|
HC MAXILLOFACIAL FIXATION
|
Facility
|
OP
|
$19,813.00
|
|
|
Service Code
|
CPT 21100
|
| Hospital Charge Code |
900501456
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$290.74 |
| Max. Negotiated Rate |
$17,831.70 |
| Rate for Payer: Adventist Health Commercial |
$3,962.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,274.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,268.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,516.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$11,976.10
|
| Rate for Payer: Cash Price |
$10,897.15
|
| Rate for Payer: Cash Price |
$10,897.15
|
| Rate for Payer: Cash Price |
$10,897.15
|
| Rate for Payer: Cash Price |
$10,897.15
|
| Rate for Payer: Central Health Plan Commercial |
$15,850.40
|
| Rate for Payer: Cigna of CA HMO |
$12,680.32
|
| Rate for Payer: Cigna of CA PPO |
$14,661.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,274.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,268.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,516.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,147.19
|
| Rate for Payer: EPIC Health Plan Senior |
$7,516.44
|
| Rate for Payer: Galaxy Health WC |
$16,841.05
|
| Rate for Payer: Global Benefits Group Commercial |
$11,887.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$17,831.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12,326.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,516.44
|
| Rate for Payer: InnovAge PACE Commercial |
$11,274.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,215.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$290.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,516.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,962.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,072.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,072.03
|
| Rate for Payer: Multiplan Commercial |
$14,859.75
|
| Rate for Payer: Multiplan WC |
$11,976.10
|
| Rate for Payer: Networks By Design Commercial |
$12,878.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7,516.44
|
| Rate for Payer: Preferred Health Network WC |
$12,220.51
|
| Rate for Payer: Prime Health Services Commercial |
$16,841.05
|
| Rate for Payer: Prime Health Services Medicare |
$7,967.43
|
| Rate for Payer: Prime Health Services WC |
$11,853.89
|
| Rate for Payer: Riverside University Health System MISP |
$8,268.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,887.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,906.50
|
| Rate for Payer: United Healthcare All Other HMO |
$9,906.50
|
| Rate for Payer: United Healthcare HMO Rider |
$9,906.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,906.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,516.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,274.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,268.08
|
| Rate for Payer: Vantage Medical Group Senior |
$7,516.44
|
|
|
HC MAXILLOFACIAL FIXATION
|
Facility
|
IP
|
$19,813.00
|
|
|
Service Code
|
CPT 21100
|
| Hospital Charge Code |
900501456
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,962.60 |
| Max. Negotiated Rate |
$17,831.70 |
| Rate for Payer: Adventist Health Commercial |
$3,962.60
|
| Rate for Payer: Cash Price |
$10,897.15
|
| Rate for Payer: Central Health Plan Commercial |
$15,850.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,925.20
|
| Rate for Payer: EPIC Health Plan Senior |
$7,925.20
|
| Rate for Payer: Galaxy Health WC |
$16,841.05
|
| Rate for Payer: Global Benefits Group Commercial |
$11,887.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$17,831.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,215.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,548.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,264.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,962.60
|
| Rate for Payer: Multiplan Commercial |
$14,859.75
|
| Rate for Payer: Networks By Design Commercial |
$12,878.45
|
| Rate for Payer: Prime Health Services Commercial |
$16,841.05
|
|
|
HC MEASLES AB
|
Facility
|
IP
|
$74.00
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
900913530
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.80 |
| Max. Negotiated Rate |
$66.60 |
| Rate for Payer: Adventist Health Commercial |
$14.80
|
| Rate for Payer: Cash Price |
$40.70
|
| Rate for Payer: Central Health Plan Commercial |
$59.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.60
|
| Rate for Payer: EPIC Health Plan Senior |
$29.60
|
| Rate for Payer: Galaxy Health WC |
$62.90
|
| Rate for Payer: Global Benefits Group Commercial |
$44.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$66.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$49.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$45.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.80
|
| Rate for Payer: Multiplan Commercial |
$55.50
|
| Rate for Payer: Networks By Design Commercial |
$48.10
|
| Rate for Payer: Prime Health Services Commercial |
$62.90
|
|
|
HC MEASLES AB
|
Facility
|
OP
|
$74.00
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
900913530
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.43 |
| Max. Negotiated Rate |
$93.74 |
| Rate for Payer: Adventist Health Commercial |
$14.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$44.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$93.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.03
|
| Rate for Payer: Blue Shield of California Commercial |
$44.92
|
| Rate for Payer: Blue Shield of California EPN |
$29.38
|
| Rate for Payer: Cash Price |
$40.70
|
| Rate for Payer: Cash Price |
$40.70
|
| Rate for Payer: Central Health Plan Commercial |
$59.20
|
| Rate for Payer: Cigna of CA HMO |
$47.36
|
| Rate for Payer: Cigna of CA PPO |
$54.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.39
|
| Rate for Payer: EPIC Health Plan Senior |
$12.88
|
| 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 |
$21.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.88
|
| Rate for Payer: InnovAge PACE Commercial |
$19.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$49.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.26
|
| 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 |
$12.88
|
| Rate for Payer: Prime Health Services Commercial |
$62.90
|
| Rate for Payer: Prime Health Services Medicare |
$13.65
|
| Rate for Payer: Riverside University Health System MISP |
$14.17
|
| 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 |
$10.43
|
| Rate for Payer: United Healthcare All Other HMO |
$10.43
|
| Rate for Payer: United Healthcare HMO Rider |
$10.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.43
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Vantage Medical Group Senior |
$12.88
|
|
|
HC MEASLES ADMINISTRATION
|
Facility
|
OP
|
$24.00
|
|
| Hospital Charge Code |
902890243
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$1,833.00 |
| Rate for Payer: Adventist Health Commercial |
$9.84
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.10
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Central Health Plan Commercial |
$19.20
|
| Rate for Payer: Cigna of CA HMO |
$15.36
|
| Rate for Payer: Cigna of CA PPO |
$17.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: InnovAge PACE Commercial |
$12.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.80
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: Riverside University Health System MISP |
$9.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.40
|
| Rate for Payer: Vantage Medical Group Senior |
$20.40
|
|
|
HC MEASLES ADMINISTRATION
|
Facility
|
IP
|
$24.00
|
|
| Hospital Charge Code |
902890243
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Central Health Plan Commercial |
$19.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
|
|
HC MECHANICAL CHEST WALL OSCILL
|
Facility
|
OP
|
$513.00
|
|
|
Service Code
|
CPT 94669
|
| Hospital Charge Code |
900100003
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$44.65 |
| Max. Negotiated Rate |
$536.00 |
| Rate for Payer: Adventist Health Commercial |
$102.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$258.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$311.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$284.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$208.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$282.15
|
| Rate for Payer: Cash Price |
$282.15
|
| Rate for Payer: Cash Price |
$282.15
|
| Rate for Payer: Cash Price |
$282.15
|
| Rate for Payer: Central Health Plan Commercial |
$410.40
|
| Rate for Payer: Cigna of CA HMO |
$328.32
|
| Rate for Payer: Cigna of CA PPO |
$379.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$284.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$348.88
|
| Rate for Payer: EPIC Health Plan Senior |
$258.43
|
| Rate for Payer: Galaxy Health WC |
$436.05
|
| Rate for Payer: Global Benefits Group Commercial |
$307.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$461.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$44.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.43
|
| Rate for Payer: InnovAge PACE Commercial |
$387.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$342.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$258.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$346.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$346.30
|
| Rate for Payer: Multiplan Commercial |
$384.75
|
| Rate for Payer: Networks By Design Commercial |
$333.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$258.43
|
| Rate for Payer: Prime Health Services Commercial |
$436.05
|
| Rate for Payer: Prime Health Services Medicare |
$273.94
|
| Rate for Payer: Riverside University Health System MISP |
$284.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$307.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$307.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$284.27
|
| Rate for Payer: Vantage Medical Group Senior |
$258.43
|
|
|
HC MECHANICAL CHEST WALL OSCILL
|
Facility
|
IP
|
$513.00
|
|
|
Service Code
|
CPT 94669
|
| Hospital Charge Code |
900100003
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$102.60 |
| Max. Negotiated Rate |
$461.70 |
| Rate for Payer: Adventist Health Commercial |
$102.60
|
| Rate for Payer: Cash Price |
$282.15
|
| Rate for Payer: Central Health Plan Commercial |
$410.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$205.20
|
| Rate for Payer: EPIC Health Plan Senior |
$205.20
|
| Rate for Payer: Galaxy Health WC |
$436.05
|
| Rate for Payer: Global Benefits Group Commercial |
$307.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$461.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$342.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$195.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$317.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.60
|
| Rate for Payer: Multiplan Commercial |
$384.75
|
| Rate for Payer: Networks By Design Commercial |
$333.45
|
| Rate for Payer: Prime Health Services Commercial |
$436.05
|
|
|
HC MECH CORO THROMBECTOMY UNLIST
|
Facility
|
OP
|
$17,053.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906819770
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$198.80 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$3,410.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$198.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,257.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,015.23
|
| 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 |
$9,379.15
|
| Rate for Payer: Cash Price |
$9,379.15
|
| Rate for Payer: Cash Price |
$9,379.15
|
| Rate for Payer: Central Health Plan Commercial |
$13,642.40
|
| Rate for Payer: Cigna of CA HMO |
$11,084.45
|
| Rate for Payer: Cigna of CA PPO |
$12,619.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.38
|
| Rate for Payer: EPIC Health Plan Senior |
$198.80
|
| Rate for Payer: Galaxy Health WC |
$14,495.05
|
| Rate for Payer: Global Benefits Group Commercial |
$10,231.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,347.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$326.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: InnovAge PACE Commercial |
$298.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,374.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,410.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$266.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$266.39
|
| Rate for Payer: Multiplan Commercial |
$12,789.75
|
| Rate for Payer: Networks By Design Commercial |
$11,084.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$198.80
|
| Rate for Payer: Prime Health Services Commercial |
$14,495.05
|
| Rate for Payer: Prime Health Services Medicare |
$210.73
|
| Rate for Payer: Riverside University Health System MISP |
$218.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,231.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10,231.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$198.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Vantage Medical Group Senior |
$198.80
|
|
|
HC MECH CORO THROMBECTOMY UNLIST
|
Facility
|
IP
|
$17,053.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906819770
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,410.60 |
| Max. Negotiated Rate |
$15,347.70 |
| Rate for Payer: Adventist Health Commercial |
$3,410.60
|
| Rate for Payer: Cash Price |
$9,379.15
|
| Rate for Payer: Central Health Plan Commercial |
$13,642.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,821.20
|
| Rate for Payer: EPIC Health Plan Senior |
$6,821.20
|
| Rate for Payer: Galaxy Health WC |
$14,495.05
|
| Rate for Payer: Global Benefits Group Commercial |
$10,231.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,347.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,374.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,497.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,555.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,410.60
|
| Rate for Payer: Multiplan Commercial |
$12,789.75
|
| Rate for Payer: Networks By Design Commercial |
$11,084.45
|
| Rate for Payer: Prime Health Services Commercial |
$14,495.05
|
|
|
HC MECH CORO THROMBECTOMY UNLIST
|
Facility
|
OP
|
$14,829.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906820328
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$198.80 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$2,965.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$198.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7,180.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,709.07
|
| 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 |
$8,155.95
|
| Rate for Payer: Cash Price |
$8,155.95
|
| Rate for Payer: Cash Price |
$8,155.95
|
| Rate for Payer: Central Health Plan Commercial |
$11,863.20
|
| Rate for Payer: Cigna of CA HMO |
$9,638.85
|
| Rate for Payer: Cigna of CA PPO |
$10,973.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.38
|
| Rate for Payer: EPIC Health Plan Senior |
$198.80
|
| Rate for Payer: Galaxy Health WC |
$12,604.65
|
| Rate for Payer: Global Benefits Group Commercial |
$8,897.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,346.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$326.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: InnovAge PACE Commercial |
$298.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,890.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,965.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$266.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$266.39
|
| Rate for Payer: Multiplan Commercial |
$11,121.75
|
| Rate for Payer: Networks By Design Commercial |
$9,638.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$198.80
|
| Rate for Payer: Prime Health Services Commercial |
$12,604.65
|
| Rate for Payer: Prime Health Services Medicare |
$210.73
|
| Rate for Payer: Riverside University Health System MISP |
$218.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,897.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,897.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$198.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Vantage Medical Group Senior |
$198.80
|
|
|
HC MECH CORO THROMBECTOMY UNLIST
|
Facility
|
IP
|
$14,829.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906820328
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,965.80 |
| Max. Negotiated Rate |
$13,346.10 |
| Rate for Payer: Adventist Health Commercial |
$2,965.80
|
| Rate for Payer: Cash Price |
$8,155.95
|
| Rate for Payer: Central Health Plan Commercial |
$11,863.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,931.60
|
| Rate for Payer: EPIC Health Plan Senior |
$5,931.60
|
| Rate for Payer: Galaxy Health WC |
$12,604.65
|
| Rate for Payer: Global Benefits Group Commercial |
$8,897.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,346.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,890.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,649.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,179.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,965.80
|
| Rate for Payer: Multiplan Commercial |
$11,121.75
|
| Rate for Payer: Networks By Design Commercial |
$9,638.85
|
| Rate for Payer: Prime Health Services Commercial |
$12,604.65
|
|
|
HC MECKELS SCAN
|
Facility
|
OP
|
$3,080.00
|
|
|
Service Code
|
CPT 78290
|
| Hospital Charge Code |
909301366
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$186.00 |
| Max. Negotiated Rate |
$2,772.00 |
| Rate for Payer: Adventist Health Commercial |
$616.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$510.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,870.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$633.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,808.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1,869.56
|
| Rate for Payer: Blue Shield of California EPN |
$1,222.76
|
| Rate for Payer: Cash Price |
$1,694.00
|
| Rate for Payer: Cash Price |
$1,694.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,464.00
|
| Rate for Payer: Cigna of CA HMO |
$1,971.20
|
| Rate for Payer: Cigna of CA PPO |
$2,279.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$510.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$689.27
|
| Rate for Payer: EPIC Health Plan Senior |
$510.57
|
| Rate for Payer: Galaxy Health WC |
$2,618.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,848.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,772.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$837.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$186.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.57
|
| Rate for Payer: InnovAge PACE Commercial |
$765.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,054.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$510.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$616.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$684.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$684.16
|
| Rate for Payer: Multiplan Commercial |
$2,310.00
|
| Rate for Payer: Networks By Design Commercial |
$2,002.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$510.57
|
| Rate for Payer: Prime Health Services Commercial |
$2,618.00
|
| Rate for Payer: Prime Health Services Medicare |
$541.20
|
| Rate for Payer: Riverside University Health System MISP |
$561.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,848.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,848.00
|
| 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: Upland Medical Group Pediatric |
$510.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Vantage Medical Group Senior |
$510.57
|
|
|
HC MECKELS SCAN
|
Facility
|
IP
|
$3,080.00
|
|
|
Service Code
|
CPT 78290
|
| Hospital Charge Code |
909301366
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$616.00 |
| Max. Negotiated Rate |
$2,772.00 |
| Rate for Payer: Adventist Health Commercial |
$616.00
|
| Rate for Payer: Cash Price |
$1,694.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,464.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,232.00
|
| Rate for Payer: Galaxy Health WC |
$2,618.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,848.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,772.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,054.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,173.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,906.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$616.00
|
| Rate for Payer: Multiplan Commercial |
$2,310.00
|
| Rate for Payer: Networks By Design Commercial |
$2,002.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,618.00
|
|
|
HC MEDCOMP TEMP DIALYSIS CATH
|
Facility
|
OP
|
$441.60
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
909081724
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$88.32 |
| Max. Negotiated Rate |
$397.44 |
| Rate for Payer: Adventist Health Commercial |
$88.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$375.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$242.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$331.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$201.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$244.51
|
| Rate for Payer: Blue Shield of California Commercial |
$341.36
|
| Rate for Payer: Blue Shield of California EPN |
$222.57
|
| Rate for Payer: Cash Price |
$242.88
|
| Rate for Payer: Central Health Plan Commercial |
$353.28
|
| Rate for Payer: Cigna of CA HMO |
$309.12
|
| Rate for Payer: Cigna of CA PPO |
$309.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$375.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$375.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$176.64
|
| Rate for Payer: EPIC Health Plan Senior |
$176.64
|
| Rate for Payer: Galaxy Health WC |
$375.36
|
| Rate for Payer: Global Benefits Group Commercial |
$264.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$397.44
|
| Rate for Payer: InnovAge PACE Commercial |
$220.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$294.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$273.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$309.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$309.12
|
| Rate for Payer: Multiplan Commercial |
$331.20
|
| Rate for Payer: Networks By Design Commercial |
$220.80
|
| Rate for Payer: Prime Health Services Commercial |
$375.36
|
| Rate for Payer: Riverside University Health System MISP |
$176.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$264.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$264.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$165.73
|
| Rate for Payer: United Healthcare All Other HMO |
$161.32
|
| Rate for Payer: United Healthcare HMO Rider |
$157.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$144.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$375.36
|
| Rate for Payer: Vantage Medical Group Senior |
$375.36
|
|
|
HC MEDCOMP TEMP DIALYSIS CATH
|
Facility
|
IP
|
$441.60
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
909081724
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$88.32 |
| Max. Negotiated Rate |
$397.44 |
| Rate for Payer: Adventist Health Commercial |
$88.32
|
| Rate for Payer: Blue Shield of California Commercial |
$341.36
|
| Rate for Payer: Blue Shield of California EPN |
$222.57
|
| Rate for Payer: Cash Price |
$242.88
|
| Rate for Payer: Central Health Plan Commercial |
$353.28
|
| Rate for Payer: Cigna of CA HMO |
$309.12
|
| Rate for Payer: Cigna of CA PPO |
$309.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$176.64
|
| Rate for Payer: EPIC Health Plan Senior |
$176.64
|
| Rate for Payer: Galaxy Health WC |
$375.36
|
| Rate for Payer: Global Benefits Group Commercial |
$264.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$397.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$294.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$273.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.32
|
| Rate for Payer: Multiplan Commercial |
$331.20
|
| Rate for Payer: Networks By Design Commercial |
$220.80
|
| Rate for Payer: Prime Health Services Commercial |
$375.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$165.73
|
| Rate for Payer: United Healthcare All Other HMO |
$161.32
|
| Rate for Payer: United Healthcare HMO Rider |
$157.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$144.62
|
|
|
HC MED ENTEER GUIDEWIRE
|
Facility
|
IP
|
$1,339.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812758
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$267.80 |
| Max. Negotiated Rate |
$1,205.10 |
| Rate for Payer: Adventist Health Commercial |
$267.80
|
| Rate for Payer: Cash Price |
$736.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,071.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$535.60
|
| Rate for Payer: EPIC Health Plan Senior |
$535.60
|
| Rate for Payer: Galaxy Health WC |
$1,138.15
|
| Rate for Payer: Global Benefits Group Commercial |
$803.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,205.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$893.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$510.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$828.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$267.80
|
| Rate for Payer: Multiplan Commercial |
$1,004.25
|
| Rate for Payer: Networks By Design Commercial |
$870.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,138.15
|
|
|
HC MED ENTEER GUIDEWIRE
|
Facility
|
OP
|
$1,339.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812758
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$267.80 |
| Max. Negotiated Rate |
$1,205.10 |
| Rate for Payer: Adventist Health Commercial |
$267.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$813.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,138.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$736.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,004.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$648.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$786.39
|
| Rate for Payer: Blue Shield of California Commercial |
$818.13
|
| Rate for Payer: Blue Shield of California EPN |
$534.26
|
| Rate for Payer: Cash Price |
$736.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,071.20
|
| Rate for Payer: Cigna of CA HMO |
$856.96
|
| Rate for Payer: Cigna of CA PPO |
$990.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,138.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,138.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,138.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$535.60
|
| Rate for Payer: EPIC Health Plan Senior |
$535.60
|
| Rate for Payer: Galaxy Health WC |
$1,138.15
|
| Rate for Payer: Global Benefits Group Commercial |
$803.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,205.10
|
| Rate for Payer: InnovAge PACE Commercial |
$669.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$893.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$510.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$828.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$267.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$937.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$937.30
|
| Rate for Payer: Multiplan Commercial |
$1,004.25
|
| Rate for Payer: Networks By Design Commercial |
$870.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,138.15
|
| Rate for Payer: Riverside University Health System MISP |
$535.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$803.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$803.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$669.50
|
| Rate for Payer: United Healthcare All Other HMO |
$669.50
|
| Rate for Payer: United Healthcare HMO Rider |
$669.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$669.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,138.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,138.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,138.15
|
|
|
HC MED ENTEER RE ENTRY CATH
|
Facility
|
OP
|
$6,051.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
906812757
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,210.20 |
| Max. Negotiated Rate |
$5,445.90 |
| Rate for Payer: Adventist Health Commercial |
$1,210.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,674.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,143.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,328.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,538.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,929.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,553.75
|
| Rate for Payer: Blue Shield of California Commercial |
$3,697.16
|
| Rate for Payer: Blue Shield of California EPN |
$2,414.35
|
| Rate for Payer: Cash Price |
$3,328.05
|
| Rate for Payer: Central Health Plan Commercial |
$4,840.80
|
| Rate for Payer: Cigna of CA HMO |
$3,872.64
|
| Rate for Payer: Cigna of CA PPO |
$4,477.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,143.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,143.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,143.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,420.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,420.40
|
| Rate for Payer: Galaxy Health WC |
$5,143.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,630.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,445.90
|
| Rate for Payer: InnovAge PACE Commercial |
$3,025.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,036.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,305.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,745.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,210.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,235.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,235.70
|
| Rate for Payer: Multiplan Commercial |
$4,538.25
|
| Rate for Payer: Networks By Design Commercial |
$3,933.15
|
| Rate for Payer: Prime Health Services Commercial |
$5,143.35
|
| Rate for Payer: Riverside University Health System MISP |
$2,420.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,630.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,630.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,025.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,025.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,025.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,025.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,143.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,143.35
|
| Rate for Payer: Vantage Medical Group Senior |
$5,143.35
|
|
|
HC MED ENTEER RE ENTRY CATH
|
Facility
|
IP
|
$6,051.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
906812757
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,210.20 |
| Max. Negotiated Rate |
$5,445.90 |
| Rate for Payer: Adventist Health Commercial |
$1,210.20
|
| Rate for Payer: Cash Price |
$3,328.05
|
| Rate for Payer: Central Health Plan Commercial |
$4,840.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,420.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,420.40
|
| Rate for Payer: Galaxy Health WC |
$5,143.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,630.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,445.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,036.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,305.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,745.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,210.20
|
| Rate for Payer: Multiplan Commercial |
$4,538.25
|
| Rate for Payer: Networks By Design Commercial |
$3,933.15
|
| Rate for Payer: Prime Health Services Commercial |
$5,143.35
|
|
|
HC MEDI BTLER-DONNG DEVC COMP SLV
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
915380010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Blue Shield of California Commercial |
$38.65
|
| Rate for Payer: Blue Shield of California EPN |
$25.20
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: Cigna of CA HMO |
$35.00
|
| Rate for Payer: Cigna of CA PPO |
$35.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.00
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| 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: United Healthcare All Other Commercial |
$18.77
|
| Rate for Payer: United Healthcare All Other HMO |
$18.27
|
| Rate for Payer: United Healthcare HMO Rider |
$17.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.38
|
|
|
HC MEDI BTLER-DONNG DEVC COMP SLV
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
915380010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$16.38 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Adventist Health Commercial |
$20.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.36
|
| Rate for Payer: Blue Shield of California Commercial |
$38.65
|
| Rate for Payer: Blue Shield of California EPN |
$25.20
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: Cigna of CA HMO |
$35.00
|
| Rate for Payer: Cigna of CA PPO |
$35.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.00
|
| 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: InnovAge PACE Commercial |
$25.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35.00
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$25.00
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Riverside University Health System MISP |
$20.00
|
| 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 |
$18.77
|
| Rate for Payer: United Healthcare All Other HMO |
$18.27
|
| Rate for Payer: United Healthcare HMO Rider |
$17.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.50
|
| Rate for Payer: Vantage Medical Group Senior |
$42.50
|
|
|
HC MEDI BTLER-DONNG DEVC COMP SLV
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
905380010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Blue Shield of California Commercial |
$38.65
|
| Rate for Payer: Blue Shield of California EPN |
$25.20
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: Cigna of CA HMO |
$35.00
|
| Rate for Payer: Cigna of CA PPO |
$35.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.00
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| 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: United Healthcare All Other Commercial |
$18.77
|
| Rate for Payer: United Healthcare All Other HMO |
$18.27
|
| Rate for Payer: United Healthcare HMO Rider |
$17.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.38
|
|
|
HC MEDI BTLER-DONNG DEVC COMP SLV
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
905380010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$16.38 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Adventist Health Commercial |
$20.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.36
|
| Rate for Payer: Blue Shield of California Commercial |
$38.65
|
| Rate for Payer: Blue Shield of California EPN |
$25.20
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: Cigna of CA HMO |
$35.00
|
| Rate for Payer: Cigna of CA PPO |
$35.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.00
|
| 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: InnovAge PACE Commercial |
$25.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35.00
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$25.00
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Riverside University Health System MISP |
$20.00
|
| 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 |
$18.77
|
| Rate for Payer: United Healthcare All Other HMO |
$18.27
|
| Rate for Payer: United Healthcare HMO Rider |
$17.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.50
|
| Rate for Payer: Vantage Medical Group Senior |
$42.50
|
|
|
HC MEDI DONNG GLV COMPRSN GARMENT
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
905380011
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Blue Shield of California Commercial |
$19.32
|
| Rate for Payer: Blue Shield of California EPN |
$12.60
|
| Rate for Payer: Cash Price |
$13.75
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: Cigna of CA HMO |
$17.50
|
| Rate for Payer: Cigna of CA PPO |
$17.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.38
|
| Rate for Payer: United Healthcare All Other HMO |
$9.13
|
| Rate for Payer: United Healthcare HMO Rider |
$8.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.19
|
|
