blue Shield of California Commercial |
$3,098.13
|
| Rate for Payer: Blue Shield of California EPN |
$1,946.95
|
| Rate for Payer: Cash Price |
$1,738.35
|
| Rate for Payer: Cash Price |
$1,738.35
|
| Rate for Payer: Central Health Plan Commercial |
$3,090.40
|
| Rate for Payer: Cigna of CA HMO |
$2,704.10
|
| Rate for Payer: Cigna of CA PPO |
$2,704.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,283.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,283.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,283.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,704.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,545.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,545.20
|
| Rate for Payer: Galaxy Health WC |
$3,283.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,317.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,476.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,406.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,453.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,658.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,279.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,583.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,704.10
|
| Rate for Payer: Multiplan Commercial |
$2,897.25
|
| Rate for Payer: Networks By Design Commercial |
$1,931.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,283.55
|
| Rate for Payer: Riverside University Health System MISP |
$1,545.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,317.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,317.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,449.78
|
| Rate for Payer: United Healthcare All Other HMO |
$1,411.15
|
| Rate for Payer: United Healthcare HMO Rider |
$1,380.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,265.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,283.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,283.55
|
| Rate for Payer: Vantage Medical Group Senior |
$3,283.55
|
|
|
HC HYDRAULIC SWING MINI HI ACTVTY
|
Facility
|
OP
|
$3,863.00
|
|
|
Service Code
|
CPT L5826
|
| Hospital Charge Code |
915355826
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,265.13 |
| Max. Negotiated Rate |
$3,476.70 |
| Rate for Payer: Adventist Health Commercial |
$1,583.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,283.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,124.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,897.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,247.11
|
| Rate for Payer: Blue Shield of California Commercial |
$3,098.13
|
| Rate for Payer: Blue Shield of California EPN |
$1,946.95
|
| Rate for Payer: Cash Price |
$1,738.35
|
| Rate for Payer: Cash Price |
$1,738.35
|
| Rate for Payer: Central Health Plan Commercial |
$3,090.40
|
| Rate for Payer: Cigna of CA HMO |
$2,704.10
|
| Rate for Payer: Cigna of CA PPO |
$2,704.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,283.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,283.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,283.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,704.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,545.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,545.20
|
| Rate for Payer: Galaxy Health WC |
$3,283.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,317.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,476.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,406.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,453.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,658.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,279.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,583.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,704.10
|
| Rate for Payer: Multiplan Commercial |
$2,897.25
|
| Rate for Payer: Networks By Design Commercial |
$1,931.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,283.55
|
| Rate for Payer: Riverside University Health System MISP |
$1,545.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,317.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,317.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,449.78
|
| Rate for Payer: United Healthcare All Other HMO |
$1,411.15
|
| Rate for Payer: United Healthcare HMO Rider |
$1,380.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,265.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,283.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,283.55
|
| Rate for Payer: Vantage Medical Group Senior |
$3,283.55
|
|
|
HC HYDRAULIC SWING MINI HI ACTVTY
|
Facility
|
IP
|
$3,863.00
|
|
|
Service Code
|
CPT L5826
|
| Hospital Charge Code |
905355826
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$772.60 |
| Max. Negotiated Rate |
$3,476.70 |
| Rate for Payer: Adventist Health Commercial |
$772.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,098.13
|
| Rate for Payer: Blue Shield of California EPN |
$1,946.95
|
| Rate for Payer: Cash Price |
$1,738.35
|
| Rate for Payer: Central Health Plan Commercial |
$3,090.40
|
| Rate for Payer: Cigna of CA HMO |
$2,704.10
|
| Rate for Payer: Cigna of CA PPO |
$2,704.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,704.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,545.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,545.20
|
| Rate for Payer: Galaxy Health WC |
$3,283.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,317.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,476.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,453.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,279.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$772.60
|
| Rate for Payer: Multiplan Commercial |
$2,897.25
|
| Rate for Payer: Networks By Design Commercial |
$2,510.95
|
| Rate for Payer: Prime Health Services Commercial |
$3,283.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,449.78
|
| Rate for Payer: United Healthcare All Other HMO |
$1,411.15
|
| Rate for Payer: United Healthcare HMO Rider |
$1,380.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,265.13
|
|
|
HC HYDRAULIC SWING MINI HI ACTVTY
|
Facility
|
IP
|
$3,863.00
|
|
|
Service Code
|
CPT L5826
|
| Hospital Charge Code |
915355826
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$772.60 |
| Max. Negotiated Rate |
$3,476.70 |
| Rate for Payer: United Healthcare HMO Rider |
$1,380.64
|
| Rate for Payer: Adventist Health Commercial |
$772.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,098.13
|
| Rate for Payer: Blue Shield of California EPN |
$1,946.95
|
| Rate for Payer: Cash Price |
$1,738.35
|
| Rate for Payer: Central Health Plan Commercial |
$3,090.40
|
| Rate for Payer: Cigna of CA HMO |
$2,704.10
|
| Rate for Payer: Cigna of CA PPO |
$2,704.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,704.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,545.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,545.20
|
| Rate for Payer: Galaxy Health WC |
$3,283.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,317.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,476.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,453.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,279.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$772.60
|
| Rate for Payer: Multiplan Commercial |
$2,897.25
|
| Rate for Payer: Networks By Design Commercial |
$2,510.95
|
| Rate for Payer: Prime Health Services Commercial |
$3,283.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,449.78
|
| Rate for Payer: United Healthcare All Other HMO |
$1,411.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,265.13
|
|
|
HC HYDROCOIL
|
Facility
|
OP
|
$3,744.00
|
|
| Hospital Charge Code |
909020028
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$748.80 |
| Max. Negotiated Rate |
$3,369.60 |
| Rate for Payer: Adventist Health Commercial |
$748.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,182.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,059.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,808.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,709.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,053.21
|
| Rate for Payer: Blue Shield of California Commercial |
$3,002.69
|
| Rate for Payer: Blue Shield of California EPN |
$1,886.98
|
| Rate for Payer: Cash Price |
$1,684.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,995.20
|
| Rate for Payer: Cigna of CA HMO |
$2,620.80
|
| Rate for Payer: Cigna of CA PPO |
$2,620.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,182.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,182.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,182.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,620.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,497.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,497.60
|
| Rate for Payer: Galaxy Health WC |
$3,182.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,246.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,369.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,377.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,359.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,208.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$748.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,620.80
|
| Rate for Payer: Multiplan Commercial |
$2,808.00
|
| Rate for Payer: Networks By Design Commercial |
$1,872.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,182.40
|
| Rate for Payer: Riverside University Health System MISP |
$1,497.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,246.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,246.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,405.12
|
| Rate for Payer: United Healthcare All Other HMO |
$1,367.68
|
| Rate for Payer: United Healthcare HMO Rider |
$1,338.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,226.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,182.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,182.40
|
| Rate for Payer: Vantage Medical Group Senior |
$3,182.40
|
|
|
HC HYDROCOIL
|
Facility
|
IP
|
$3,744.00
|
|
| Hospital Charge Code |
909020028
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$748.80 |
| Max. Negotiated Rate |
$3,369.60 |
| Rate for Payer: Adventist Health Commercial |
$748.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,002.69
|
| Rate for Payer: Blue Shield of California EPN |
$1,886.98
|
| Rate for Payer: Cash Price |
$1,684.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,995.20
|
| Rate for Payer: Cigna of CA HMO |
$2,620.80
|
| Rate for Payer: Cigna of CA PPO |
$2,620.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,620.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,497.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,497.60
|
| Rate for Payer: Galaxy Health WC |
$3,182.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,246.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,369.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,377.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,208.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$748.80
|
| Rate for Payer: Multiplan Commercial |
$2,808.00
|
| Rate for Payer: Networks By Design Commercial |
$1,872.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,182.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,405.12
|
| Rate for Payer: United Healthcare All Other HMO |
$1,367.68
|
| Rate for Payer: United Healthcare HMO Rider |
$1,338.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,226.16
|
|
|
HC HYDROCOIL DETACHMENT CONTROLLE
|
Facility
|
OP
|
$828.00
|
|
| Hospital Charge Code |
909020029
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$165.60 |
| Max. Negotiated Rate |
$745.20 |
| Rate for Payer: Adventist Health Commercial |
$165.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$502.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$703.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$455.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$621.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$400.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$481.65
|
| Rate for Payer: Blue Shield of California Commercial |
$524.95
|
| Rate for Payer: Blue Shield of California EPN |
$330.37
|
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Central Health Plan Commercial |
$662.40
|
| Rate for Payer: Cigna of CA HMO |
$529.92
|
| Rate for Payer: Cigna of CA PPO |
$612.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$703.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$703.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$703.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$579.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$331.20
|
| Rate for Payer: EPIC Health Plan Senior |
$331.20
|
| Rate for Payer: Galaxy Health WC |
$703.80
|
| Rate for Payer: Global Benefits Group Commercial |
$496.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$745.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$525.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$300.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$488.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$579.60
|
| Rate for Payer: Multiplan Commercial |
$621.00
|
| Rate for Payer: Networks By Design Commercial |
$538.20
|
| Rate for Payer: Prime Health Services Commercial |
$703.80
|
| Rate for Payer: Riverside University Health System MISP |
$331.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$496.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$496.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$414.00
|
| Rate for Payer: United Healthcare All Other HMO |
$414.00
|
| Rate for Payer: United Healthcare HMO Rider |
$414.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$414.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$703.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$703.80
|
| Rate for Payer: Vantage Medical Group Senior |
$703.80
|
|
|
HC HYDROCOIL DETACHMENT CONTROLLE
|
Facility
|
IP
|
$828.00
|
|
| Hospital Charge Code |
909020029
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$165.60 |
| Max. Negotiated Rate |
$745.20 |
| Rate for Payer: Adventist Health Commercial |
$165.60
|
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Central Health Plan Commercial |
$662.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$579.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$331.20
|
| Rate for Payer: EPIC Health Plan Senior |
$331.20
|
| Rate for Payer: Galaxy Health WC |
$703.80
|
| Rate for Payer: Global Benefits Group Commercial |
$496.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$745.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$525.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$488.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.60
|
| Rate for Payer: Multiplan Commercial |
$621.00
|
| Rate for Payer: Networks By Design Commercial |
$538.20
|
| Rate for Payer: Prime Health Services Commercial |
$703.80
|
|
|
HC HYDROGEL 4OZ WOUND DRESSING
|
Facility
|
IP
|
$46.17
|
|
|
Service Code
|
CPT A6248
|
| Hospital Charge Code |
901698768
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$9.23 |
| Max. Negotiated Rate |
$41.55 |
| Rate for Payer: Adventist Health Commercial |
$9.23
|
| Rate for Payer: Cash Price |
$20.78
|
| Rate for Payer: Central Health Plan Commercial |
$36.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$32.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.47
|
| Rate for Payer: EPIC Health Plan Senior |
$18.47
|
| Rate for Payer: Galaxy Health WC |
$39.24
|
| Rate for Payer: Global Benefits Group Commercial |
$27.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$41.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$29.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.23
|
| Rate for Payer: Multiplan Commercial |
$34.63
|
| Rate for Payer: Networks By Design Commercial |
$30.01
|
| Rate for Payer: Prime Health Services Commercial |
$39.24
|
|
|
HC HYDROGEL 4OZ WOUND DRESSING
|
Facility
|
OP
|
$46.17
|
|
|
Service Code
|
CPT A6248
|
| Hospital Charge Code |
901698768
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$9.23 |
| Max. Negotiated Rate |
$41.55 |
| Rate for Payer: Adventist Health Commercial |
$9.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$40.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$39.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$34.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$22.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.86
|
| Rate for Payer: Blue Shield of California Commercial |
$29.27
|
| Rate for Payer: Blue Shield of California EPN |
$18.42
|
| Rate for Payer: Cash Price |
$20.78
|
| Rate for Payer: Cash Price |
$20.78
|
| Rate for Payer: Central Health Plan Commercial |
$36.94
|
| Rate for Payer: Cigna of CA HMO |
$29.55
|
| Rate for Payer: Cigna of CA PPO |
$34.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$39.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$39.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$32.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.47
|
| Rate for Payer: EPIC Health Plan Senior |
$18.47
|
| Rate for Payer: Galaxy Health WC |
$39.24
|
| Rate for Payer: Global Benefits Group Commercial |
$27.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$41.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$29.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$32.32
|
| Rate for Payer: Multiplan Commercial |
$34.63
|
| Rate for Payer: Networks By Design Commercial |
$30.01
|
| Rate for Payer: Prime Health Services Commercial |
$39.24
|
| Rate for Payer: Riverside University Health System MISP |
$18.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.09
|
| Rate for Payer: United Healthcare All Other HMO |
$23.09
|
| Rate for Payer: United Healthcare HMO Rider |
$23.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$39.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39.24
|
| Rate for Payer: Vantage Medical Group Senior |
$39.24
|
|
|
HC HYDROGEL WOUND GEL 4 OZ
|
Facility
|
OP
|
$50.35
|
|
| Hospital Charge Code |
901698843
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$10.07 |
| Max. Negotiated Rate |
$45.31 |
| Rate for Payer: Adventist Health Commercial |
$10.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.76
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$24.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.29
|
| Rate for Payer: Blue Shield of California Commercial |
$31.92
|
| Rate for Payer: Blue Shield of California EPN |
$20.09
|
| Rate for Payer: Cash Price |
$22.66
|
| Rate for Payer: Central Health Plan Commercial |
$40.28
|
| Rate for Payer: Cigna of CA HMO |
$32.22
|
| Rate for Payer: Cigna of CA PPO |
$37.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.14
|
| Rate for Payer: EPIC Health Plan Senior |
$20.14
|
| Rate for Payer: Galaxy Health WC |
$42.80
|
| Rate for Payer: Global Benefits Group Commercial |
$30.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$35.24
|
| Rate for Payer: Multiplan Commercial |
$37.76
|
| Rate for Payer: Networks By Design Commercial |
$32.73
|
| Rate for Payer: Prime Health Services Commercial |
$42.80
|
| Rate for Payer: Riverside University Health System MISP |
$20.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.18
|
| Rate for Payer: United Healthcare All Other HMO |
$25.18
|
| Rate for Payer: United Healthcare HMO Rider |
$25.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.80
|
| Rate for Payer: Vantage Medical Group Senior |
$42.80
|
|
|
HC HYDROGEL WOUND GEL 4 OZ
|
Facility
|
IP
|
$50.35
|
|
| Hospital Charge Code |
901698843
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$10.07 |
| Max. Negotiated Rate |
$45.31 |
| Rate for Payer: Adventist Health Commercial |
$10.07
|
| Rate for Payer: Cash Price |
$22.66
|
| Rate for Payer: Central Health Plan Commercial |
$40.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.14
|
| Rate for Payer: EPIC Health Plan Senior |
$20.14
|
| Rate for Payer: Galaxy Health WC |
$42.80
|
| Rate for Payer: Global Benefits Group Commercial |
$30.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.07
|
| Rate for Payer: Multiplan Commercial |
$37.76
|
| Rate for Payer: Networks By Design Commercial |
$32.73
|
| Rate for Payer: Prime Health Services Commercial |
$42.80
|
|
|
HC HYMENOTOMY, SIMPLE INCISION
|
Facility
|
IP
|
$10,901.00
|
|
|
Service Code
|
CPT 56442
|
| Hospital Charge Code |
900506442
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,180.20 |
| Max. Negotiated Rate |
$9,810.90 |
| Rate for Payer: Adventist Health Commercial |
$2,180.20
|
| Rate for Payer: Cash Price |
$4,905.45
|
| Rate for Payer: Central Health Plan Commercial |
$8,720.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,630.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,360.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,360.40
|
| Rate for Payer: Galaxy Health WC |
$9,265.85
|
| Rate for Payer: Global Benefits Group Commercial |
$6,540.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,810.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,922.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,431.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,180.20
|
| Rate for Payer: Multiplan Commercial |
$8,175.75
|
| Rate for Payer: Networks By Design Commercial |
$7,085.65
|
| Rate for Payer: Prime Health Services Commercial |
$9,265.85
|
|
|
HC HYMENOTOMY, SIMPLE INCISION
|
Facility
|
OP
|
$10,901.00
|
|
|
Service Code
|
CPT 56442
|
| Hospital Charge Code |
900506442
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.59 |
| Max. Negotiated Rate |
$9,810.90 |
| Rate for Payer: Adventist Health Commercial |
$2,180.20
|
| 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 |
$6,245.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,163.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,436.87
|
| Rate for Payer: Cash Price |
$4,905.45
|
| Rate for Payer: Cash Price |
$4,905.45
|
| Rate for Payer: Cash Price |
$4,905.45
|
| Rate for Payer: Cash Price |
$4,905.45
|
| Rate for Payer: Central Health Plan Commercial |
$8,720.80
|
| Rate for Payer: Cigna of CA HMO |
$6,976.64
|
| Rate for Payer: Cigna of CA PPO |
$8,066.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,579.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,163.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,630.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,869.74
|
| Rate for Payer: EPIC Health Plan Senior |
$4,579.83
|
| Rate for Payer: Galaxy Health WC |
$9,265.85
|
| Rate for Payer: Global Benefits Group Commercial |
$6,540.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,810.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,828.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,163.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,922.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$165.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,475.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,180.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,579.06
|
| Rate for Payer: Multiplan Commercial |
$8,175.75
|
| Rate for Payer: Multiplan WC |
$6,436.87
|
| Rate for Payer: Networks By Design Commercial |
$7,085.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,163.48
|
| Rate for Payer: Preferred Health Network WC |
$6,568.23
|
| Rate for Payer: Prime Health Services Commercial |
$9,265.85
|
| Rate for Payer: Prime Health Services Medicare |
$4,413.29
|
| Rate for Payer: Prime Health Services WC |
$6,371.18
|
| Rate for Payer: Riverside University Health System MISP |
$4,579.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,540.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,450.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5,450.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5,450.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,450.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,163.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Vantage Medical Group Senior |
$4,163.48
|
|
|
HC HYSTEROSALPINGOGRAM
|
Facility
|
IP
|
$467.00
|
|
|
Service Code
|
CPT 58340
|
| Hospital Charge Code |
909000176
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$93.40 |
| Max. Negotiated Rate |
$420.30 |
| Rate for Payer: Adventist Health Commercial |
$93.40
|
| Rate for Payer: Cash Price |
$210.15
|
| Rate for Payer: Central Health Plan Commercial |
$373.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$326.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$186.80
|
| Rate for Payer: EPIC Health Plan Senior |
$186.80
|
| Rate for Payer: Galaxy Health WC |
$396.95
|
| Rate for Payer: Global Benefits Group Commercial |
$280.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$420.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$296.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$275.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.40
|
| Rate for Payer: Multiplan Commercial |
$350.25
|
| Rate for Payer: Networks By Design Commercial |
$303.55
|
| Rate for Payer: Prime Health Services Commercial |
$396.95
|
|
|
HC HYSTEROSALPINGOGRAM
|
Facility
|
OP
|
$467.00
|
|
|
Service Code
|
CPT 58340
|
| Hospital Charge Code |
909000176
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$93.40 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$93.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$396.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$256.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$350.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$210.15
|
| Rate for Payer: Cash Price |
$210.15
|
| Rate for Payer: Cash Price |
$210.15
|
| Rate for Payer: Central Health Plan Commercial |
$373.60
|
| Rate for Payer: Cigna of CA HMO |
$298.88
|
| Rate for Payer: Cigna of CA PPO |
$345.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$396.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$396.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$396.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$326.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$186.80
|
| Rate for Payer: EPIC Health Plan Senior |
$186.80
|
| Rate for Payer: Galaxy Health WC |
$396.95
|
| Rate for Payer: Global Benefits Group Commercial |
$280.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$420.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$318.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$296.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$352.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$275.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$326.90
|
| Rate for Payer: Multiplan Commercial |
$350.25
|
| Rate for Payer: Networks By Design Commercial |
$303.55
|
| Rate for Payer: Prime Health Services Commercial |
$396.95
|
| Rate for Payer: Riverside University Health System MISP |
$186.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$280.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$233.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$396.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$396.95
|
| Rate for Payer: Vantage Medical Group Senior |
$396.95
|
|
|
HC HYSTEROSALPINGOGRAM EXAM
|
Facility
|
OP
|
$1,118.00
|
|
|
Service Code
|
CPT 74740
|
| Hospital Charge Code |
909001930
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$80.36 |
| Max. Negotiated Rate |
$1,006.20 |
| Rate for Payer: Adventist Health Commercial |
$223.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$306.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$386.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$269.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$375.04
|
| Rate for Payer: Blue Shield of California Commercial |
$704.34
|
| Rate for Payer: Blue Shield of California EPN |
$443.85
|
| Rate for Payer: Cash Price |
$503.10
|
| Rate for Payer: Cash Price |
$503.10
|
| Rate for Payer: Central Health Plan Commercial |
$894.40
|
| Rate for Payer: Cigna of CA HMO |
$715.52
|
| Rate for Payer: Cigna of CA PPO |
$827.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$782.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.35
|
| Rate for Payer: EPIC Health Plan Senior |
$337.57
|
| Rate for Payer: Galaxy Health WC |
$950.30
|
| Rate for Payer: Global Benefits Group Commercial |
$670.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,006.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$80.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$709.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$88.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$411.22
|
| Rate for Payer: Multiplan Commercial |
$838.50
|
| Rate for Payer: Networks By Design Commercial |
$726.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$306.88
|
| Rate for Payer: Prime Health Services Commercial |
$950.30
|
| Rate for Payer: Prime Health Services Medicare |
$325.29
|
| Rate for Payer: Riverside University Health System MISP |
$337.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$670.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$670.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$605.23
|
| Rate for Payer: United Healthcare All Other HMO |
$605.23
|
| Rate for Payer: United Healthcare HMO Rider |
$605.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$306.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
|
|
HC HYSTEROSALPINGOGRAM EXAM
|
Facility
|
IP
|
$1,118.00
|
|
|
Service Code
|
CPT 74740
|
| Hospital Charge Code |
909001930
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$223.60 |
| Max. Negotiated Rate |
$1,006.20 |
| Rate for Payer: Adventist Health Commercial |
$223.60
|
| Rate for Payer: Cash Price |
$503.10
|
| Rate for Payer: Central Health Plan Commercial |
$894.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$782.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$447.20
|
| Rate for Payer: EPIC Health Plan Senior |
$447.20
|
| Rate for Payer: Galaxy Health WC |
$950.30
|
| Rate for Payer: Global Benefits Group Commercial |
$670.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,006.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$709.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$659.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.60
|
| Rate for Payer: Multiplan Commercial |
$838.50
|
| Rate for Payer: Networks By Design Commercial |
$726.70
|
| Rate for Payer: Prime Health Services Commercial |
$950.30
|
|
|
HC I-111 OXINE PER .5 MCI
|
Facility
|
OP
|
$1,468.00
|
|
|
Service Code
|
CPT A9547
|
| Hospital Charge Code |
909301529
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$293.60 |
| Max. Negotiated Rate |
$1,371.91 |
| Rate for Payer: Adventist Health Commercial |
$293.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$831.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,039.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$914.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$914.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$534.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$666.85
|
| Rate for Payer: Blue Shield of California Commercial |
$930.71
|
| Rate for Payer: Blue Shield of California EPN |
$585.73
|
| Rate for Payer: Cash Price |
$660.60
|
| Rate for Payer: Cash Price |
$660.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,174.40
|
| Rate for Payer: Cigna of CA HMO |
$1,027.60
|
| Rate for Payer: Cigna of CA PPO |
$1,027.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,039.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$914.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$914.61
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,027.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,371.91
|
| Rate for Payer: EPIC Health Plan Senior |
$914.61
|
| Rate for Payer: Galaxy Health WC |
$1,247.80
|
| Rate for Payer: Global Benefits Group Commercial |
$880.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,321.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,363.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$401.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$831.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$932.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$443.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,164.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$293.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,114.16
|
| Rate for Payer: Multiplan Commercial |
$1,101.00
|
| Rate for Payer: Networks By Design Commercial |
$734.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$831.46
|
| Rate for Payer: Prime Health Services Commercial |
$1,247.80
|
| Rate for Payer: Prime Health Services Medicare |
$881.35
|
| Rate for Payer: Riverside University Health System MISP |
$914.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$880.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$880.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$550.94
|
| Rate for Payer: United Healthcare All Other HMO |
$536.26
|
| Rate for Payer: United Healthcare HMO Rider |
$524.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$480.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$831.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,039.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$914.61
|
| Rate for Payer: Vantage Medical Group Senior |
$914.61
|
|
|
HC I-111 OXINE PER .5 MCI
|
Facility
|
IP
|
$1,468.00
|
|
|
Service Code
|
CPT A9547
|
| Hospital Charge Code |
909301529
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$293.60 |
| Max. Negotiated Rate |
$1,321.20 |
| Rate for Payer: Adventist Health Commercial |
$293.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,177.34
|
| Rate for Payer: Blue Shield of California EPN |
$739.87
|
| Rate for Payer: Cash Price |
$660.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,174.40
|
| Rate for Payer: Cigna of CA HMO |
$1,027.60
|
| Rate for Payer: Cigna of CA PPO |
$1,027.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,027.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$587.20
|
| Rate for Payer: EPIC Health Plan Senior |
$587.20
|
| Rate for Payer: Galaxy Health WC |
$1,247.80
|
| Rate for Payer: Global Benefits Group Commercial |
$880.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,321.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$932.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$866.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$293.60
|
| Rate for Payer: Multiplan Commercial |
$1,101.00
|
| Rate for Payer: Networks By Design Commercial |
$734.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,247.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$550.94
|
| Rate for Payer: United Healthcare All Other HMO |
$536.26
|
| Rate for Payer: United Healthcare HMO Rider |
$524.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$480.77
|
|
