|
HC HOSPITAL BLOOD BANK STORAGE FEE
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
CPT 86999
|
| Hospital Charge Code |
900905000
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$16.20 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Adventist Health Commercial |
$16.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$31.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$39.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.57
|
| Rate for Payer: Blue Shield of California Commercial |
$49.49
|
| Rate for Payer: Blue Shield of California EPN |
$32.32
|
| Rate for Payer: Cash Price |
$44.55
|
| Rate for Payer: Cash Price |
$44.55
|
| Rate for Payer: Cash Price |
$44.55
|
| Rate for Payer: Central Health Plan Commercial |
$64.80
|
| Rate for Payer: Cigna of CA HMO |
$51.84
|
| Rate for Payer: Cigna of CA PPO |
$59.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.01
|
| Rate for Payer: EPIC Health Plan Senior |
$31.12
|
| Rate for Payer: Galaxy Health WC |
$68.85
|
| Rate for Payer: Global Benefits Group Commercial |
$48.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$72.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$51.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$31.12
|
| Rate for Payer: InnovAge PACE Commercial |
$46.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.70
|
| Rate for Payer: Multiplan Commercial |
$60.75
|
| Rate for Payer: Networks By Design Commercial |
$52.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$31.12
|
| Rate for Payer: Prime Health Services Commercial |
$68.85
|
| Rate for Payer: Prime Health Services Medicare |
$32.99
|
| Rate for Payer: Riverside University Health System MISP |
$34.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$48.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$48.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$31.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.23
|
| Rate for Payer: Vantage Medical Group Senior |
$31.12
|
|
|
HC HO W/O JOINTS CF
|
Facility
|
IP
|
$405.00
|
|
|
Service Code
|
CPT L3919
|
| Hospital Charge Code |
915353919
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$81.00 |
| Max. Negotiated Rate |
$364.50 |
| Rate for Payer: Adventist Health Commercial |
$81.00
|
| Rate for Payer: Blue Shield of California Commercial |
$313.06
|
| Rate for Payer: Blue Shield of California EPN |
$204.12
|
| Rate for Payer: Cash Price |
$222.75
|
| Rate for Payer: Central Health Plan Commercial |
$324.00
|
| Rate for Payer: Cigna of CA HMO |
$283.50
|
| Rate for Payer: Cigna of CA PPO |
$283.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.00
|
| Rate for Payer: EPIC Health Plan Senior |
$162.00
|
| Rate for Payer: Galaxy Health WC |
$344.25
|
| Rate for Payer: Global Benefits Group Commercial |
$243.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$364.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$270.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$154.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.00
|
| Rate for Payer: Multiplan Commercial |
$303.75
|
| Rate for Payer: Networks By Design Commercial |
$263.25
|
| Rate for Payer: Prime Health Services Commercial |
$344.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$152.00
|
| Rate for Payer: United Healthcare All Other HMO |
$147.95
|
| Rate for Payer: United Healthcare HMO Rider |
$144.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.64
|
|
|
HC HO W/O JOINTS CF
|
Facility
|
OP
|
$405.00
|
|
|
Service Code
|
CPT L3919
|
| Hospital Charge Code |
915353919
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$132.64 |
| Max. Negotiated Rate |
$364.50 |
| Rate for Payer: Adventist Health Commercial |
$166.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$344.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$222.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$303.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$237.86
|
| Rate for Payer: Blue Shield of California Commercial |
$313.06
|
| Rate for Payer: Blue Shield of California EPN |
$204.12
|
| Rate for Payer: Cash Price |
$222.75
|
| Rate for Payer: Cash Price |
$222.75
|
| Rate for Payer: Central Health Plan Commercial |
$324.00
|
| Rate for Payer: Cigna of CA HMO |
$283.50
|
| Rate for Payer: Cigna of CA PPO |
$283.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$344.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$344.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.00
|
| Rate for Payer: EPIC Health Plan Senior |
$162.00
|
| Rate for Payer: Galaxy Health WC |
$344.25
|
| Rate for Payer: Global Benefits Group Commercial |
$243.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$364.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$266.51
|
| Rate for Payer: InnovAge PACE Commercial |
$202.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$270.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$294.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$283.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$283.50
|
| Rate for Payer: Multiplan Commercial |
$303.75
|
| Rate for Payer: Networks By Design Commercial |
$202.50
|
| Rate for Payer: Prime Health Services Commercial |
$344.25
|
| Rate for Payer: Riverside University Health System MISP |
$162.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$243.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$243.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$152.00
|
| Rate for Payer: United Healthcare All Other HMO |
$147.95
|
| Rate for Payer: United Healthcare HMO Rider |
$144.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$344.25
|
| Rate for Payer: Vantage Medical Group Senior |
$344.25
|
|
|
HC HO W/O JOINTS CF
|
Facility
|
OP
|
$405.00
|
|
|
Service Code
|
CPT L3919
|
| Hospital Charge Code |
905353919
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$132.64 |
| Max. Negotiated Rate |
$364.50 |
| Rate for Payer: Adventist Health Commercial |
$166.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$344.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$222.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$303.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$237.86
|
| Rate for Payer: Blue Shield of California Commercial |
$313.06
|
| Rate for Payer: Blue Shield of California EPN |
$204.12
|
| Rate for Payer: Cash Price |
$222.75
|
| Rate for Payer: Cash Price |
$222.75
|
| Rate for Payer: Central Health Plan Commercial |
$324.00
|
| Rate for Payer: Cigna of CA HMO |
$283.50
|
| Rate for Payer: Cigna of CA PPO |
$283.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$344.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$344.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.00
|
| Rate for Payer: EPIC Health Plan Senior |
$162.00
|
| Rate for Payer: Galaxy Health WC |
$344.25
|
| Rate for Payer: Global Benefits Group Commercial |
$243.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$364.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$266.51
|
| Rate for Payer: InnovAge PACE Commercial |
$202.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$270.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$294.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$283.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$283.50
|
| Rate for Payer: Multiplan Commercial |
$303.75
|
| Rate for Payer: Networks By Design Commercial |
$202.50
|
| Rate for Payer: Prime Health Services Commercial |
$344.25
|
| Rate for Payer: Riverside University Health System MISP |
$162.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$243.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$243.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$152.00
|
| Rate for Payer: United Healthcare All Other HMO |
$147.95
|
| Rate for Payer: United Healthcare HMO Rider |
$144.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$344.25
|
| Rate for Payer: Vantage Medical Group Senior |
$344.25
|
|
|
HC HO W/O JOINTS CF
|
Facility
|
IP
|
$405.00
|
|
|
Service Code
|
CPT L3919
|
| Hospital Charge Code |
905353919
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$81.00 |
| Max. Negotiated Rate |
$364.50 |
| Rate for Payer: Adventist Health Commercial |
$81.00
|
| Rate for Payer: Blue Shield of California Commercial |
$313.06
|
| Rate for Payer: Blue Shield of California EPN |
$204.12
|
| Rate for Payer: Cash Price |
$222.75
|
| Rate for Payer: Central Health Plan Commercial |
$324.00
|
| Rate for Payer: Cigna of CA HMO |
$283.50
|
| Rate for Payer: Cigna of CA PPO |
$283.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.00
|
| Rate for Payer: EPIC Health Plan Senior |
$162.00
|
| Rate for Payer: Galaxy Health WC |
$344.25
|
| Rate for Payer: Global Benefits Group Commercial |
$243.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$364.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$270.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$154.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.00
|
| Rate for Payer: Multiplan Commercial |
$303.75
|
| Rate for Payer: Networks By Design Commercial |
$263.25
|
| Rate for Payer: Prime Health Services Commercial |
$344.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$152.00
|
| Rate for Payer: United Healthcare All Other HMO |
$147.95
|
| Rate for Payer: United Healthcare HMO Rider |
$144.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.64
|
|
|
HC HP ADDITION TEST SOCKET
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
CPT L5628
|
| Hospital Charge Code |
915355628
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$149.00 |
| Max. Negotiated Rate |
$670.50 |
| Rate for Payer: Adventist Health Commercial |
$149.00
|
| Rate for Payer: Blue Shield of California Commercial |
$575.88
|
| Rate for Payer: Blue Shield of California EPN |
$375.48
|
| Rate for Payer: Cash Price |
$409.75
|
| Rate for Payer: Central Health Plan Commercial |
$596.00
|
| Rate for Payer: Cigna of CA HMO |
$521.50
|
| Rate for Payer: Cigna of CA PPO |
$521.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$298.00
|
| Rate for Payer: EPIC Health Plan Senior |
$298.00
|
| Rate for Payer: Galaxy Health WC |
$633.25
|
| Rate for Payer: Global Benefits Group Commercial |
$447.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$670.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$496.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$283.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$461.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.00
|
| Rate for Payer: Multiplan Commercial |
$558.75
|
| Rate for Payer: Networks By Design Commercial |
$484.25
|
| Rate for Payer: Prime Health Services Commercial |
$633.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$279.60
|
| Rate for Payer: United Healthcare All Other HMO |
$272.15
|
| Rate for Payer: United Healthcare HMO Rider |
$266.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$243.99
|
|
|
HC HP ADDITION TEST SOCKET
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
CPT L5628
|
| Hospital Charge Code |
905355628
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$243.99 |
| Max. Negotiated Rate |
$670.50 |
| Rate for Payer: Adventist Health Commercial |
$305.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$633.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$409.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$558.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$437.54
|
| Rate for Payer: Blue Shield of California Commercial |
$575.88
|
| Rate for Payer: Blue Shield of California EPN |
$375.48
|
| Rate for Payer: Cash Price |
$409.75
|
| Rate for Payer: Cash Price |
$409.75
|
| Rate for Payer: Central Health Plan Commercial |
$596.00
|
| Rate for Payer: Cigna of CA HMO |
$521.50
|
| Rate for Payer: Cigna of CA PPO |
$521.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$633.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$633.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$633.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$298.00
|
| Rate for Payer: EPIC Health Plan Senior |
$298.00
|
| Rate for Payer: Galaxy Health WC |
$633.25
|
| Rate for Payer: Global Benefits Group Commercial |
$447.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$670.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$299.45
|
| Rate for Payer: InnovAge PACE Commercial |
$372.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$496.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$330.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$461.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$305.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$521.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$521.50
|
| Rate for Payer: Multiplan Commercial |
$558.75
|
| Rate for Payer: Networks By Design Commercial |
$372.50
|
| Rate for Payer: Prime Health Services Commercial |
$633.25
|
| Rate for Payer: Riverside University Health System MISP |
$298.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$447.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$447.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$279.60
|
| Rate for Payer: United Healthcare All Other HMO |
$272.15
|
| Rate for Payer: United Healthcare HMO Rider |
$266.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$243.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$633.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$633.25
|
| Rate for Payer: Vantage Medical Group Senior |
$633.25
|
|
|
HC HP ADDITION TEST SOCKET
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
CPT L5628
|
| Hospital Charge Code |
905355628
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$149.00 |
| Max. Negotiated Rate |
$670.50 |
| Rate for Payer: Adventist Health Commercial |
$149.00
|
| Rate for Payer: Blue Shield of California Commercial |
$575.88
|
| Rate for Payer: Blue Shield of California EPN |
$375.48
|
| Rate for Payer: Cash Price |
$409.75
|
| Rate for Payer: Central Health Plan Commercial |
$596.00
|
| Rate for Payer: Cigna of CA HMO |
$521.50
|
| Rate for Payer: Cigna of CA PPO |
$521.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$298.00
|
| Rate for Payer: EPIC Health Plan Senior |
$298.00
|
| Rate for Payer: Galaxy Health WC |
$633.25
|
| Rate for Payer: Global Benefits Group Commercial |
$447.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$670.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$496.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$283.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$461.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.00
|
| Rate for Payer: Multiplan Commercial |
$558.75
|
| Rate for Payer: Networks By Design Commercial |
$484.25
|
| Rate for Payer: Prime Health Services Commercial |
$633.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$279.60
|
| Rate for Payer: United Healthcare All Other HMO |
$272.15
|
| Rate for Payer: United Healthcare HMO Rider |
$266.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$243.99
|
|
|
HC HP ADDITION TEST SOCKET
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
CPT L5628
|
| Hospital Charge Code |
915355628
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$243.99 |
| Max. Negotiated Rate |
$670.50 |
| Rate for Payer: Adventist Health Commercial |
$305.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$633.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$409.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$558.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$437.54
|
| Rate for Payer: Blue Shield of California Commercial |
$575.88
|
| Rate for Payer: Blue Shield of California EPN |
$375.48
|
| Rate for Payer: Cash Price |
$409.75
|
| Rate for Payer: Cash Price |
$409.75
|
| Rate for Payer: Central Health Plan Commercial |
$596.00
|
| Rate for Payer: Cigna of CA HMO |
$521.50
|
| Rate for Payer: Cigna of CA PPO |
$521.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$633.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$633.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$633.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$298.00
|
| Rate for Payer: EPIC Health Plan Senior |
$298.00
|
| Rate for Payer: Galaxy Health WC |
$633.25
|
| Rate for Payer: Global Benefits Group Commercial |
$447.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$670.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$299.45
|
| Rate for Payer: InnovAge PACE Commercial |
$372.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$496.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$330.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$461.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$305.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$521.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$521.50
|
| Rate for Payer: Multiplan Commercial |
$558.75
|
| Rate for Payer: Networks By Design Commercial |
$372.50
|
| Rate for Payer: Prime Health Services Commercial |
$633.25
|
| Rate for Payer: Riverside University Health System MISP |
$298.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$447.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$447.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$279.60
|
| Rate for Payer: United Healthcare All Other HMO |
$272.15
|
| Rate for Payer: United Healthcare HMO Rider |
$266.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$243.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$633.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$633.25
|
| Rate for Payer: Vantage Medical Group Senior |
$633.25
|
|
|
HC HP CANADIAN TYPE ENDOSKELETAL
|
Facility
|
OP
|
$30,883.00
|
|
|
Service Code
|
CPT L5341
|
| Hospital Charge Code |
915355340
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7,436.11 |
| Max. Negotiated Rate |
$27,794.70 |
| Rate for Payer: Adventist Health Commercial |
$12,662.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26,250.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,985.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23,162.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18,137.59
|
| Rate for Payer: Blue Shield of California Commercial |
$23,872.56
|
| Rate for Payer: Blue Shield of California EPN |
$15,565.03
|
| Rate for Payer: Cash Price |
$16,985.65
|
| Rate for Payer: Cash Price |
$16,985.65
|
| Rate for Payer: Central Health Plan Commercial |
$24,706.40
|
| Rate for Payer: Cigna of CA HMO |
$21,618.10
|
| Rate for Payer: Cigna of CA PPO |
$21,618.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26,250.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$26,250.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26,250.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,353.20
|
| Rate for Payer: EPIC Health Plan Senior |
$12,353.20
|
| Rate for Payer: Galaxy Health WC |
$26,250.55
|
| Rate for Payer: Global Benefits Group Commercial |
$18,529.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$27,794.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7,436.11
|
| Rate for Payer: InnovAge PACE Commercial |
$15,441.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20,598.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,214.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19,116.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,662.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21,618.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21,618.10
|
| Rate for Payer: Multiplan Commercial |
$23,162.25
|
| Rate for Payer: Networks By Design Commercial |
$15,441.50
|
| Rate for Payer: Prime Health Services Commercial |
$26,250.55
|
| Rate for Payer: Riverside University Health System MISP |
$12,353.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18,529.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18,529.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,590.39
|
| Rate for Payer: United Healthcare All Other HMO |
$11,281.56
|
| Rate for Payer: United Healthcare HMO Rider |
$11,037.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10,114.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26,250.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26,250.55
|
| Rate for Payer: Vantage Medical Group Senior |
$26,250.55
|
|
|
HC HP CANADIAN TYPE ENDOSKELETAL
|
Facility
|
OP
|
$30,883.00
|
|
|
Service Code
|
CPT L5341
|
| Hospital Charge Code |
905355340
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7,436.11 |
| Max. Negotiated Rate |
$27,794.70 |
| Rate for Payer: Adventist Health Commercial |
$12,662.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26,250.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,985.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23,162.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18,137.59
|
| Rate for Payer: Blue Shield of California Commercial |
$23,872.56
|
| Rate for Payer: Blue Shield of California EPN |
$15,565.03
|
| Rate for Payer: Cash Price |
$16,985.65
|
| Rate for Payer: Cash Price |
$16,985.65
|
| Rate for Payer: Central Health Plan Commercial |
$24,706.40
|
| Rate for Payer: Cigna of CA HMO |
$21,618.10
|
| Rate for Payer: Cigna of CA PPO |
$21,618.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26,250.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$26,250.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26,250.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,353.20
|
| Rate for Payer: EPIC Health Plan Senior |
$12,353.20
|
| Rate for Payer: Galaxy Health WC |
$26,250.55
|
| Rate for Payer: Global Benefits Group Commercial |
$18,529.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$27,794.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7,436.11
|
| Rate for Payer: InnovAge PACE Commercial |
$15,441.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20,598.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,214.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19,116.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,662.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21,618.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21,618.10
|
| Rate for Payer: Multiplan Commercial |
$23,162.25
|
| Rate for Payer: Networks By Design Commercial |
$15,441.50
|
| Rate for Payer: Prime Health Services Commercial |
$26,250.55
|
| Rate for Payer: Riverside University Health System MISP |
$12,353.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18,529.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18,529.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,590.39
|
| Rate for Payer: United Healthcare All Other HMO |
$11,281.56
|
| Rate for Payer: United Healthcare HMO Rider |
$11,037.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10,114.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26,250.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26,250.55
|
| Rate for Payer: Vantage Medical Group Senior |
$26,250.55
|
|
|
HC HP CANADIAN TYPE ENDOSKELETAL
|
Facility
|
IP
|
$30,883.00
|
|
|
Service Code
|
CPT L5341
|
| Hospital Charge Code |
905355340
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6,176.60 |
| Max. Negotiated Rate |
$27,794.70 |
| Rate for Payer: Adventist Health Commercial |
$6,176.60
|
| Rate for Payer: Blue Shield of California Commercial |
$23,872.56
|
| Rate for Payer: Blue Shield of California EPN |
$15,565.03
|
| Rate for Payer: Cash Price |
$16,985.65
|
| Rate for Payer: Central Health Plan Commercial |
$24,706.40
|
| Rate for Payer: Cigna of CA HMO |
$21,618.10
|
| Rate for Payer: Cigna of CA PPO |
$21,618.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,353.20
|
| Rate for Payer: EPIC Health Plan Senior |
$12,353.20
|
| Rate for Payer: Galaxy Health WC |
$26,250.55
|
| Rate for Payer: Global Benefits Group Commercial |
$18,529.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$27,794.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20,598.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,766.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19,116.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,176.60
|
| Rate for Payer: Multiplan Commercial |
$23,162.25
|
| Rate for Payer: Networks By Design Commercial |
$20,073.95
|
| Rate for Payer: Prime Health Services Commercial |
$26,250.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,590.39
|
| Rate for Payer: United Healthcare All Other HMO |
$11,281.56
|
| Rate for Payer: United Healthcare HMO Rider |
$11,037.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10,114.18
|
|
|
HC HP CANADIAN TYPE ENDOSKELETAL
|
Facility
|
IP
|
$30,883.00
|
|
|
Service Code
|
CPT L5341
|
| Hospital Charge Code |
915355340
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6,176.60 |
| Max. Negotiated Rate |
$27,794.70 |
| Rate for Payer: Adventist Health Commercial |
$6,176.60
|
| Rate for Payer: Blue Shield of California Commercial |
$23,872.56
|
| Rate for Payer: Blue Shield of California EPN |
$15,565.03
|
| Rate for Payer: Cash Price |
$16,985.65
|
| Rate for Payer: Central Health Plan Commercial |
$24,706.40
|
| Rate for Payer: Cigna of CA HMO |
$21,618.10
|
| Rate for Payer: Cigna of CA PPO |
$21,618.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,353.20
|
| Rate for Payer: EPIC Health Plan Senior |
$12,353.20
|
| Rate for Payer: Galaxy Health WC |
$26,250.55
|
| Rate for Payer: Global Benefits Group Commercial |
$18,529.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$27,794.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20,598.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,766.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19,116.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,176.60
|
| Rate for Payer: Multiplan Commercial |
$23,162.25
|
| Rate for Payer: Networks By Design Commercial |
$20,073.95
|
| Rate for Payer: Prime Health Services Commercial |
$26,250.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,590.39
|
| Rate for Payer: United Healthcare All Other HMO |
$11,281.56
|
| Rate for Payer: United Healthcare HMO Rider |
$11,037.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10,114.18
|
|
|
HC HP CANADIAN TYPE W SACH
|
Facility
|
OP
|
$15,701.00
|
|
|
Service Code
|
CPT L5280
|
| Hospital Charge Code |
915355280
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,945.61 |
| Max. Negotiated Rate |
$14,130.90 |
| Rate for Payer: Adventist Health Commercial |
$6,437.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,345.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,635.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,775.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,221.20
|
| Rate for Payer: Blue Shield of California Commercial |
$12,136.87
|
| Rate for Payer: Blue Shield of California EPN |
$7,913.30
|
| Rate for Payer: Cash Price |
$8,635.55
|
| Rate for Payer: Cash Price |
$8,635.55
|
| Rate for Payer: Central Health Plan Commercial |
$12,560.80
|
| Rate for Payer: Cigna of CA HMO |
$10,990.70
|
| Rate for Payer: Cigna of CA PPO |
$10,990.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,345.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,345.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,345.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,280.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,280.40
|
| Rate for Payer: Galaxy Health WC |
$13,345.85
|
| Rate for Payer: Global Benefits Group Commercial |
$9,420.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,130.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,945.61
|
| Rate for Payer: InnovAge PACE Commercial |
$7,850.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,472.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,358.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,718.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,437.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,990.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,990.70
|
| Rate for Payer: Multiplan Commercial |
$11,775.75
|
| Rate for Payer: Networks By Design Commercial |
$7,850.50
|
| Rate for Payer: Prime Health Services Commercial |
$13,345.85
|
| Rate for Payer: Riverside University Health System MISP |
$6,280.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,420.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,420.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,892.59
|
| Rate for Payer: United Healthcare All Other HMO |
$5,735.58
|
| Rate for Payer: United Healthcare HMO Rider |
$5,611.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,142.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,345.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,345.85
|
| Rate for Payer: Vantage Medical Group Senior |
$13,345.85
|
|
|
HC HP CANADIAN TYPE W SACH
|
Facility
|
IP
|
$15,701.00
|
|
|
Service Code
|
CPT L5280
|
| Hospital Charge Code |
915355280
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,140.20 |
| Max. Negotiated Rate |
$14,130.90 |
| Rate for Payer: Adventist Health Commercial |
$3,140.20
|
| Rate for Payer: Blue Shield of California Commercial |
$12,136.87
|
| Rate for Payer: Blue Shield of California EPN |
$7,913.30
|
| Rate for Payer: Cash Price |
$8,635.55
|
| Rate for Payer: Central Health Plan Commercial |
$12,560.80
|
| Rate for Payer: Cigna of CA HMO |
$10,990.70
|
| Rate for Payer: Cigna of CA PPO |
$10,990.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,280.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,280.40
|
| Rate for Payer: Galaxy Health WC |
$13,345.85
|
| Rate for Payer: Global Benefits Group Commercial |
$9,420.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,130.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,472.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,982.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,718.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,140.20
|
| Rate for Payer: Multiplan Commercial |
$11,775.75
|
| Rate for Payer: Networks By Design Commercial |
$10,205.65
|
| Rate for Payer: Prime Health Services Commercial |
$13,345.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,892.59
|
| Rate for Payer: United Healthcare All Other HMO |
$5,735.58
|
| Rate for Payer: United Healthcare HMO Rider |
$5,611.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,142.08
|
|
|
HC HP CANADIAN TYPE W SACH
|
Facility
|
IP
|
$15,701.00
|
|
|
Service Code
|
CPT L5280
|
| Hospital Charge Code |
905355280
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,140.20 |
| Max. Negotiated Rate |
$14,130.90 |
| Rate for Payer: Adventist Health Commercial |
$3,140.20
|
| Rate for Payer: Blue Shield of California Commercial |
$12,136.87
|
| Rate for Payer: Blue Shield of California EPN |
$7,913.30
|
| Rate for Payer: Cash Price |
$8,635.55
|
| Rate for Payer: Central Health Plan Commercial |
$12,560.80
|
| Rate for Payer: Cigna of CA HMO |
$10,990.70
|
| Rate for Payer: Cigna of CA PPO |
$10,990.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,280.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,280.40
|
| Rate for Payer: Galaxy Health WC |
$13,345.85
|
| Rate for Payer: Global Benefits Group Commercial |
$9,420.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,130.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,472.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,982.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,718.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,140.20
|
| Rate for Payer: Multiplan Commercial |
$11,775.75
|
| Rate for Payer: Networks By Design Commercial |
$10,205.65
|
| Rate for Payer: Prime Health Services Commercial |
$13,345.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,892.59
|
| Rate for Payer: United Healthcare All Other HMO |
$5,735.58
|
| Rate for Payer: United Healthcare HMO Rider |
$5,611.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,142.08
|
|
|
HC HP CANADIAN TYPE W SACH
|
Facility
|
OP
|
$15,701.00
|
|
|
Service Code
|
CPT L5280
|
| Hospital Charge Code |
905355280
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,945.61 |
| Max. Negotiated Rate |
$14,130.90 |
| Rate for Payer: Adventist Health Commercial |
$6,437.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,345.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,635.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,775.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,221.20
|
| Rate for Payer: Blue Shield of California Commercial |
$12,136.87
|
| Rate for Payer: Blue Shield of California EPN |
$7,913.30
|
| Rate for Payer: Cash Price |
$8,635.55
|
| Rate for Payer: Cash Price |
$8,635.55
|
| Rate for Payer: Central Health Plan Commercial |
$12,560.80
|
| Rate for Payer: Cigna of CA HMO |
$10,990.70
|
| Rate for Payer: Cigna of CA PPO |
$10,990.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,345.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,345.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,345.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,280.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,280.40
|
| Rate for Payer: Galaxy Health WC |
$13,345.85
|
| Rate for Payer: Global Benefits Group Commercial |
$9,420.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,130.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,945.61
|
| Rate for Payer: InnovAge PACE Commercial |
$7,850.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,472.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,358.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,718.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,437.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,990.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,990.70
|
| Rate for Payer: Multiplan Commercial |
$11,775.75
|
| Rate for Payer: Networks By Design Commercial |
$7,850.50
|
| Rate for Payer: Prime Health Services Commercial |
$13,345.85
|
| Rate for Payer: Riverside University Health System MISP |
$6,280.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,420.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,420.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,892.59
|
| Rate for Payer: United Healthcare All Other HMO |
$5,735.58
|
| Rate for Payer: United Healthcare HMO Rider |
$5,611.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,142.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,345.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,345.85
|
| Rate for Payer: Vantage Medical Group Senior |
$13,345.85
|
|
|
HC HP PROS MID SKT ENDO,NO-COVER
|
Facility
|
OP
|
$10,808.00
|
|
|
Service Code
|
CPT L5341
|
| Hospital Charge Code |
915355341
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,539.62 |
| Max. Negotiated Rate |
$9,727.20 |
| Rate for Payer: Adventist Health Commercial |
$4,431.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,186.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,944.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,106.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,347.54
|
| Rate for Payer: Blue Shield of California Commercial |
$8,354.58
|
| Rate for Payer: Blue Shield of California EPN |
$5,447.23
|
| Rate for Payer: Cash Price |
$5,944.40
|
| Rate for Payer: Cash Price |
$5,944.40
|
| Rate for Payer: Central Health Plan Commercial |
$8,646.40
|
| Rate for Payer: Cigna of CA HMO |
$7,565.60
|
| Rate for Payer: Cigna of CA PPO |
$7,565.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,186.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,186.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,186.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,323.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,323.20
|
| Rate for Payer: Galaxy Health WC |
$9,186.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6,484.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,727.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7,436.11
|
| Rate for Payer: InnovAge PACE Commercial |
$5,404.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,208.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,214.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,690.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,431.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,565.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,565.60
|
| Rate for Payer: Multiplan Commercial |
$8,106.00
|
| Rate for Payer: Networks By Design Commercial |
$5,404.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,186.80
|
| Rate for Payer: Riverside University Health System MISP |
$4,323.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,484.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,484.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,056.24
|
| Rate for Payer: United Healthcare All Other HMO |
$3,948.16
|
| Rate for Payer: United Healthcare HMO Rider |
$3,862.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,539.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,186.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,186.80
|
| Rate for Payer: Vantage Medical Group Senior |
$9,186.80
|
|
|
HC HP PROS MID SKT ENDO,NO-COVER
|
Facility
|
IP
|
$10,808.00
|
|
|
Service Code
|
CPT L5341
|
| Hospital Charge Code |
915355341
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,161.60 |
| Max. Negotiated Rate |
$9,727.20 |
| Rate for Payer: Adventist Health Commercial |
$2,161.60
|
| Rate for Payer: Blue Shield of California Commercial |
$8,354.58
|
| Rate for Payer: Blue Shield of California EPN |
$5,447.23
|
| Rate for Payer: Cash Price |
$5,944.40
|
| Rate for Payer: Central Health Plan Commercial |
$8,646.40
|
| Rate for Payer: Cigna of CA HMO |
$7,565.60
|
| Rate for Payer: Cigna of CA PPO |
$7,565.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,323.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,323.20
|
| Rate for Payer: Galaxy Health WC |
$9,186.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6,484.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,727.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,208.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,117.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,690.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,161.60
|
| Rate for Payer: Multiplan Commercial |
$8,106.00
|
| Rate for Payer: Networks By Design Commercial |
$7,025.20
|
| Rate for Payer: Prime Health Services Commercial |
$9,186.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,056.24
|
| Rate for Payer: United Healthcare All Other HMO |
$3,948.16
|
| Rate for Payer: United Healthcare HMO Rider |
$3,862.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,539.62
|
|
|
HC HP PROS MID SKT ENDO,NO-COVER
|
Facility
|
OP
|
$10,808.00
|
|
|
Service Code
|
CPT L5341
|
| Hospital Charge Code |
905355341
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,539.62 |
| Max. Negotiated Rate |
$9,727.20 |
| Rate for Payer: Adventist Health Commercial |
$4,431.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,186.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,944.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,106.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,347.54
|
| Rate for Payer: Blue Shield of California Commercial |
$8,354.58
|
| Rate for Payer: Blue Shield of California EPN |
$5,447.23
|
| Rate for Payer: Cash Price |
$5,944.40
|
| Rate for Payer: Cash Price |
$5,944.40
|
| Rate for Payer: Central Health Plan Commercial |
$8,646.40
|
| Rate for Payer: Cigna of CA HMO |
$7,565.60
|
| Rate for Payer: Cigna of CA PPO |
$7,565.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,186.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,186.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,186.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,323.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,323.20
|
| Rate for Payer: Galaxy Health WC |
$9,186.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6,484.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,727.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7,436.11
|
| Rate for Payer: InnovAge PACE Commercial |
$5,404.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,208.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,214.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,690.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,431.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,565.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,565.60
|
| Rate for Payer: Multiplan Commercial |
$8,106.00
|
| Rate for Payer: Networks By Design Commercial |
$5,404.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,186.80
|
| Rate for Payer: Riverside University Health System MISP |
$4,323.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,484.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,484.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,056.24
|
| Rate for Payer: United Healthcare All Other HMO |
$3,948.16
|
| Rate for Payer: United Healthcare HMO Rider |
$3,862.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,539.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,186.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,186.80
|
| Rate for Payer: Vantage Medical Group Senior |
$9,186.80
|
|
|
HC HP PROS MID SKT ENDO,NO-COVER
|
Facility
|
IP
|
$10,808.00
|
|
|
Service Code
|
CPT L5341
|
| Hospital Charge Code |
905355341
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,161.60 |
| Max. Negotiated Rate |
$9,727.20 |
| Rate for Payer: Adventist Health Commercial |
$2,161.60
|
| Rate for Payer: Blue Shield of California Commercial |
$8,354.58
|
| Rate for Payer: Blue Shield of California EPN |
$5,447.23
|
| Rate for Payer: Cash Price |
$5,944.40
|
| Rate for Payer: Central Health Plan Commercial |
$8,646.40
|
| Rate for Payer: Cigna of CA HMO |
$7,565.60
|
| Rate for Payer: Cigna of CA PPO |
$7,565.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,323.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,323.20
|
| Rate for Payer: Galaxy Health WC |
$9,186.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6,484.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,727.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,208.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,117.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,690.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,161.60
|
| Rate for Payer: Multiplan Commercial |
$8,106.00
|
| Rate for Payer: Networks By Design Commercial |
$7,025.20
|
| Rate for Payer: Prime Health Services Commercial |
$9,186.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,056.24
|
| Rate for Payer: United Healthcare All Other HMO |
$3,948.16
|
| Rate for Payer: United Healthcare HMO Rider |
$3,862.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,539.62
|
|
|
HC HPV BY NUCLEIC ACID
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
CPT 87626
|
| Hospital Charge Code |
900913641
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.49 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Adventist Health Commercial |
$28.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$70.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$85.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$105.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$77.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$70.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$86.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.49
|
| Rate for Payer: Blue Shield of California Commercial |
$84.98
|
| Rate for Payer: Blue Shield of California EPN |
$55.58
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Central Health Plan Commercial |
$112.00
|
| Rate for Payer: Cigna of CA HMO |
$89.60
|
| Rate for Payer: Cigna of CA PPO |
$103.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$105.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$77.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$70.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.77
|
| Rate for Payer: EPIC Health Plan Senior |
$70.20
|
| Rate for Payer: Galaxy Health WC |
$119.00
|
| Rate for Payer: Global Benefits Group Commercial |
$84.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$126.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$115.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$70.20
|
| Rate for Payer: InnovAge PACE Commercial |
$105.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$93.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$70.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$94.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$94.07
|
| Rate for Payer: Multiplan Commercial |
$105.00
|
| Rate for Payer: Networks By Design Commercial |
$91.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$70.20
|
| Rate for Payer: Prime Health Services Commercial |
$119.00
|
| Rate for Payer: Prime Health Services Medicare |
$74.41
|
| Rate for Payer: Riverside University Health System MISP |
$77.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$84.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$84.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$70.00
|
| Rate for Payer: United Healthcare All Other HMO |
$70.00
|
| Rate for Payer: United Healthcare HMO Rider |
$70.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$70.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$70.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$105.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$77.22
|
| Rate for Payer: Vantage Medical Group Senior |
$70.20
|
|
|
HC HPV BY NUCLEIC ACID
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
CPT 87626
|
| Hospital Charge Code |
900913641
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Adventist Health Commercial |
$28.00
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Central Health Plan Commercial |
$112.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.00
|
| Rate for Payer: EPIC Health Plan Senior |
$56.00
|
| Rate for Payer: Galaxy Health WC |
$119.00
|
| Rate for Payer: Global Benefits Group Commercial |
$84.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$126.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$93.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$86.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.00
|
| Rate for Payer: Multiplan Commercial |
$105.00
|
| Rate for Payer: Networks By Design Commercial |
$91.00
|
| Rate for Payer: Prime Health Services Commercial |
$119.00
|
|
|
HC H. PYLORI AB, IGG
|
Facility
|
IP
|
$74.00
|
|
|
Service Code
|
CPT 86677
|
| Hospital Charge Code |
900913556
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.80 |
| Max. Negotiated Rate |
$66.60 |
| Rate for Payer: Adventist Health Commercial |
$14.80
|
| Rate for Payer: Cash Price |
$40.70
|
| Rate for Payer: Central Health Plan Commercial |
$59.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.60
|
| Rate for Payer: EPIC Health Plan Senior |
$29.60
|
| Rate for Payer: Galaxy Health WC |
$62.90
|
| Rate for Payer: Global Benefits Group Commercial |
$44.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$66.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$49.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$45.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.80
|
| Rate for Payer: Multiplan Commercial |
$55.50
|
| Rate for Payer: Networks By Design Commercial |
$48.10
|
| Rate for Payer: Prime Health Services Commercial |
$62.90
|
|
|
HC H. PYLORI AB, IGG
|
Facility
|
OP
|
$74.00
|
|
|
Service Code
|
CPT 86677
|
| Hospital Charge Code |
900913556
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.65 |
| Max. Negotiated Rate |
$108.34 |
| Rate for Payer: Adventist Health Commercial |
$14.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$16.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$44.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$108.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.99
|
| Rate for Payer: Blue Shield of California Commercial |
$44.92
|
| Rate for Payer: Blue Shield of California EPN |
$29.38
|
| Rate for Payer: Cash Price |
$40.70
|
| Rate for Payer: Cash Price |
$40.70
|
| Rate for Payer: Central Health Plan Commercial |
$59.20
|
| Rate for Payer: Cigna of CA HMO |
$47.36
|
| Rate for Payer: Cigna of CA PPO |
$54.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.75
|
| Rate for Payer: EPIC Health Plan Senior |
$16.85
|
| Rate for Payer: Galaxy Health WC |
$62.90
|
| Rate for Payer: Global Benefits Group Commercial |
$44.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$66.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.85
|
| Rate for Payer: InnovAge PACE Commercial |
$25.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$49.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.58
|
| Rate for Payer: Multiplan Commercial |
$55.50
|
| Rate for Payer: Networks By Design Commercial |
$48.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16.85
|
| Rate for Payer: Prime Health Services Commercial |
$62.90
|
| Rate for Payer: Prime Health Services Medicare |
$17.86
|
| Rate for Payer: Riverside University Health System MISP |
$18.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$44.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$44.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.65
|
| Rate for Payer: United Healthcare All Other HMO |
$13.65
|
| Rate for Payer: United Healthcare HMO Rider |
$13.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.65
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.54
|
| Rate for Payer: Vantage Medical Group Senior |
$16.85
|
|
