|
HC HEPATITIS B SURFACE AG INDIVIDUAL
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT 87340
|
| Hospital Charge Code |
900912333
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.37 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$10.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$72.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.75
|
| Rate for Payer: Blue Shield of California Commercial |
$49.77
|
| Rate for Payer: Blue Shield of California EPN |
$32.55
|
| Rate for Payer: Cash Price |
$45.10
|
| Rate for Payer: Cash Price |
$45.10
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.95
|
| Rate for Payer: EPIC Health Plan Senior |
$10.33
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$16.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$15.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.33
|
| Rate for Payer: InnovAge PACE Commercial |
$15.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.84
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$10.33
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Prime Health Services Medicare |
$10.95
|
| Rate for Payer: Riverside University Health System MISP |
$11.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.37
|
| Rate for Payer: United Healthcare All Other HMO |
$8.37
|
| Rate for Payer: United Healthcare HMO Rider |
$8.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.37
|
| Rate for Payer: Upland Medical Group Pediatric |
$10.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.36
|
| Rate for Payer: Vantage Medical Group Senior |
$10.33
|
|
|
HC HEPATITIS B SURFACE AG INDIVIDUAL
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT 87340
|
| Hospital Charge Code |
900912333
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Cash Price |
$45.10
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
|
|
HC HEPATITIS B SURFACE ANTIBODY
|
Facility
|
IP
|
$97.44
|
|
|
Service Code
|
CPT 86706
|
| Hospital Charge Code |
900910860
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.49 |
| Max. Negotiated Rate |
$87.70 |
| Rate for Payer: Adventist Health Commercial |
$19.49
|
| Rate for Payer: Cash Price |
$53.59
|
| Rate for Payer: Central Health Plan Commercial |
$77.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.98
|
| Rate for Payer: EPIC Health Plan Senior |
$38.98
|
| Rate for Payer: Galaxy Health WC |
$82.82
|
| Rate for Payer: Global Benefits Group Commercial |
$58.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$87.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$60.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.49
|
| Rate for Payer: Multiplan Commercial |
$73.08
|
| Rate for Payer: Networks By Design Commercial |
$63.34
|
| Rate for Payer: Prime Health Services Commercial |
$82.82
|
|
|
HC HEPATITIS B SURFACE ANTIBODY
|
Facility
|
OP
|
$97.44
|
|
|
Service Code
|
CPT 86706
|
| Hospital Charge Code |
900910860
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.70 |
| Max. Negotiated Rate |
$87.70 |
| Rate for Payer: Adventist Health Commercial |
$19.49
|
| Rate for Payer: Adventist Health Medi-Cal |
$10.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$75.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.34
|
| Rate for Payer: Blue Shield of California Commercial |
$59.15
|
| Rate for Payer: Blue Shield of California EPN |
$38.68
|
| Rate for Payer: Cash Price |
$53.59
|
| Rate for Payer: Cash Price |
$53.59
|
| Rate for Payer: Central Health Plan Commercial |
$77.95
|
| Rate for Payer: Cigna of CA HMO |
$62.36
|
| Rate for Payer: Cigna of CA PPO |
$72.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.50
|
| Rate for Payer: EPIC Health Plan Senior |
$10.74
|
| Rate for Payer: Galaxy Health WC |
$82.82
|
| Rate for Payer: Global Benefits Group Commercial |
$58.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$87.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$17.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$16.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.74
|
| Rate for Payer: InnovAge PACE Commercial |
$16.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.39
|
| Rate for Payer: Multiplan Commercial |
$73.08
|
| Rate for Payer: Networks By Design Commercial |
$63.34
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$10.74
|
| Rate for Payer: Prime Health Services Commercial |
$82.82
|
| Rate for Payer: Prime Health Services Medicare |
$11.38
|
| Rate for Payer: Riverside University Health System MISP |
$11.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.70
|
| Rate for Payer: United Healthcare All Other HMO |
$8.70
|
| Rate for Payer: United Healthcare HMO Rider |
$8.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$10.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.81
|
| Rate for Payer: Vantage Medical Group Senior |
$10.74
|
|
|
HC HEPATITIS C AB TOTAL
|
Facility
|
OP
|
$141.07
|
|
|
Service Code
|
CPT 86803
|
| Hospital Charge Code |
900912155
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.56 |
| Max. Negotiated Rate |
$126.96 |
| Rate for Payer: Adventist Health Commercial |
$28.21
|
| Rate for Payer: Adventist Health Medi-Cal |
$14.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$85.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$100.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.40
|
| Rate for Payer: Blue Shield of California Commercial |
$85.63
|
| Rate for Payer: Blue Shield of California EPN |
$56.00
|
| Rate for Payer: Cash Price |
$77.59
|
| Rate for Payer: Cash Price |
$77.59
|
| Rate for Payer: Central Health Plan Commercial |
$112.86
|
| Rate for Payer: Cigna of CA HMO |
$90.28
|
| Rate for Payer: Cigna of CA PPO |
$104.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.26
|
| Rate for Payer: EPIC Health Plan Senior |
$14.27
|
| Rate for Payer: Galaxy Health WC |
$119.91
|
| Rate for Payer: Global Benefits Group Commercial |
$84.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$126.96
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.27
|
| Rate for Payer: InnovAge PACE Commercial |
$21.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$94.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.12
|
| Rate for Payer: Multiplan Commercial |
$105.80
|
| Rate for Payer: Networks By Design Commercial |
$91.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14.27
|
| Rate for Payer: Prime Health Services Commercial |
$119.91
|
| Rate for Payer: Prime Health Services Medicare |
$15.13
|
| Rate for Payer: Riverside University Health System MISP |
$15.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$84.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$84.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.56
|
| Rate for Payer: United Healthcare All Other HMO |
$11.56
|
| Rate for Payer: United Healthcare HMO Rider |
$11.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.70
|
| Rate for Payer: Vantage Medical Group Senior |
$14.27
|
|
|
HC HEPATITIS C AB TOTAL
|
Facility
|
IP
|
$141.07
|
|
|
Service Code
|
CPT 86803
|
| Hospital Charge Code |
900912155
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$28.21 |
| Max. Negotiated Rate |
$126.96 |
| Rate for Payer: Adventist Health Commercial |
$28.21
|
| Rate for Payer: Cash Price |
$77.59
|
| Rate for Payer: Central Health Plan Commercial |
$112.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.43
|
| Rate for Payer: EPIC Health Plan Senior |
$56.43
|
| Rate for Payer: Galaxy Health WC |
$119.91
|
| Rate for Payer: Global Benefits Group Commercial |
$84.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$126.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$94.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$87.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.21
|
| Rate for Payer: Multiplan Commercial |
$105.80
|
| Rate for Payer: Networks By Design Commercial |
$91.70
|
| Rate for Payer: Prime Health Services Commercial |
$119.91
|
|
|
HC HEPATITIS C AB TOTAL INDIVIDUAL
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
CPT 86803
|
| Hospital Charge Code |
900912156
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.56 |
| Max. Negotiated Rate |
$113.40 |
| Rate for Payer: Adventist Health Commercial |
$25.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$14.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$76.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$100.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.40
|
| Rate for Payer: Blue Shield of California Commercial |
$76.48
|
| Rate for Payer: Blue Shield of California EPN |
$50.02
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Central Health Plan Commercial |
$100.80
|
| Rate for Payer: Cigna of CA HMO |
$80.64
|
| Rate for Payer: Cigna of CA PPO |
$93.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.26
|
| Rate for Payer: EPIC Health Plan Senior |
$14.27
|
| Rate for Payer: Galaxy Health WC |
$107.10
|
| Rate for Payer: Global Benefits Group Commercial |
$75.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$113.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.27
|
| Rate for Payer: InnovAge PACE Commercial |
$21.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$84.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.12
|
| Rate for Payer: Multiplan Commercial |
$94.50
|
| Rate for Payer: Networks By Design Commercial |
$81.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14.27
|
| Rate for Payer: Prime Health Services Commercial |
$107.10
|
| Rate for Payer: Prime Health Services Medicare |
$15.13
|
| Rate for Payer: Riverside University Health System MISP |
$15.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.56
|
| Rate for Payer: United Healthcare All Other HMO |
$11.56
|
| Rate for Payer: United Healthcare HMO Rider |
$11.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.70
|
| Rate for Payer: Vantage Medical Group Senior |
$14.27
|
|
|
HC HEPATITIS C AB TOTAL INDIVIDUAL
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
CPT 86803
|
| Hospital Charge Code |
900912156
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$113.40 |
| Rate for Payer: Adventist Health Commercial |
$25.20
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Central Health Plan Commercial |
$100.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.40
|
| Rate for Payer: EPIC Health Plan Senior |
$50.40
|
| Rate for Payer: Galaxy Health WC |
$107.10
|
| Rate for Payer: Global Benefits Group Commercial |
$75.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$113.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$84.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$77.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.20
|
| Rate for Payer: Multiplan Commercial |
$94.50
|
| Rate for Payer: Networks By Design Commercial |
$81.90
|
| Rate for Payer: Prime Health Services Commercial |
$107.10
|
|
|
HC HEPATOBIL SYST IMAGE W DRUG
|
Facility
|
IP
|
$955.00
|
|
|
Service Code
|
CPT 78227
|
| Hospital Charge Code |
909301227
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$191.00 |
| Max. Negotiated Rate |
$859.50 |
| Rate for Payer: Adventist Health Commercial |
$191.00
|
| Rate for Payer: Cash Price |
$525.25
|
| Rate for Payer: Central Health Plan Commercial |
$764.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$382.00
|
| Rate for Payer: EPIC Health Plan Senior |
$382.00
|
| Rate for Payer: Galaxy Health WC |
$811.75
|
| Rate for Payer: Global Benefits Group Commercial |
$573.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$859.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$636.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$363.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$591.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$191.00
|
| Rate for Payer: Multiplan Commercial |
$716.25
|
| Rate for Payer: Networks By Design Commercial |
$620.75
|
| Rate for Payer: Prime Health Services Commercial |
$811.75
|
|
|
HC HEPATOBIL SYST IMAGE W DRUG
|
Facility
|
OP
|
$955.00
|
|
|
Service Code
|
CPT 78227
|
| Hospital Charge Code |
909301227
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$191.00 |
| Max. Negotiated Rate |
$1,766.50 |
| Rate for Payer: Adventist Health Commercial |
$191.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$683.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$579.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$752.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$683.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,766.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$358.52
|
| Rate for Payer: Blue Shield of California Commercial |
$579.68
|
| Rate for Payer: Blue Shield of California EPN |
$379.13
|
| Rate for Payer: Cash Price |
$525.25
|
| Rate for Payer: Cash Price |
$525.25
|
| Rate for Payer: Central Health Plan Commercial |
$764.00
|
| Rate for Payer: Cigna of CA HMO |
$611.20
|
| Rate for Payer: Cigna of CA PPO |
$706.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$752.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$683.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$923.31
|
| Rate for Payer: EPIC Health Plan Senior |
$683.93
|
| Rate for Payer: Galaxy Health WC |
$811.75
|
| Rate for Payer: Global Benefits Group Commercial |
$573.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$859.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,121.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$674.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$683.93
|
| Rate for Payer: InnovAge PACE Commercial |
$1,025.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$636.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$744.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$683.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$191.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$916.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$916.47
|
| Rate for Payer: Multiplan Commercial |
$716.25
|
| Rate for Payer: Networks By Design Commercial |
$620.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$683.93
|
| Rate for Payer: Prime Health Services Commercial |
$811.75
|
| Rate for Payer: Prime Health Services Medicare |
$724.97
|
| Rate for Payer: Riverside University Health System MISP |
$752.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$573.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$573.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$751.01
|
| Rate for Payer: United Healthcare All Other HMO |
$751.01
|
| Rate for Payer: United Healthcare HMO Rider |
$751.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$751.01
|
| Rate for Payer: Upland Medical Group Pediatric |
$683.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$752.32
|
| Rate for Payer: Vantage Medical Group Senior |
$683.93
|
|
|
HC HEP B ADULT ADMINISTRATION
|
Facility
|
OP
|
$24.00
|
|
| Hospital Charge Code |
902890237
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$1,833.00 |
| Rate for Payer: Adventist Health Commercial |
$9.84
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.10
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Central Health Plan Commercial |
$19.20
|
| Rate for Payer: Cigna of CA HMO |
$15.36
|
| Rate for Payer: Cigna of CA PPO |
$17.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: InnovAge PACE Commercial |
$12.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.80
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: Riverside University Health System MISP |
$9.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.40
|
| Rate for Payer: Vantage Medical Group Senior |
$20.40
|
|
|
HC HEP B ADULT ADMINISTRATION
|
Facility
|
IP
|
$24.00
|
|
| Hospital Charge Code |
902890237
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Central Health Plan Commercial |
$19.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
|
|
HC HEP B HIGH RISK ADMINISTRATION
|
Facility
|
IP
|
$24.00
|
|
| Hospital Charge Code |
902890238
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Central Health Plan Commercial |
$19.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
|
|
HC HEP B HIGH RISK ADMINISTRATION
|
Facility
|
OP
|
$24.00
|
|
| Hospital Charge Code |
902890238
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$1,833.00 |
| Rate for Payer: Adventist Health Commercial |
$9.84
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.10
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Central Health Plan Commercial |
$19.20
|
| Rate for Payer: Cigna of CA HMO |
$15.36
|
| Rate for Payer: Cigna of CA PPO |
$17.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: InnovAge PACE Commercial |
$12.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.80
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: Riverside University Health System MISP |
$9.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.40
|
| Rate for Payer: Vantage Medical Group Senior |
$20.40
|
|
|
HC HEP B IMMUNE GLOBULIN
|
Facility
|
IP
|
$24.00
|
|
| Hospital Charge Code |
902890236
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Central Health Plan Commercial |
$19.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
|
|
HC HEP B IMMUNE GLOBULIN
|
Facility
|
OP
|
$24.00
|
|
| Hospital Charge Code |
902890236
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$1,833.00 |
| Rate for Payer: Adventist Health Commercial |
$9.84
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.10
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Central Health Plan Commercial |
$19.20
|
| Rate for Payer: Cigna of CA HMO |
$15.36
|
| Rate for Payer: Cigna of CA PPO |
$17.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: InnovAge PACE Commercial |
$12.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.80
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: Riverside University Health System MISP |
$9.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.40
|
| Rate for Payer: Vantage Medical Group Senior |
$20.40
|
|
|
HC HEP B LOW RISK ADMINISTRATION
|
Facility
|
IP
|
$24.00
|
|
| Hospital Charge Code |
902890239
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Central Health Plan Commercial |
$19.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
|
|
HC HEP B LOW RISK ADMINISTRATION
|
Facility
|
OP
|
$24.00
|
|
| Hospital Charge Code |
902890239
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$1,833.00 |
| Rate for Payer: Adventist Health Commercial |
$9.84
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.10
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Central Health Plan Commercial |
$19.20
|
| Rate for Payer: Cigna of CA HMO |
$15.36
|
| Rate for Payer: Cigna of CA PPO |
$17.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: InnovAge PACE Commercial |
$12.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.80
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: Riverside University Health System MISP |
$9.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.40
|
| Rate for Payer: Vantage Medical Group Senior |
$20.40
|
|
|
HC HERMETIC CATH DRAIN LUMBAR KIT
|
Facility
|
OP
|
$632.91
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
901698826
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$126.58 |
| Max. Negotiated Rate |
$569.62 |
| Rate for Payer: Adventist Health Commercial |
$126.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$537.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$348.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$474.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$288.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$350.44
|
| Rate for Payer: Blue Shield of California Commercial |
$489.24
|
| Rate for Payer: Blue Shield of California EPN |
$318.99
|
| Rate for Payer: Cash Price |
$348.10
|
| Rate for Payer: Central Health Plan Commercial |
$506.33
|
| Rate for Payer: Cigna of CA HMO |
$443.04
|
| Rate for Payer: Cigna of CA PPO |
$443.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$537.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$537.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$537.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$253.16
|
| Rate for Payer: EPIC Health Plan Senior |
$253.16
|
| Rate for Payer: Galaxy Health WC |
$537.97
|
| Rate for Payer: Global Benefits Group Commercial |
$379.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$569.62
|
| Rate for Payer: InnovAge PACE Commercial |
$316.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$422.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$241.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$391.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$443.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$443.04
|
| Rate for Payer: Multiplan Commercial |
$474.68
|
| Rate for Payer: Networks By Design Commercial |
$316.45
|
| Rate for Payer: Prime Health Services Commercial |
$537.97
|
| Rate for Payer: Riverside University Health System MISP |
$253.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$379.75
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$379.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$237.53
|
| Rate for Payer: United Healthcare All Other HMO |
$231.20
|
| Rate for Payer: United Healthcare HMO Rider |
$226.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$207.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$537.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$537.97
|
| Rate for Payer: Vantage Medical Group Senior |
$537.97
|
|
|
HC HERMETIC CATH DRAIN LUMBAR KIT
|
Facility
|
IP
|
$632.91
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
901698826
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$126.58 |
| Max. Negotiated Rate |
$569.62 |
| Rate for Payer: Adventist Health Commercial |
$126.58
|
| Rate for Payer: Blue Shield of California Commercial |
$489.24
|
| Rate for Payer: Blue Shield of California EPN |
$318.99
|
| Rate for Payer: Cash Price |
$348.10
|
| Rate for Payer: Central Health Plan Commercial |
$506.33
|
| Rate for Payer: Cigna of CA HMO |
$443.04
|
| Rate for Payer: Cigna of CA PPO |
$443.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$253.16
|
| Rate for Payer: EPIC Health Plan Senior |
$253.16
|
| Rate for Payer: Galaxy Health WC |
$537.97
|
| Rate for Payer: Global Benefits Group Commercial |
$379.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$569.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$422.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$241.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$391.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.58
|
| Rate for Payer: Multiplan Commercial |
$474.68
|
| Rate for Payer: Networks By Design Commercial |
$316.45
|
| Rate for Payer: Prime Health Services Commercial |
$537.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$237.53
|
| Rate for Payer: United Healthcare All Other HMO |
$231.20
|
| Rate for Payer: United Healthcare HMO Rider |
$226.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$207.28
|
|
|
HC HERMETIC VENTRCLR CATH SET 6MM
|
Facility
|
IP
|
$580.00
|
|
| Hospital Charge Code |
901698859
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
|
|
HC HERMETIC VENTRCLR CATH SET 6MM
|
Facility
|
OP
|
$580.00
|
|
| Hospital Charge Code |
901698859
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$352.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$280.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$340.63
|
| Rate for Payer: Blue Shield of California Commercial |
$354.38
|
| Rate for Payer: Blue Shield of California EPN |
$231.42
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Cigna of CA HMO |
$371.20
|
| Rate for Payer: Cigna of CA PPO |
$429.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$493.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: InnovAge PACE Commercial |
$290.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$406.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Riverside University Health System MISP |
$232.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$290.00
|
| Rate for Payer: United Healthcare All Other HMO |
$290.00
|
| Rate for Payer: United Healthcare HMO Rider |
$290.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC HERNIA REDUCTION
|
Facility
|
IP
|
$16,106.00
|
|
|
Service Code
|
CPT 49999
|
| Hospital Charge Code |
909020037
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,221.20 |
| Max. Negotiated Rate |
$14,495.40 |
| Rate for Payer: Adventist Health Commercial |
$3,221.20
|
| Rate for Payer: Cash Price |
$8,858.30
|
| Rate for Payer: Central Health Plan Commercial |
$12,884.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,442.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,442.40
|
| Rate for Payer: Galaxy Health WC |
$13,690.10
|
| Rate for Payer: Global Benefits Group Commercial |
$9,663.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,495.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,742.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,136.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,969.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,221.20
|
| Rate for Payer: Multiplan Commercial |
$12,079.50
|
| Rate for Payer: Networks By Design Commercial |
$10,468.90
|
| Rate for Payer: Prime Health Services Commercial |
$13,690.10
|
|
|
HC HERNIA REDUCTION
|
Facility
|
OP
|
$16,106.00
|
|
|
Service Code
|
CPT 49999
|
| Hospital Charge Code |
909020037
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,191.26 |
| Max. Negotiated Rate |
$14,495.40 |
| Rate for Payer: Adventist Health Commercial |
$3,221.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,191.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,764.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,898.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,851.77
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$8,858.30
|
| Rate for Payer: Cash Price |
$8,858.30
|
| Rate for Payer: Cash Price |
$8,858.30
|
| Rate for Payer: Central Health Plan Commercial |
$12,884.80
|
| Rate for Payer: Cigna of CA HMO |
$10,307.84
|
| Rate for Payer: Cigna of CA PPO |
$11,918.44
|
| 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 |
$13,690.10
|
| Rate for Payer: Global Benefits Group Commercial |
$9,663.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,495.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,953.67
|
| 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 |
$10,742.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,191.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,221.20
|
| 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 |
$12,079.50
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: Networks By Design Commercial |
$10,468.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Preferred Health Network WC |
$1,936.80
|
| Rate for Payer: Prime Health Services Commercial |
$13,690.10
|
| Rate for Payer: Prime Health Services Medicare |
$1,262.74
|
| Rate for Payer: Prime Health Services WC |
$1,878.70
|
| Rate for Payer: Riverside University Health System MISP |
$1,310.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,663.60
|
| 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 HERNIA REDUCTION
|
Facility
|
OP
|
$16,106.00
|
|
|
Service Code
|
CPT 49999
|
| Hospital Charge Code |
909020037
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$14,495.40 |
| Rate for Payer: Adventist Health Commercial |
$3,221.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$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 |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,764.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,898.06
|
| Rate for Payer: Cash Price |
$8,858.30
|
| Rate for Payer: Cash Price |
$8,858.30
|
| Rate for Payer: Cash Price |
$8,858.30
|
| Rate for Payer: Cash Price |
$8,858.30
|
| Rate for Payer: Central Health Plan Commercial |
$12,884.80
|
| Rate for Payer: Cigna of CA HMO |
$10,307.84
|
| Rate for Payer: Cigna of CA PPO |
$11,918.44
|
| 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 |
$13,690.10
|
| Rate for Payer: Global Benefits Group Commercial |
$9,663.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,495.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,953.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| 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 |
$10,742.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,191.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,221.20
|
| 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 |
$12,079.50
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: Networks By Design Commercial |
$10,468.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Preferred Health Network WC |
$1,936.80
|
| Rate for Payer: Prime Health Services Commercial |
$13,690.10
|
| Rate for Payer: Prime Health Services Medicare |
$1,262.74
|
| Rate for Payer: Prime Health Services WC |
$1,878.70
|
| Rate for Payer: Riverside University Health System MISP |
$1,310.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,663.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,053.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,053.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,053.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,053.00
|
| 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
|
|
