|
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 |
$4,863.60
|
| Rate for Payer: Cash Price |
$4,863.60
|
| 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 |
$4,863.60
|
| 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 |
$4,863.60
|
| Rate for Payer: Cash Price |
$4,863.60
|
| 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 HPV BY NUCLEIC ACID
|
Facility
|
IP
|
$161.00
|
|
|
Service Code
|
CPT 87626
|
| Hospital Charge Code |
900913641
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.20 |
| Max. Negotiated Rate |
$144.90 |
| Rate for Payer: Adventist Health Commercial |
$32.20
|
| Rate for Payer: Cash Price |
$72.45
|
| Rate for Payer: Central Health Plan Commercial |
$128.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.40
|
| Rate for Payer: EPIC Health Plan Senior |
$64.40
|
| Rate for Payer: Galaxy Health WC |
$136.85
|
| Rate for Payer: Global Benefits Group Commercial |
$96.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$144.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$107.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$99.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.20
|
| Rate for Payer: Multiplan Commercial |
$120.75
|
| Rate for Payer: Networks By Design Commercial |
$104.65
|
| Rate for Payer: Prime Health Services Commercial |
$136.85
|
|
|
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 |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| 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 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 |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| 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
|
|
|
HC H. PYLORI AB, IGG
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
CPT 86677
|
| Hospital Charge Code |
900913556
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$54.00 |
| Max. Negotiated Rate |
$243.00 |
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Central Health Plan Commercial |
$216.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.00
|
| Rate for Payer: EPIC Health Plan Senior |
$108.00
|
| Rate for Payer: Galaxy Health WC |
$229.50
|
| Rate for Payer: Global Benefits Group Commercial |
$162.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$243.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$180.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$167.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.00
|
| Rate for Payer: Multiplan Commercial |
$202.50
|
| Rate for Payer: Networks By Design Commercial |
$175.50
|
| Rate for Payer: Prime Health Services Commercial |
$229.50
|
|
|
HC H REFLEX SOLEUS
|
Facility
|
IP
|
$199.00
|
|
| Hospital Charge Code |
900600259
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$39.80 |
| Max. Negotiated Rate |
$179.10 |
| Rate for Payer: Adventist Health Commercial |
$39.80
|
| Rate for Payer: Cash Price |
$89.55
|
| Rate for Payer: Central Health Plan Commercial |
$159.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.60
|
| Rate for Payer: EPIC Health Plan Senior |
$79.60
|
| Rate for Payer: Galaxy Health WC |
$169.15
|
| Rate for Payer: Global Benefits Group Commercial |
$119.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$179.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$132.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$75.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$123.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.80
|
| Rate for Payer: Multiplan Commercial |
$149.25
|
| Rate for Payer: Networks By Design Commercial |
$129.35
|
| Rate for Payer: Prime Health Services Commercial |
$169.15
|
|
|
HC H REFLEX SOLEUS
|
Facility
|
OP
|
$199.00
|
|
| Hospital Charge Code |
900600259
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$39.80 |
| Max. Negotiated Rate |
$1,297.00 |
| Rate for Payer: Adventist Health Commercial |
$39.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$120.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$169.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$109.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$149.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$96.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$116.87
|
| Rate for Payer: Blue Shield of California Commercial |
$120.79
|
| Rate for Payer: Blue Shield of California EPN |
$79.00
|
| Rate for Payer: Cash Price |
$89.55
|
| Rate for Payer: Cash Price |
$89.55
|
| Rate for Payer: Central Health Plan Commercial |
$159.20
|
| Rate for Payer: Cigna of CA HMO |
$127.36
|
| Rate for Payer: Cigna of CA PPO |
$147.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$169.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$169.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$169.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.60
|
| Rate for Payer: EPIC Health Plan Senior |
$79.60
|
| Rate for Payer: Galaxy Health WC |
$169.15
|
| Rate for Payer: Global Benefits Group Commercial |
$119.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$179.10
|
| Rate for Payer: InnovAge PACE Commercial |
$99.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$132.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$75.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$123.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$139.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$139.30
|
| Rate for Payer: Multiplan Commercial |
$149.25
|
| Rate for Payer: Networks By Design Commercial |
$129.35
|
| Rate for Payer: Prime Health Services Commercial |
$169.15
|
| Rate for Payer: Riverside University Health System MISP |
$79.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$119.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$119.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,297.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,024.00
|
| Rate for Payer: United Healthcare HMO Rider |
$776.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$711.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$169.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$169.15
|
| Rate for Payer: Vantage Medical Group Senior |
$169.15
|
|
|
HC HRHC INT TRANAL DARTLZN 2+
|
Facility
|
IP
|
$11,567.00
|
|
|
Service Code
|
CPT 46948
|
| Hospital Charge Code |
906706948
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,313.40 |
| Max. Negotiated Rate |
$10,410.30 |
| Rate for Payer: Adventist Health Commercial |
$2,313.40
|
| Rate for Payer: Cash Price |
$5,205.15
|
| Rate for Payer: Central Health Plan Commercial |
$9,253.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,626.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,626.80
|
| Rate for Payer: Galaxy Health WC |
$9,831.95
|
| Rate for Payer: Global Benefits Group Commercial |
$6,940.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,410.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,715.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,407.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,159.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,313.40
|
| Rate for Payer: Multiplan Commercial |
$8,675.25
|
| Rate for Payer: Networks By Design Commercial |
$7,518.55
|
| Rate for Payer: Prime Health Services Commercial |
$9,831.95
|
|
|
HC HRHC INT TRANAL DARTLZN 2+
|
Facility
|
OP
|
$11,567.00
|
|
|
Service Code
|
CPT 46948
|
| Hospital Charge Code |
906706948
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$671.09 |
| Max. Negotiated Rate |
$16,122.00 |
| Rate for Payer: Adventist Health Commercial |
$2,313.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$3,484.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,226.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,832.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,484.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,877.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,194.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$5,551.91
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$5,205.15
|
| Rate for Payer: Cash Price |
$5,205.15
|
| Rate for Payer: Cash Price |
$5,205.15
|
| Rate for Payer: Central Health Plan Commercial |
$9,253.60
|
| Rate for Payer: Cigna of CA HMO |
$7,402.88
|
| Rate for Payer: Cigna of CA PPO |
$8,559.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,226.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,832.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,484.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,704.05
|
| Rate for Payer: EPIC Health Plan Senior |
$3,484.48
|
| Rate for Payer: Galaxy Health WC |
$9,831.95
|
| Rate for Payer: Global Benefits Group Commercial |
$6,940.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,410.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5,714.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$671.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,484.48
|
| Rate for Payer: InnovAge PACE Commercial |
$5,226.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,715.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$741.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,484.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,313.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,669.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,669.20
|
| Rate for Payer: Multiplan Commercial |
$8,675.25
|
| Rate for Payer: Multiplan WC |
$5,551.91
|
| Rate for Payer: Networks By Design Commercial |
$7,518.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,484.48
|
| Rate for Payer: Preferred Health Network WC |
$5,665.21
|
| Rate for Payer: Prime Health Services Commercial |
$9,831.95
|
| Rate for Payer: Prime Health Services Medicare |
$3,693.55
|
| Rate for Payer: Prime Health Services WC |
$5,495.25
|
| Rate for Payer: Riverside University Health System MISP |
$3,832.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,940.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,984.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,484.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,226.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,832.93
|
| Rate for Payer: Vantage Medical Group Senior |
$3,484.48
|
|
|
HC H STRISCPE LRG SNGL USE BRNCHSCPE 5.8 MM OD 2.8 MM WC
|
Facility
|
OP
|
$738.00
|
|
| Hospital Charge Code |
900831715
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$147.60 |
| Max. Negotiated Rate |
$664.20 |
| Rate for Payer: Adventist Health Commercial |
$147.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$448.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$627.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$405.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$553.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$357.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$433.43
|
| Rate for Payer: Blue Shield of California Commercial |
$450.92
|
| Rate for Payer: Blue Shield of California EPN |
$294.46
|
| Rate for Payer: Cash Price |
$332.10
|
| Rate for Payer: Central Health Plan Commercial |
$590.40
|
| Rate for Payer: Cigna of CA HMO |
$472.32
|
| Rate for Payer: Cigna of CA PPO |
$546.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$627.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$627.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$627.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$295.20
|
| Rate for Payer: EPIC Health Plan Senior |
$295.20
|
| Rate for Payer: Galaxy Health WC |
$627.30
|
| Rate for Payer: Global Benefits Group Commercial |
$442.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$664.20
|
| Rate for Payer: InnovAge PACE Commercial |
$369.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$492.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$281.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$456.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$147.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$516.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$516.60
|
| Rate for Payer: Multiplan Commercial |
$553.50
|
| Rate for Payer: Networks By Design Commercial |
$479.70
|
| Rate for Payer: Prime Health Services Commercial |
$627.30
|
| Rate for Payer: Riverside University Health System MISP |
$295.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$442.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$442.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$369.00
|
| Rate for Payer: United Healthcare All Other HMO |
$369.00
|
| Rate for Payer: United Healthcare HMO Rider |
$369.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$369.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$627.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$627.30
|
| Rate for Payer: Vantage Medical Group Senior |
$627.30
|
|
|
HC H STRISCPE LRG SNGL USE BRNCHSCPE 5.8 MM OD 2.8 MM WC
|
Facility
|
IP
|
$738.00
|
|
| Hospital Charge Code |
900831715
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$147.60 |
| Max. Negotiated Rate |
$664.20 |
| Rate for Payer: Adventist Health Commercial |
$147.60
|
| Rate for Payer: Cash Price |
$332.10
|
| Rate for Payer: Central Health Plan Commercial |
$590.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$295.20
|
| Rate for Payer: EPIC Health Plan Senior |
$295.20
|
| Rate for Payer: Galaxy Health WC |
$627.30
|
| Rate for Payer: Global Benefits Group Commercial |
$442.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$664.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$492.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$281.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$456.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$147.60
|
| Rate for Payer: Multiplan Commercial |
$553.50
|
| Rate for Payer: Networks By Design Commercial |
$479.70
|
| Rate for Payer: Prime Health Services Commercial |
$627.30
|
|
|
HC H STRISCPE NRML SNGL USE BRNCHSCPE 4.9 MM OD 2.2 MM WC
|
Facility
|
OP
|
$738.00
|
|
| Hospital Charge Code |
900831714
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$147.60 |
| Max. Negotiated Rate |
$664.20 |
| Rate for Payer: Adventist Health Commercial |
$147.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$448.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$627.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$405.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$553.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$357.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$433.43
|
| Rate for Payer: Blue Shield of California Commercial |
$450.92
|
| Rate for Payer: Blue Shield of California EPN |
$294.46
|
| Rate for Payer: Cash Price |
$332.10
|
| Rate for Payer: Central Health Plan Commercial |
$590.40
|
| Rate for Payer: Cigna of CA HMO |
$472.32
|
| Rate for Payer: Cigna of CA PPO |
$546.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$627.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$627.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$627.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$295.20
|
| Rate for Payer: EPIC Health Plan Senior |
$295.20
|
| Rate for Payer: Galaxy Health WC |
$627.30
|
| Rate for Payer: Global Benefits Group Commercial |
$442.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$664.20
|
| Rate for Payer: InnovAge PACE Commercial |
$369.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$492.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$281.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$456.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$147.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$516.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$516.60
|
| Rate for Payer: Multiplan Commercial |
$553.50
|
| Rate for Payer: Networks By Design Commercial |
$479.70
|
| Rate for Payer: Prime Health Services Commercial |
$627.30
|
| Rate for Payer: Riverside University Health System MISP |
$295.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$442.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$442.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$369.00
|
| Rate for Payer: United Healthcare All Other HMO |
$369.00
|
| Rate for Payer: United Healthcare HMO Rider |
$369.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$369.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$627.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$627.30
|
| Rate for Payer: Vantage Medical Group Senior |
$627.30
|
|
|
HC H STRISCPE NRML SNGL USE BRNCHSCPE 4.9 MM OD 2.2 MM WC
|
Facility
|
IP
|
$738.00
|
|
| Hospital Charge Code |
900831714
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$147.60 |
| Max. Negotiated Rate |
$664.20 |
| Rate for Payer: Adventist Health Commercial |
$147.60
|
| Rate for Payer: Cash Price |
$332.10
|
| Rate for Payer: Central Health Plan Commercial |
$590.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$295.20
|
| Rate for Payer: EPIC Health Plan Senior |
$295.20
|
| Rate for Payer: Galaxy Health WC |
$627.30
|
| Rate for Payer: Global Benefits Group Commercial |
$442.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$664.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$492.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$281.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$456.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$147.60
|
| Rate for Payer: Multiplan Commercial |
$553.50
|
| Rate for Payer: Networks By Design Commercial |
$479.70
|
| Rate for Payer: Prime Health Services Commercial |
$627.30
|
|
|
HC H STRISCPE SLIM SNGL USE BRNCHSCPE 3.2 MM OD 1.2 MM WC
|
Facility
|
OP
|
$738.00
|
|
| Hospital Charge Code |
900831713
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$147.60 |
| Max. Negotiated Rate |
$664.20 |
| Rate for Payer: Adventist Health Commercial |
$147.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$448.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$627.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$405.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$553.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$357.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$433.43
|
| Rate for Payer: Blue Shield of California Commercial |
$450.92
|
| Rate for Payer: Blue Shield of California EPN |
$294.46
|
| Rate for Payer: Cash Price |
$332.10
|
| Rate for Payer: Central Health Plan Commercial |
$590.40
|
| Rate for Payer: Cigna of CA HMO |
$472.32
|
| Rate for Payer: Cigna of CA PPO |
$546.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$627.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$627.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$627.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$295.20
|
| Rate for Payer: EPIC Health Plan Senior |
$295.20
|
| Rate for Payer: Galaxy Health WC |
$627.30
|
| Rate for Payer: Global Benefits Group Commercial |
$442.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$664.20
|
| Rate for Payer: InnovAge PACE Commercial |
$369.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$492.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$281.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$456.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$147.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$516.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$516.60
|
| Rate for Payer: Multiplan Commercial |
$553.50
|
| Rate for Payer: Networks By Design Commercial |
$479.70
|
| Rate for Payer: Prime Health Services Commercial |
$627.30
|
| Rate for Payer: Riverside University Health System MISP |
$295.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$442.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$442.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$369.00
|
| Rate for Payer: United Healthcare All Other HMO |
$369.00
|
| Rate for Payer: United Healthcare HMO Rider |
$369.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$369.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$627.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$627.30
|
| Rate for Payer: Vantage Medical Group Senior |
$627.30
|
|
|
HC H STRISCPE SLIM SNGL USE BRNCHSCPE 3.2 MM OD 1.2 MM WC
|
Facility
|
IP
|
$738.00
|
|
| Hospital Charge Code |
900831713
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$147.60 |
| Max. Negotiated Rate |
$664.20 |
| Rate for Payer: Adventist Health Commercial |
$147.60
|
| Rate for Payer: Cash Price |
$332.10
|
| Rate for Payer: Central Health Plan Commercial |
$590.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$295.20
|
| Rate for Payer: EPIC Health Plan Senior |
$295.20
|
| Rate for Payer: Galaxy Health WC |
$627.30
|
| Rate for Payer: Global Benefits Group Commercial |
$442.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$664.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$492.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$281.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$456.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$147.60
|
| Rate for Payer: Multiplan Commercial |
$553.50
|
| Rate for Payer: Networks By Design Commercial |
$479.70
|
| Rate for Payer: Prime Health Services Commercial |
$627.30
|
|
|
HC H STRISCPE XTRA SNGL USE BRNCHSCPE 6.2 MM OD 3.2 MM WC
|
Facility
|
IP
|
$738.00
|
|
| Hospital Charge Code |
900831716
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$147.60 |
| Max. Negotiated Rate |
$664.20 |
| Rate for Payer: Adventist Health Commercial |
$147.60
|
| Rate for Payer: Cash Price |
$332.10
|
| Rate for Payer: Central Health Plan Commercial |
$590.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$295.20
|
| Rate for Payer: EPIC Health Plan Senior |
$295.20
|
| Rate for Payer: Galaxy Health WC |
$627.30
|
| Rate for Payer: Global Benefits Group Commercial |
$442.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$664.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$492.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$281.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$456.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$147.60
|
| Rate for Payer: Multiplan Commercial |
$553.50
|
| Rate for Payer: Networks By Design Commercial |
$479.70
|
| Rate for Payer: Prime Health Services Commercial |
$627.30
|
|
|
HC H STRISCPE XTRA SNGL USE BRNCHSCPE 6.2 MM OD 3.2 MM WC
|
Facility
|
OP
|
$738.00
|
|
| Hospital Charge Code |
900831716
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$147.60 |
| Max. Negotiated Rate |
$664.20 |
| Rate for Payer: Adventist Health Commercial |
$147.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$448.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$627.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$405.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$553.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$357.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$433.43
|
| Rate for Payer: Blue Shield of California Commercial |
$450.92
|
| Rate for Payer: Blue Shield of California EPN |
$294.46
|
| Rate for Payer: Cash Price |
$332.10
|
| Rate for Payer: Central Health Plan Commercial |
$590.40
|
| Rate for Payer: Cigna of CA HMO |
$472.32
|
| Rate for Payer: Cigna of CA PPO |
$546.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$627.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$627.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$627.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$295.20
|
| Rate for Payer: EPIC Health Plan Senior |
$295.20
|
| Rate for Payer: Galaxy Health WC |
$627.30
|
| Rate for Payer: Global Benefits Group Commercial |
$442.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$664.20
|
| Rate for Payer: InnovAge PACE Commercial |
$369.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$492.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$281.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$456.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$147.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$516.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$516.60
|
| Rate for Payer: Multiplan Commercial |
$553.50
|
| Rate for Payer: Networks By Design Commercial |
$479.70
|
| Rate for Payer: Prime Health Services Commercial |
$627.30
|
| Rate for Payer: Riverside University Health System MISP |
$295.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$442.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$442.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$369.00
|
| Rate for Payer: United Healthcare All Other HMO |
$369.00
|
| Rate for Payer: United Healthcare HMO Rider |
$369.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$369.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$627.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$627.30
|
| Rate for Payer: Vantage Medical Group Senior |
$627.30
|
|
|
HC H STRISCPE ZERO SNGL USE BRNCHSCPE 2.2 MM OD 0.0 MM WC
|
Facility
|
IP
|
$738.00
|
|
| Hospital Charge Code |
900831712
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$147.60 |
| Max. Negotiated Rate |
$664.20 |
| Rate for Payer: Adventist Health Commercial |
$147.60
|
| Rate for Payer: Cash Price |
$332.10
|
| Rate for Payer: Central Health Plan Commercial |
$590.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$295.20
|
| Rate for Payer: EPIC Health Plan Senior |
$295.20
|
| Rate for Payer: Galaxy Health WC |
$627.30
|
| Rate for Payer: Global Benefits Group Commercial |
$442.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$664.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$492.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$281.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$456.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$147.60
|
| Rate for Payer: Multiplan Commercial |
$553.50
|
| Rate for Payer: Networks By Design Commercial |
$479.70
|
| Rate for Payer: Prime Health Services Commercial |
$627.30
|
|
|
HC H STRISCPE ZERO SNGL USE BRNCHSCPE 2.2 MM OD 0.0 MM WC
|
Facility
|
OP
|
$738.00
|
|
| Hospital Charge Code |
900831712
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$147.60 |
| Max. Negotiated Rate |
$664.20 |
| Rate for Payer: Adventist Health Commercial |
$147.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$448.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$627.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$405.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$553.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$357.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$433.43
|
| Rate for Payer: Blue Shield of California Commercial |
$450.92
|
| Rate for Payer: Blue Shield of California EPN |
$294.46
|
| Rate for Payer: Cash Price |
$332.10
|
| Rate for Payer: Central Health Plan Commercial |
$590.40
|
| Rate for Payer: Cigna of CA HMO |
$472.32
|
| Rate for Payer: Cigna of CA PPO |
$546.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$627.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$627.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$627.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$295.20
|
| Rate for Payer: EPIC Health Plan Senior |
$295.20
|
| Rate for Payer: Galaxy Health WC |
$627.30
|
| Rate for Payer: Global Benefits Group Commercial |
$442.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$664.20
|
| Rate for Payer: InnovAge PACE Commercial |
$369.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$492.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$281.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$456.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$147.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$516.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$516.60
|
| Rate for Payer: Multiplan Commercial |
$553.50
|
| Rate for Payer: Networks By Design Commercial |
$479.70
|
| Rate for Payer: Prime Health Services Commercial |
$627.30
|
| Rate for Payer: Riverside University Health System MISP |
$295.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$442.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$442.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$369.00
|
| Rate for Payer: United Healthcare All Other HMO |
$369.00
|
| Rate for Payer: United Healthcare HMO Rider |
$369.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$369.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$627.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$627.30
|
| Rate for Payer: Vantage Medical Group Senior |
$627.30
|
|
|
HC HSTROPONIN T
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
CPT 84484
|
| Hospital Charge Code |
900912258
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.10 |
| Max. Negotiated Rate |
$138.80 |
| Rate for Payer: Adventist Health Commercial |
$17.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$51.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$138.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.17
|
| Rate for Payer: Blue Shield of California Commercial |
$51.59
|
| Rate for Payer: Blue Shield of California EPN |
$33.74
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Central Health Plan Commercial |
$68.00
|
| Rate for Payer: Cigna of CA HMO |
$54.40
|
| Rate for Payer: Cigna of CA PPO |
$62.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.83
|
| Rate for Payer: EPIC Health Plan Senior |
$12.47
|
| Rate for Payer: Galaxy Health WC |
$72.25
|
| Rate for Payer: Global Benefits Group Commercial |
$51.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$76.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$20.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.47
|
| Rate for Payer: InnovAge PACE Commercial |
$18.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.71
|
| Rate for Payer: Multiplan Commercial |
$63.75
|
| Rate for Payer: Networks By Design Commercial |
$55.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.47
|
| Rate for Payer: Prime Health Services Commercial |
$72.25
|
| Rate for Payer: Prime Health Services Medicare |
$13.22
|
| Rate for Payer: Riverside University Health System MISP |
$13.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.10
|
| Rate for Payer: United Healthcare All Other HMO |
$10.10
|
| Rate for Payer: United Healthcare HMO Rider |
$10.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.10
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.72
|
| Rate for Payer: Vantage Medical Group Senior |
$12.47
|
|
|
HC HSTROPONIN T
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
CPT 84484
|
| Hospital Charge Code |
900912258
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.60 |
| Max. Negotiated Rate |
$79.20 |
| Rate for Payer: Adventist Health Commercial |
$17.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Central Health Plan Commercial |
$70.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.20
|
| Rate for Payer: EPIC Health Plan Senior |
$35.20
|
| Rate for Payer: Galaxy Health WC |
$74.80
|
| Rate for Payer: Global Benefits Group Commercial |
$52.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$79.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$54.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.60
|
| Rate for Payer: Multiplan Commercial |
$66.00
|
| Rate for Payer: Networks By Design Commercial |
$57.20
|
| Rate for Payer: Prime Health Services Commercial |
$74.80
|
|
|
HC HSV 1,2 IGM
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
CPT 86694
|
| Hospital Charge Code |
900913562
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Adventist Health Commercial |
$6.80
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Central Health Plan Commercial |
$27.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.60
|
| Rate for Payer: EPIC Health Plan Senior |
$13.60
|
| Rate for Payer: Galaxy Health WC |
$28.90
|
| Rate for Payer: Global Benefits Group Commercial |
$20.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.80
|
| Rate for Payer: Multiplan Commercial |
$25.50
|
| Rate for Payer: Networks By Design Commercial |
$22.10
|
| Rate for Payer: Prime Health Services Commercial |
$28.90
|
|
|
HC HSV 1,2 IGM
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
CPT 86694
|
| Hospital Charge Code |
900913562
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.20 |
| Max. Negotiated Rate |
$104.37 |
| Rate for Payer: Adventist Health Commercial |
$6.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$14.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$104.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.18
|
| Rate for Payer: Blue Shield of California Commercial |
$18.82
|
| Rate for Payer: Blue Shield of California EPN |
$12.31
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Central Health Plan Commercial |
$24.80
|
| Rate for Payer: Cigna of CA HMO |
$19.84
|
| Rate for Payer: Cigna of CA PPO |
$22.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.43
|
| Rate for Payer: EPIC Health Plan Senior |
$14.39
|
| Rate for Payer: Galaxy Health WC |
$26.35
|
| Rate for Payer: Global Benefits Group Commercial |
$18.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.39
|
| Rate for Payer: InnovAge PACE Commercial |
$21.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.28
|
| Rate for Payer: Multiplan Commercial |
$23.25
|
| Rate for Payer: Networks By Design Commercial |
$20.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14.39
|
| Rate for Payer: Prime Health Services Commercial |
$26.35
|
| Rate for Payer: Prime Health Services Medicare |
$15.25
|
| Rate for Payer: Riverside University Health System MISP |
$15.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.65
|
| Rate for Payer: United Healthcare All Other HMO |
$11.65
|
| Rate for Payer: United Healthcare HMO Rider |
$11.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.65
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Vantage Medical Group Senior |
$14.39
|
|
