|
HC GB GALLBLADDER
|
Facility
|
IP
|
$470.00
|
|
|
Service Code
|
CPT 74290
|
| Hospital Charge Code |
909001818
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$423.00 |
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Central Health Plan Commercial |
$376.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$188.00
|
| Rate for Payer: Galaxy Health WC |
$399.50
|
| Rate for Payer: Global Benefits Group Commercial |
$282.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$423.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$313.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$179.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.00
|
| Rate for Payer: Multiplan Commercial |
$352.50
|
| Rate for Payer: Networks By Design Commercial |
$305.50
|
| Rate for Payer: Prime Health Services Commercial |
$399.50
|
|
|
HC GB GALLBLADDER
|
Facility
|
OP
|
$470.00
|
|
|
Service Code
|
CPT 74290
|
| Hospital Charge Code |
909001818
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$73.02 |
| Max. Negotiated Rate |
$423.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$229.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$297.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$154.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$188.24
|
| Rate for Payer: Blue Distinction Transplant |
$282.00
|
| Rate for Payer: Blue Shield of California Commercial |
$290.46
|
| Rate for Payer: Blue Shield of California EPN |
$228.42
|
| Rate for Payer: Caremore Medicare Advantage |
$229.56
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Central Health Plan Commercial |
$376.00
|
| Rate for Payer: Cigna of CA HMO |
$300.80
|
| Rate for Payer: Cigna of CA PPO |
$347.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: Dignity Health Media |
$229.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$229.56
|
| Rate for Payer: Galaxy Health WC |
$399.50
|
| Rate for Payer: Global Benefits Group Commercial |
$282.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$423.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$352.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$376.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$378.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$229.56
|
| Rate for Payer: InnovAge PACE Commercial |
$344.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$313.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$307.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$307.61
|
| Rate for Payer: Multiplan Commercial |
$352.50
|
| Rate for Payer: Networks By Design Commercial |
$305.50
|
| Rate for Payer: Prime Health Services Commercial |
$399.50
|
| Rate for Payer: Prime Health Services Medicare |
$243.33
|
| Rate for Payer: Riverside University Health System MISP |
$252.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$282.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$282.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$219.73
|
| Rate for Payer: United Healthcare All Other HMO |
$219.73
|
| Rate for Payer: United Healthcare HMO Rider |
$219.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$219.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
HC GDC 2-DIAMETER
|
Facility
|
IP
|
$1,764.00
|
|
| Hospital Charge Code |
909081817
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$352.80 |
| Max. Negotiated Rate |
$1,587.60 |
| Rate for Payer: Blue Shield of California EPN |
$941.98
|
| Rate for Payer: Cash Price |
$793.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,411.20
|
| Rate for Payer: Cigna of CA HMO |
$1,234.80
|
| Rate for Payer: Cigna of CA PPO |
$1,234.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$705.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$705.60
|
| Rate for Payer: Galaxy Health WC |
$1,499.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,058.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,587.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,176.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$672.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$352.80
|
| Rate for Payer: Multiplan Commercial |
$1,323.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,499.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$666.09
|
| Rate for Payer: United Healthcare All Other HMO |
$650.56
|
| Rate for Payer: United Healthcare HMO Rider |
$636.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$582.12
|
|
|
HC GDC 2-DIAMETER
|
Facility
|
OP
|
$1,764.00
|
|
| Hospital Charge Code |
909081817
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$352.80 |
| Max. Negotiated Rate |
$1,587.60 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,499.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$970.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$970.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$805.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$982.55
|
| Rate for Payer: Blue Distinction Transplant |
$1,058.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,323.00
|
| Rate for Payer: Blue Shield of California EPN |
$959.62
|
| Rate for Payer: Cash Price |
$793.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,411.20
|
| Rate for Payer: Cigna of CA HMO |
$1,234.80
|
| Rate for Payer: Cigna of CA PPO |
$1,234.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,499.40
|
| Rate for Payer: Dignity Health Media |
$1,499.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,499.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$705.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$705.60
|
| Rate for Payer: Galaxy Health WC |
$1,499.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,058.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,587.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,323.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$617.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,176.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$672.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$352.80
|
| Rate for Payer: Multiplan Commercial |
$1,323.00
|
| Rate for Payer: Networks By Design Commercial |
$882.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,499.40
|
| Rate for Payer: Riverside University Health System MISP |
$705.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,058.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,058.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$882.00
|
| Rate for Payer: United Healthcare All Other HMO |
$882.00
|
| Rate for Payer: United Healthcare HMO Rider |
$882.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$882.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,499.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,499.40
|
|
|
HC GDC 3-D SHAPE
|
Facility
|
IP
|
$3,900.00
|
|
| Hospital Charge Code |
909081818
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Blue Shield of California EPN |
$2,082.60
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: Cigna of CA HMO |
$2,730.00
|
| Rate for Payer: Cigna of CA PPO |
$2,730.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,472.64
|
| Rate for Payer: United Healthcare All Other HMO |
$1,438.32
|
| Rate for Payer: United Healthcare HMO Rider |
$1,407.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,287.00
|
|
|
HC GDC 3-D SHAPE
|
Facility
|
OP
|
$3,900.00
|
|
| Hospital Charge Code |
909081818
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,145.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,780.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,172.30
|
| Rate for Payer: Blue Distinction Transplant |
$2,340.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,925.00
|
| Rate for Payer: Blue Shield of California EPN |
$2,121.60
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: Cigna of CA HMO |
$2,730.00
|
| Rate for Payer: Cigna of CA PPO |
$2,730.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Media |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,925.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,365.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$1,950.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,560.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,340.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,950.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,950.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,950.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,950.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC GDC SOFT
|
Facility
|
IP
|
$1,530.00
|
|
| Hospital Charge Code |
909081814
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$306.00 |
| Max. Negotiated Rate |
$1,377.00 |
| Rate for Payer: Blue Shield of California EPN |
$817.02
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,224.00
|
| Rate for Payer: Cigna of CA HMO |
$1,071.00
|
| Rate for Payer: Cigna of CA PPO |
$1,071.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$612.00
|
| Rate for Payer: Galaxy Health WC |
$1,300.50
|
| Rate for Payer: Global Benefits Group Commercial |
$918.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,377.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,020.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$582.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$306.00
|
| Rate for Payer: Multiplan Commercial |
$1,147.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,300.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$577.73
|
| Rate for Payer: United Healthcare All Other HMO |
$564.26
|
| Rate for Payer: United Healthcare HMO Rider |
$552.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$504.90
|
|
|
HC GDC SOFT
|
Facility
|
OP
|
$1,530.00
|
|
| Hospital Charge Code |
909081814
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$306.00 |
| Max. Negotiated Rate |
$1,377.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,300.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$841.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$841.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$698.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$852.21
|
| Rate for Payer: Blue Distinction Transplant |
$918.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,147.50
|
| Rate for Payer: Blue Shield of California EPN |
$832.32
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,224.00
|
| Rate for Payer: Cigna of CA HMO |
$1,071.00
|
| Rate for Payer: Cigna of CA PPO |
$1,071.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,300.50
|
| Rate for Payer: Dignity Health Media |
$1,300.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,300.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$612.00
|
| Rate for Payer: Galaxy Health WC |
$1,300.50
|
| Rate for Payer: Global Benefits Group Commercial |
$918.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,377.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,147.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$535.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,020.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$582.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$306.00
|
| Rate for Payer: Multiplan Commercial |
$1,147.50
|
| Rate for Payer: Networks By Design Commercial |
$765.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,300.50
|
| Rate for Payer: Riverside University Health System MISP |
$612.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$918.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$918.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$765.00
|
| Rate for Payer: United Healthcare All Other HMO |
$765.00
|
| Rate for Payer: United Healthcare HMO Rider |
$765.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$765.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,300.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,300.50
|
|
|
HC GDC STANDARD
|
Facility
|
OP
|
$4,347.50
|
|
| Hospital Charge Code |
909081815
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$869.50 |
| Max. Negotiated Rate |
$3,912.75 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,695.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,391.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,391.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,985.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,421.56
|
| Rate for Payer: Blue Distinction Transplant |
$2,608.50
|
| Rate for Payer: Blue Shield of California Commercial |
$3,260.62
|
| Rate for Payer: Blue Shield of California EPN |
$2,365.04
|
| Rate for Payer: Cash Price |
$1,956.38
|
| Rate for Payer: Central Health Plan Commercial |
$3,478.00
|
| Rate for Payer: Cigna of CA HMO |
$3,043.25
|
| Rate for Payer: Cigna of CA PPO |
$3,043.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,695.38
|
| Rate for Payer: Dignity Health Media |
$3,695.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,695.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,739.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,739.00
|
| Rate for Payer: Galaxy Health WC |
$3,695.38
|
| Rate for Payer: Global Benefits Group Commercial |
$2,608.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,912.75
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,260.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,521.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,899.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,656.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$869.50
|
| Rate for Payer: Multiplan Commercial |
$3,260.62
|
| Rate for Payer: Networks By Design Commercial |
$2,173.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,695.38
|
| Rate for Payer: Riverside University Health System MISP |
$1,739.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,608.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,608.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,173.75
|
| Rate for Payer: United Healthcare All Other HMO |
$2,173.75
|
| Rate for Payer: United Healthcare HMO Rider |
$2,173.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,173.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,695.38
|
| Rate for Payer: Vantage Medical Group Senior |
$3,695.38
|
|
|
HC GDC STANDARD
|
Facility
|
IP
|
$4,347.50
|
|
| Hospital Charge Code |
909081815
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$869.50 |
| Max. Negotiated Rate |
$3,912.75 |
| Rate for Payer: Blue Shield of California EPN |
$2,321.56
|
| Rate for Payer: Cash Price |
$1,956.38
|
| Rate for Payer: Central Health Plan Commercial |
$3,478.00
|
| Rate for Payer: Cigna of CA HMO |
$3,043.25
|
| Rate for Payer: Cigna of CA PPO |
$3,043.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,739.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,739.00
|
| Rate for Payer: Galaxy Health WC |
$3,695.38
|
| Rate for Payer: Global Benefits Group Commercial |
$2,608.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,912.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,899.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,656.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$869.50
|
| Rate for Payer: Multiplan Commercial |
$3,260.62
|
| Rate for Payer: Prime Health Services Commercial |
$3,695.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,641.62
|
| Rate for Payer: United Healthcare All Other HMO |
$1,603.36
|
| Rate for Payer: United Healthcare HMO Rider |
$1,568.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,434.68
|
|
|
HC GDC STRETCH RESISTANT
|
Facility
|
OP
|
$1,536.00
|
|
| Hospital Charge Code |
909081816
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$307.20 |
| Max. Negotiated Rate |
$1,382.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$932.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,305.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$844.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$844.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$743.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$907.47
|
| Rate for Payer: Blue Distinction Transplant |
$921.60
|
| Rate for Payer: Blue Shield of California Commercial |
$966.14
|
| Rate for Payer: Blue Shield of California EPN |
$751.10
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,228.80
|
| Rate for Payer: Cigna of CA HMO |
$983.04
|
| Rate for Payer: Cigna of CA PPO |
$1,136.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,305.60
|
| Rate for Payer: Dignity Health Media |
$1,305.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,305.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$614.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$614.40
|
| Rate for Payer: Galaxy Health WC |
$1,305.60
|
| Rate for Payer: Global Benefits Group Commercial |
$921.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,382.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,152.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$537.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,024.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$585.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$307.20
|
| Rate for Payer: Multiplan Commercial |
$1,152.00
|
| Rate for Payer: Networks By Design Commercial |
$998.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,305.60
|
| Rate for Payer: Riverside University Health System MISP |
$614.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$921.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$921.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Other HMO |
$768.00
|
| Rate for Payer: United Healthcare HMO Rider |
$768.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$768.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,305.60
|
| Rate for Payer: Vantage Medical Group Senior |
$1,305.60
|
|
|
HC GDC STRETCH RESISTANT
|
Facility
|
IP
|
$1,536.00
|
|
| Hospital Charge Code |
909081816
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$307.20 |
| Max. Negotiated Rate |
$1,382.40 |
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,228.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$614.40
|
| Rate for Payer: Galaxy Health WC |
$1,305.60
|
| Rate for Payer: Global Benefits Group Commercial |
$921.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,382.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,024.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$585.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$307.20
|
| Rate for Payer: Multiplan Commercial |
$1,152.00
|
| Rate for Payer: Networks By Design Commercial |
$998.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,305.60
|
|
|
HC GECKO NASAL GEL PAD LARGE
|
Facility
|
IP
|
$91.12
|
|
|
Service Code
|
CPT A7032
|
| Hospital Charge Code |
901606818
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$18.22 |
| Max. Negotiated Rate |
$82.01 |
| Rate for Payer: Blue Shield of California EPN |
$48.66
|
| Rate for Payer: Cash Price |
$41.00
|
| Rate for Payer: Central Health Plan Commercial |
$72.90
|
| Rate for Payer: Cigna of CA HMO |
$63.78
|
| Rate for Payer: Cigna of CA PPO |
$63.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$36.45
|
| Rate for Payer: Galaxy Health WC |
$77.45
|
| Rate for Payer: Global Benefits Group Commercial |
$54.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$82.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.22
|
| Rate for Payer: Multiplan Commercial |
$68.34
|
| Rate for Payer: Networks By Design Commercial |
$45.56
|
| Rate for Payer: Prime Health Services Commercial |
$77.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.41
|
| Rate for Payer: United Healthcare All Other HMO |
$33.61
|
| Rate for Payer: United Healthcare HMO Rider |
$32.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.07
|
|
|
HC GECKO NASAL GEL PAD LARGE
|
Facility
|
OP
|
$91.12
|
|
|
Service Code
|
CPT A7032
|
| Hospital Charge Code |
901606818
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$31.89 |
| Max. Negotiated Rate |
$82.01 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$77.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$50.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$50.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$44.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.83
|
| Rate for Payer: Blue Distinction Transplant |
$54.67
|
| Rate for Payer: Blue Shield of California Commercial |
$68.34
|
| Rate for Payer: Blue Shield of California EPN |
$49.57
|
| Rate for Payer: Cash Price |
$41.00
|
| Rate for Payer: Cash Price |
$41.00
|
| Rate for Payer: Central Health Plan Commercial |
$72.90
|
| Rate for Payer: Cigna of CA HMO |
$63.78
|
| Rate for Payer: Cigna of CA PPO |
$63.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$77.45
|
| Rate for Payer: Dignity Health Media |
$77.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$77.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$36.45
|
| Rate for Payer: Galaxy Health WC |
$77.45
|
| Rate for Payer: Global Benefits Group Commercial |
$54.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$82.01
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$68.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$31.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.36
|
| Rate for Payer: Multiplan Commercial |
$68.34
|
| Rate for Payer: Networks By Design Commercial |
$45.56
|
| Rate for Payer: Prime Health Services Commercial |
$77.45
|
| Rate for Payer: Riverside University Health System MISP |
$36.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$54.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$54.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.56
|
| Rate for Payer: United Healthcare All Other HMO |
$45.56
|
| Rate for Payer: United Healthcare HMO Rider |
$45.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$45.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$77.45
|
| Rate for Payer: Vantage Medical Group Senior |
$77.45
|
|
|
HC GECKO NASAL PAD SMALL
|
Facility
|
OP
|
$91.12
|
|
|
Service Code
|
CPT A7032
|
| Hospital Charge Code |
901606819
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$31.89 |
| Max. Negotiated Rate |
$82.01 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$77.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$50.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$50.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$44.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.83
|
| Rate for Payer: Blue Distinction Transplant |
$54.67
|
| Rate for Payer: Blue Shield of California Commercial |
$68.34
|
| Rate for Payer: Blue Shield of California EPN |
$49.57
|
| Rate for Payer: Cash Price |
$41.00
|
| Rate for Payer: Cash Price |
$41.00
|
| Rate for Payer: Central Health Plan Commercial |
$72.90
|
| Rate for Payer: Cigna of CA HMO |
$63.78
|
| Rate for Payer: Cigna of CA PPO |
$63.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$77.45
|
| Rate for Payer: Dignity Health Media |
$77.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$77.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$36.45
|
| Rate for Payer: Galaxy Health WC |
$77.45
|
| Rate for Payer: Global Benefits Group Commercial |
$54.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$82.01
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$68.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$31.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.36
|
| Rate for Payer: Multiplan Commercial |
$68.34
|
| Rate for Payer: Networks By Design Commercial |
$45.56
|
| Rate for Payer: Prime Health Services Commercial |
$77.45
|
| Rate for Payer: Riverside University Health System MISP |
$36.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$54.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$54.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.56
|
| Rate for Payer: United Healthcare All Other HMO |
$45.56
|
| Rate for Payer: United Healthcare HMO Rider |
$45.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$45.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$77.45
|
| Rate for Payer: Vantage Medical Group Senior |
$77.45
|
|
|
HC GECKO NASAL PAD SMALL
|
Facility
|
IP
|
$91.12
|
|
|
Service Code
|
CPT A7032
|
| Hospital Charge Code |
901606819
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$18.22 |
| Max. Negotiated Rate |
$82.01 |
| Rate for Payer: Blue Shield of California EPN |
$48.66
|
| Rate for Payer: Cash Price |
$41.00
|
| Rate for Payer: Central Health Plan Commercial |
$72.90
|
| Rate for Payer: Cigna of CA HMO |
$63.78
|
| Rate for Payer: Cigna of CA PPO |
$63.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$36.45
|
| Rate for Payer: Galaxy Health WC |
$77.45
|
| Rate for Payer: Global Benefits Group Commercial |
$54.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$82.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.22
|
| Rate for Payer: Multiplan Commercial |
$68.34
|
| Rate for Payer: Networks By Design Commercial |
$45.56
|
| Rate for Payer: Prime Health Services Commercial |
$77.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.41
|
| Rate for Payer: United Healthcare All Other HMO |
$33.61
|
| Rate for Payer: United Healthcare HMO Rider |
$32.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.07
|
|
|
HC GEL PILLOW W/COVER 6" X 9"
|
Facility
|
OP
|
$85.27
|
|
| Hospital Charge Code |
901698550
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.05 |
| Max. Negotiated Rate |
$76.74 |
| Rate for Payer: Aetna of CA HMO/PPO |
$51.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$46.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$46.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$41.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.38
|
| Rate for Payer: Blue Distinction Transplant |
$51.16
|
| Rate for Payer: Blue Shield of California Commercial |
$53.63
|
| Rate for Payer: Blue Shield of California EPN |
$41.70
|
| Rate for Payer: Cash Price |
$38.37
|
| Rate for Payer: Central Health Plan Commercial |
$68.22
|
| Rate for Payer: Cigna of CA HMO |
$54.57
|
| Rate for Payer: Cigna of CA PPO |
$63.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.48
|
| Rate for Payer: Dignity Health Media |
$72.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$72.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$34.11
|
| Rate for Payer: Galaxy Health WC |
$72.48
|
| Rate for Payer: Global Benefits Group Commercial |
$51.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$76.74
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$63.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$29.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.05
|
| Rate for Payer: Multiplan Commercial |
$63.95
|
| Rate for Payer: Networks By Design Commercial |
$55.43
|
| Rate for Payer: Prime Health Services Commercial |
$72.48
|
| Rate for Payer: Riverside University Health System MISP |
$34.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$42.64
|
| Rate for Payer: United Healthcare All Other HMO |
$42.64
|
| Rate for Payer: United Healthcare HMO Rider |
$42.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$42.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$72.48
|
| Rate for Payer: Vantage Medical Group Senior |
$72.48
|
|
|
HC GEL PILLOW W/COVER 6" X 9"
|
Facility
|
IP
|
$85.27
|
|
| Hospital Charge Code |
901698550
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.05 |
| Max. Negotiated Rate |
$76.74 |
| Rate for Payer: Cash Price |
$38.37
|
| Rate for Payer: Central Health Plan Commercial |
$68.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.11
|
| Rate for Payer: Galaxy Health WC |
$72.48
|
| Rate for Payer: Global Benefits Group Commercial |
$51.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$76.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.05
|
| Rate for Payer: Multiplan Commercial |
$63.95
|
| Rate for Payer: Networks By Design Commercial |
$55.43
|
| Rate for Payer: Prime Health Services Commercial |
$72.48
|
|
|
HC GENTAMICIN
|
Facility
|
IP
|
$223.00
|
|
|
Service Code
|
CPT 80170
|
| Hospital Charge Code |
900910406
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.60 |
| Max. Negotiated Rate |
$200.70 |
| Rate for Payer: Cash Price |
$100.35
|
| Rate for Payer: Central Health Plan Commercial |
$178.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.20
|
| Rate for Payer: Galaxy Health WC |
$189.55
|
| Rate for Payer: Global Benefits Group Commercial |
$133.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$200.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$148.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$84.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.60
|
| Rate for Payer: Multiplan Commercial |
$167.25
|
| Rate for Payer: Networks By Design Commercial |
$144.95
|
| Rate for Payer: Prime Health Services Commercial |
$189.55
|
|
|
HC GENTAMICIN
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 80170
|
| Hospital Charge Code |
900910406
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$131.73 |
| Rate for Payer: Adventist Health Medi-Cal |
$16.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$120.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$107.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$131.73
|
| Rate for Payer: Blue Distinction Transplant |
$30.00
|
| Rate for Payer: Blue Shield of California Commercial |
$30.90
|
| Rate for Payer: Blue Shield of California EPN |
$24.30
|
| Rate for Payer: Caremore Medicare Advantage |
$16.38
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: Cigna of CA HMO |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.57
|
| Rate for Payer: Dignity Health Media |
$16.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.11
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$16.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.38
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$37.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$26.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.38
|
| Rate for Payer: InnovAge PACE Commercial |
$24.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.95
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Prime Health Services Medicare |
$17.36
|
| Rate for Payer: Riverside University Health System MISP |
$18.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.27
|
| Rate for Payer: United Healthcare All Other HMO |
$13.27
|
| Rate for Payer: United Healthcare HMO Rider |
$13.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.02
|
| Rate for Payer: Vantage Medical Group Senior |
$16.38
|
|
|
HC GI BLEED SCAN
|
Facility
|
OP
|
$4,422.00
|
|
|
Service Code
|
CPT 78278
|
| Hospital Charge Code |
909301360
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$246.62 |
| Max. Negotiated Rate |
$3,979.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$515.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,342.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,014.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,612.52
|
| Rate for Payer: Blue Distinction Transplant |
$2,653.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,732.80
|
| Rate for Payer: Blue Shield of California EPN |
$2,149.09
|
| Rate for Payer: Caremore Medicare Advantage |
$515.32
|
| Rate for Payer: Cash Price |
$1,989.90
|
| Rate for Payer: Cash Price |
$1,989.90
|
| Rate for Payer: Central Health Plan Commercial |
$3,537.60
|
| Rate for Payer: Cigna of CA HMO |
$2,830.08
|
| Rate for Payer: Cigna of CA PPO |
$3,272.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: Dignity Health Media |
$515.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$566.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$695.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$515.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$515.32
|
| Rate for Payer: Galaxy Health WC |
$3,758.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,653.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,979.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,316.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$845.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$850.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$515.32
|
| Rate for Payer: InnovAge PACE Commercial |
$772.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,949.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$246.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$515.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$884.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$690.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$690.53
|
| Rate for Payer: Multiplan Commercial |
$3,316.50
|
| Rate for Payer: Networks By Design Commercial |
$2,874.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,758.70
|
| Rate for Payer: Prime Health Services Medicare |
$546.24
|
| Rate for Payer: Riverside University Health System MISP |
$566.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,653.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,653.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$623.82
|
| Rate for Payer: United Healthcare All Other HMO |
$623.82
|
| Rate for Payer: United Healthcare HMO Rider |
$623.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$623.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Vantage Medical Group Senior |
$515.32
|
|
|
HC GI BLEED SCAN
|
Facility
|
IP
|
$4,422.00
|
|
|
Service Code
|
CPT 78278
|
| Hospital Charge Code |
909301360
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$884.40 |
| Max. Negotiated Rate |
$3,979.80 |
| Rate for Payer: Cash Price |
$1,989.90
|
| Rate for Payer: Central Health Plan Commercial |
$3,537.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,768.80
|
| Rate for Payer: Galaxy Health WC |
$3,758.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,653.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,979.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,949.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,684.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$884.40
|
| Rate for Payer: Multiplan Commercial |
$3,316.50
|
| Rate for Payer: Networks By Design Commercial |
$2,874.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,758.70
|
|
|
HC GI ENDOSCOPIC ULTRASOUND
|
Facility
|
OP
|
$1,205.00
|
|
|
Service Code
|
CPT 76975
|
| Hospital Charge Code |
906776975
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$91.01 |
| Max. Negotiated Rate |
$1,084.50 |
| Rate for Payer: Adventist Health Medi-Cal |
$306.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$858.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$316.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$711.91
|
| Rate for Payer: Blue Distinction Transplant |
$723.00
|
| Rate for Payer: Blue Shield of California Commercial |
$744.69
|
| Rate for Payer: Blue Shield of California EPN |
$585.63
|
| Rate for Payer: Caremore Medicare Advantage |
$306.16
|
| Rate for Payer: Cash Price |
$542.25
|
| Rate for Payer: Cash Price |
$542.25
|
| Rate for Payer: Central Health Plan Commercial |
$964.00
|
| Rate for Payer: Cigna of CA HMO |
$771.20
|
| Rate for Payer: Cigna of CA PPO |
$891.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Media |
$306.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$413.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$306.16
|
| Rate for Payer: Galaxy Health WC |
$1,024.25
|
| Rate for Payer: Global Benefits Group Commercial |
$723.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,084.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$903.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$502.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$505.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.16
|
| Rate for Payer: InnovAge PACE Commercial |
$459.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$803.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$91.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$241.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$410.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$410.25
|
| Rate for Payer: Multiplan Commercial |
$903.75
|
| Rate for Payer: Networks By Design Commercial |
$783.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,024.25
|
| Rate for Payer: Prime Health Services Medicare |
$324.53
|
| Rate for Payer: Riverside University Health System MISP |
$336.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$723.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$723.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$389.46
|
| Rate for Payer: United Healthcare All Other HMO |
$389.46
|
| Rate for Payer: United Healthcare HMO Rider |
$389.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$389.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC GI ENDOSCOPIC ULTRASOUND
|
Facility
|
IP
|
$1,205.00
|
|
|
Service Code
|
CPT 76975
|
| Hospital Charge Code |
906776975
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$241.00 |
| Max. Negotiated Rate |
$1,084.50 |
| Rate for Payer: Cash Price |
$542.25
|
| Rate for Payer: Central Health Plan Commercial |
$964.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$482.00
|
| Rate for Payer: Galaxy Health WC |
$1,024.25
|
| Rate for Payer: Global Benefits Group Commercial |
$723.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,084.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$803.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$459.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$241.00
|
| Rate for Payer: Multiplan Commercial |
$903.75
|
| Rate for Payer: Networks By Design Commercial |
$783.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,024.25
|
|
|
HC GI INJ TREATMENT NR
|
Facility
|
OP
|
$1,483.00
|
|
|
Service Code
|
CPT 64640
|
| Hospital Charge Code |
906764640
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$238.39 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,138.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,138.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$889.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$1,138.83
|
| Rate for Payer: Cash Price |
$667.35
|
| Rate for Payer: Cash Price |
$667.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,186.40
|
| Rate for Payer: Cigna of CA PPO |
$1,097.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Dignity Health Media |
$1,138.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,252.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,537.42
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,138.83
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,138.83
|
| Rate for Payer: Galaxy Health WC |
$1,260.55
|
| Rate for Payer: Global Benefits Group Commercial |
$889.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,334.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,112.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,867.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,879.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,138.83
|
| Rate for Payer: InnovAge PACE Commercial |
$1,708.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$989.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$238.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,138.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$296.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,526.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,526.03
|
| Rate for Payer: Multiplan Commercial |
$1,112.25
|
| Rate for Payer: Networks By Design Commercial |
$963.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,260.55
|
| Rate for Payer: Prime Health Services Medicare |
$1,207.16
|
| Rate for Payer: Riverside University Health System MISP |
$1,252.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$889.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,366.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: Vantage Medical Group Senior |
$1,138.83
|
|
