|
HC OTOLARYNGOLOGIC EXAM GEN ANEST
|
Facility
|
IP
|
$942.00
|
|
|
Service Code
|
CPT 92502
|
| Hospital Charge Code |
900501620
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$188.40 |
| Max. Negotiated Rate |
$847.80 |
| Rate for Payer: Adventist Health Commercial |
$188.40
|
| Rate for Payer: Cash Price |
$423.90
|
| Rate for Payer: Central Health Plan Commercial |
$753.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$376.80
|
| Rate for Payer: EPIC Health Plan Senior |
$376.80
|
| Rate for Payer: Galaxy Health WC |
$800.70
|
| Rate for Payer: Global Benefits Group Commercial |
$565.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$847.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$628.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$358.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$583.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.40
|
| Rate for Payer: Multiplan Commercial |
$706.50
|
| Rate for Payer: Networks By Design Commercial |
$612.30
|
| Rate for Payer: Prime Health Services Commercial |
$800.70
|
|
|
HC OT PRELIMINARY EVALUATION
|
Facility
|
OP
|
$618.00
|
|
| Hospital Charge Code |
905104349
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$556.20 |
| Rate for Payer: Adventist Health Commercial |
$253.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$375.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$525.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$463.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| 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 |
$278.10
|
| Rate for Payer: Cash Price |
$278.10
|
| Rate for Payer: Cash Price |
$278.10
|
| Rate for Payer: Central Health Plan Commercial |
$494.40
|
| Rate for Payer: Cigna of CA HMO |
$395.52
|
| Rate for Payer: Cigna of CA PPO |
$457.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$525.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$525.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$525.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$247.20
|
| Rate for Payer: EPIC Health Plan Senior |
$247.20
|
| Rate for Payer: Galaxy Health WC |
$525.30
|
| Rate for Payer: Global Benefits Group Commercial |
$370.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$556.20
|
| Rate for Payer: InnovAge PACE Commercial |
$309.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$412.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$235.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$382.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$432.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$432.60
|
| Rate for Payer: Multiplan Commercial |
$463.50
|
| Rate for Payer: Networks By Design Commercial |
$401.70
|
| Rate for Payer: Prime Health Services Commercial |
$525.30
|
| Rate for Payer: Riverside University Health System MISP |
$247.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$370.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$370.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$525.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$525.30
|
| Rate for Payer: Vantage Medical Group Senior |
$525.30
|
|
|
HC OT PRELIMINARY EVALUATION
|
Facility
|
IP
|
$618.00
|
|
| Hospital Charge Code |
905104349
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$123.60 |
| Max. Negotiated Rate |
$556.20 |
| Rate for Payer: Adventist Health Commercial |
$123.60
|
| Rate for Payer: Cash Price |
$278.10
|
| Rate for Payer: Central Health Plan Commercial |
$494.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$247.20
|
| Rate for Payer: EPIC Health Plan Senior |
$247.20
|
| Rate for Payer: Galaxy Health WC |
$525.30
|
| Rate for Payer: Global Benefits Group Commercial |
$370.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$556.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$412.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$235.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$382.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.60
|
| Rate for Payer: Multiplan Commercial |
$463.50
|
| Rate for Payer: Networks By Design Commercial |
$401.70
|
| Rate for Payer: Prime Health Services Commercial |
$525.30
|
|
|
HC OT RE-EVALUATION
|
Facility
|
IP
|
$487.00
|
|
|
Service Code
|
CPT 97168
|
| Hospital Charge Code |
905104008
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$97.40 |
| Max. Negotiated Rate |
$438.30 |
| Rate for Payer: Adventist Health Commercial |
$97.40
|
| Rate for Payer: Cash Price |
$219.15
|
| Rate for Payer: Central Health Plan Commercial |
$389.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$194.80
|
| Rate for Payer: EPIC Health Plan Senior |
$194.80
|
| Rate for Payer: Galaxy Health WC |
$413.95
|
| Rate for Payer: Global Benefits Group Commercial |
$292.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$438.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$324.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$185.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$301.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.40
|
| Rate for Payer: Multiplan Commercial |
$365.25
|
| Rate for Payer: Networks By Design Commercial |
$316.55
|
| Rate for Payer: Prime Health Services Commercial |
$413.95
|
|
|
HC OT RE-EVALUATION
|
Facility
|
OP
|
$487.00
|
|
|
Service Code
|
CPT 97168
|
| Hospital Charge Code |
905104008
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$150.19 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$199.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$295.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$413.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$267.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$365.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| 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 |
$219.15
|
| Rate for Payer: Cash Price |
$219.15
|
| Rate for Payer: Cash Price |
$219.15
|
| Rate for Payer: Cash Price |
$219.15
|
| Rate for Payer: Central Health Plan Commercial |
$389.60
|
| Rate for Payer: Cigna of CA HMO |
$311.68
|
| Rate for Payer: Cigna of CA PPO |
$360.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$413.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$413.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$413.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$194.80
|
| Rate for Payer: EPIC Health Plan Senior |
$194.80
|
| Rate for Payer: Galaxy Health WC |
$413.95
|
| Rate for Payer: Global Benefits Group Commercial |
$292.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$438.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$150.19
|
| Rate for Payer: InnovAge PACE Commercial |
$243.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$324.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$301.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$199.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$340.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$340.90
|
| Rate for Payer: Multiplan Commercial |
$365.25
|
| Rate for Payer: Networks By Design Commercial |
$316.55
|
| Rate for Payer: Prime Health Services Commercial |
$413.95
|
| Rate for Payer: Riverside University Health System MISP |
$194.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$292.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$292.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$413.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$413.95
|
| Rate for Payer: Vantage Medical Group Senior |
$413.95
|
|
|
HC OTSM POUCH DRAIN BR 1.5"-38MM
|
Facility
|
OP
|
$11.40
|
|
|
Service Code
|
CPT A5057
|
| Hospital Charge Code |
901698480
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$10.26 |
| Rate for Payer: Adventist Health Commercial |
$2.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.70
|
| Rate for Payer: Blue Shield of California Commercial |
$6.97
|
| Rate for Payer: Blue Shield of California EPN |
$4.55
|
| Rate for Payer: Cash Price |
$5.13
|
| Rate for Payer: Central Health Plan Commercial |
$9.12
|
| Rate for Payer: Cigna of CA HMO |
$7.30
|
| Rate for Payer: Cigna of CA PPO |
$8.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.56
|
| Rate for Payer: EPIC Health Plan Senior |
$4.56
|
| Rate for Payer: Galaxy Health WC |
$9.69
|
| Rate for Payer: Global Benefits Group Commercial |
$6.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.26
|
| Rate for Payer: InnovAge PACE Commercial |
$5.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.98
|
| Rate for Payer: Multiplan Commercial |
$8.55
|
| Rate for Payer: Networks By Design Commercial |
$7.41
|
| Rate for Payer: Prime Health Services Commercial |
$9.69
|
| Rate for Payer: Riverside University Health System MISP |
$4.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.70
|
| Rate for Payer: United Healthcare All Other HMO |
$5.70
|
| Rate for Payer: United Healthcare HMO Rider |
$5.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.69
|
| Rate for Payer: Vantage Medical Group Senior |
$9.69
|
|
|
HC OTSM POUCH DRAIN BR 1.5"-38MM
|
Facility
|
IP
|
$11.40
|
|
|
Service Code
|
CPT A5057
|
| Hospital Charge Code |
901698480
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$10.26 |
| Rate for Payer: Adventist Health Commercial |
$2.28
|
| Rate for Payer: Cash Price |
$5.13
|
| Rate for Payer: Central Health Plan Commercial |
$9.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.56
|
| Rate for Payer: EPIC Health Plan Senior |
$4.56
|
| Rate for Payer: Galaxy Health WC |
$9.69
|
| Rate for Payer: Global Benefits Group Commercial |
$6.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.28
|
| Rate for Payer: Multiplan Commercial |
$8.55
|
| Rate for Payer: Networks By Design Commercial |
$7.41
|
| Rate for Payer: Prime Health Services Commercial |
$9.69
|
|
|
HC OTSM POUCH DRN BR 2.125"-55MM
|
Facility
|
OP
|
$11.40
|
|
|
Service Code
|
CPT A5057
|
| Hospital Charge Code |
901698479
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$10.26 |
| Rate for Payer: Adventist Health Commercial |
$2.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.70
|
| Rate for Payer: Blue Shield of California Commercial |
$6.97
|
| Rate for Payer: Blue Shield of California EPN |
$4.55
|
| Rate for Payer: Cash Price |
$5.13
|
| Rate for Payer: Central Health Plan Commercial |
$9.12
|
| Rate for Payer: Cigna of CA HMO |
$7.30
|
| Rate for Payer: Cigna of CA PPO |
$8.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.56
|
| Rate for Payer: EPIC Health Plan Senior |
$4.56
|
| Rate for Payer: Galaxy Health WC |
$9.69
|
| Rate for Payer: Global Benefits Group Commercial |
$6.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.26
|
| Rate for Payer: InnovAge PACE Commercial |
$5.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.98
|
| Rate for Payer: Multiplan Commercial |
$8.55
|
| Rate for Payer: Networks By Design Commercial |
$7.41
|
| Rate for Payer: Prime Health Services Commercial |
$9.69
|
| Rate for Payer: Riverside University Health System MISP |
$4.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.70
|
| Rate for Payer: United Healthcare All Other HMO |
$5.70
|
| Rate for Payer: United Healthcare HMO Rider |
$5.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.69
|
| Rate for Payer: Vantage Medical Group Senior |
$9.69
|
|
|
HC OTSM POUCH DRN BR 2.125"-55MM
|
Facility
|
IP
|
$11.40
|
|
|
Service Code
|
CPT A5057
|
| Hospital Charge Code |
901698479
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$10.26 |
| Rate for Payer: Adventist Health Commercial |
$2.28
|
| Rate for Payer: Cash Price |
$5.13
|
| Rate for Payer: Central Health Plan Commercial |
$9.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.56
|
| Rate for Payer: EPIC Health Plan Senior |
$4.56
|
| Rate for Payer: Galaxy Health WC |
$9.69
|
| Rate for Payer: Global Benefits Group Commercial |
$6.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.28
|
| Rate for Payer: Multiplan Commercial |
$8.55
|
| Rate for Payer: Networks By Design Commercial |
$7.41
|
| Rate for Payer: Prime Health Services Commercial |
$9.69
|
|
|
HC OT TASK GROUP
|
Facility
|
IP
|
$374.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804025
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$74.80 |
| Max. Negotiated Rate |
$336.60 |
| Rate for Payer: Adventist Health Commercial |
$74.80
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Central Health Plan Commercial |
$299.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$149.60
|
| Rate for Payer: EPIC Health Plan Senior |
$149.60
|
| Rate for Payer: Galaxy Health WC |
$317.90
|
| Rate for Payer: Global Benefits Group Commercial |
$224.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$336.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$249.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$231.51
|
| Rate for Payer: Multiplan Commercial |
$280.50
|
| Rate for Payer: Networks By Design Commercial |
$243.10
|
| Rate for Payer: Prime Health Services Commercial |
$317.90
|
|
|
HC OT TASK GROUP
|
Facility
|
OP
|
$374.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804025
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$41.21 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Adventist Health Commercial |
$74.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$117.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$227.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$176.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$129.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$117.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$181.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$219.65
|
| Rate for Payer: Blue Shield of California Commercial |
$228.51
|
| Rate for Payer: Blue Shield of California EPN |
$149.23
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Central Health Plan Commercial |
$299.20
|
| Rate for Payer: Cigna of CA HMO |
$239.36
|
| Rate for Payer: Cigna of CA PPO |
$276.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$176.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$129.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$117.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$158.67
|
| Rate for Payer: EPIC Health Plan Senior |
$117.53
|
| Rate for Payer: Galaxy Health WC |
$317.90
|
| Rate for Payer: Global Benefits Group Commercial |
$224.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$336.60
|
| Rate for Payer: Health Net Behavioral |
$800.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$192.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$41.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$117.53
|
| Rate for Payer: InnovAge PACE Commercial |
$176.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$249.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$117.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$157.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$157.49
|
| Rate for Payer: Multiplan Commercial |
$280.50
|
| Rate for Payer: Networks By Design Commercial |
$243.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$117.53
|
| Rate for Payer: Prime Health Services Commercial |
$317.90
|
| Rate for Payer: Prime Health Services Medicare |
$124.58
|
| Rate for Payer: Riverside University Health System MISP |
$129.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$224.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$224.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$187.00
|
| Rate for Payer: United Healthcare All Other HMO |
$187.00
|
| Rate for Payer: United Healthcare HMO Rider |
$187.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$187.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$117.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$176.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$129.28
|
| Rate for Payer: Vantage Medical Group Senior |
$117.53
|
|
|
HC OUTBACK CATHETER
|
Facility
|
OP
|
$5,075.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909020023
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,015.00 |
| Max. Negotiated Rate |
$4,567.50 |
| Rate for Payer: Adventist Health Commercial |
$1,015.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,313.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,791.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,806.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,317.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,810.03
|
| Rate for Payer: Blue Shield of California Commercial |
$3,922.97
|
| Rate for Payer: Blue Shield of California EPN |
$2,557.80
|
| Rate for Payer: Cash Price |
$2,283.75
|
| Rate for Payer: Central Health Plan Commercial |
$4,060.00
|
| Rate for Payer: Cigna of CA HMO |
$3,552.50
|
| Rate for Payer: Cigna of CA PPO |
$3,552.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,313.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,313.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,313.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,030.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,030.00
|
| Rate for Payer: Galaxy Health WC |
$4,313.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,045.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,567.50
|
| Rate for Payer: InnovAge PACE Commercial |
$2,537.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,385.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,933.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,141.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,015.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,552.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,552.50
|
| Rate for Payer: Multiplan Commercial |
$3,806.25
|
| Rate for Payer: Networks By Design Commercial |
$2,537.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,313.75
|
| Rate for Payer: Riverside University Health System MISP |
$2,030.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,045.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,045.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,904.65
|
| Rate for Payer: United Healthcare All Other HMO |
$1,853.90
|
| Rate for Payer: United Healthcare HMO Rider |
$1,813.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,662.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,313.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,313.75
|
| Rate for Payer: Vantage Medical Group Senior |
$4,313.75
|
|
|
HC OUTBACK CATHETER
|
Facility
|
IP
|
$5,075.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909020023
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,015.00 |
| Max. Negotiated Rate |
$4,567.50 |
| Rate for Payer: Adventist Health Commercial |
$1,015.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,922.97
|
| Rate for Payer: Blue Shield of California EPN |
$2,557.80
|
| Rate for Payer: Cash Price |
$2,283.75
|
| Rate for Payer: Central Health Plan Commercial |
$4,060.00
|
| Rate for Payer: Cigna of CA HMO |
$3,552.50
|
| Rate for Payer: Cigna of CA PPO |
$3,552.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,030.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,030.00
|
| Rate for Payer: Galaxy Health WC |
$4,313.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,045.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,567.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,385.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,933.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,141.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,015.00
|
| Rate for Payer: Multiplan Commercial |
$3,806.25
|
| Rate for Payer: Networks By Design Commercial |
$2,537.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,313.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,904.65
|
| Rate for Payer: United Healthcare All Other HMO |
$1,853.90
|
| Rate for Payer: United Healthcare HMO Rider |
$1,813.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,662.06
|
|
|
HC OUTBACK ELITE RE-ENTRY CATH
|
Facility
|
OP
|
$4,075.00
|
|
| Hospital Charge Code |
906812724
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$815.00 |
| Max. Negotiated Rate |
$3,667.50 |
| Rate for Payer: Adventist Health Commercial |
$815.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,474.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,463.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,241.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,056.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,973.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,393.25
|
| Rate for Payer: Blue Shield of California Commercial |
$2,489.82
|
| Rate for Payer: Blue Shield of California EPN |
$1,625.92
|
| Rate for Payer: Cash Price |
$1,833.75
|
| Rate for Payer: Central Health Plan Commercial |
$3,260.00
|
| Rate for Payer: Cigna of CA HMO |
$2,608.00
|
| Rate for Payer: Cigna of CA PPO |
$3,015.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,463.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,463.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,463.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,630.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,630.00
|
| Rate for Payer: Galaxy Health WC |
$3,463.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,445.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,667.50
|
| Rate for Payer: InnovAge PACE Commercial |
$2,037.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,718.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,552.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,522.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$815.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,852.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,852.50
|
| Rate for Payer: Multiplan Commercial |
$3,056.25
|
| Rate for Payer: Networks By Design Commercial |
$2,648.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,463.75
|
| Rate for Payer: Riverside University Health System MISP |
$1,630.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,445.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,445.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,037.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,037.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,037.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,037.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,463.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,463.75
|
| Rate for Payer: Vantage Medical Group Senior |
$3,463.75
|
|
|
HC OUTBACK ELITE RE-ENTRY CATH
|
Facility
|
IP
|
$4,075.00
|
|
| Hospital Charge Code |
906812724
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$815.00 |
| Max. Negotiated Rate |
$3,667.50 |
| Rate for Payer: Adventist Health Commercial |
$815.00
|
| Rate for Payer: Cash Price |
$1,833.75
|
| Rate for Payer: Central Health Plan Commercial |
$3,260.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,630.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,630.00
|
| Rate for Payer: Galaxy Health WC |
$3,463.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,445.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,667.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,718.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,552.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,522.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$815.00
|
| Rate for Payer: Multiplan Commercial |
$3,056.25
|
| Rate for Payer: Networks By Design Commercial |
$2,648.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,463.75
|
|
|
HC OUTFLARE WEDGE
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT L3390
|
| Hospital Charge Code |
905353390
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$32.75 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Adventist Health Commercial |
$41.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$85.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$58.73
|
| Rate for Payer: Blue Shield of California Commercial |
$77.30
|
| Rate for Payer: Blue Shield of California EPN |
$50.40
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Central Health Plan Commercial |
$80.00
|
| Rate for Payer: Cigna of CA HMO |
$70.00
|
| Rate for Payer: Cigna of CA PPO |
$70.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$85.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$85.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$85.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Senior |
$40.00
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$32.75
|
| Rate for Payer: InnovAge PACE Commercial |
$50.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$61.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$70.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
| Rate for Payer: Networks By Design Commercial |
$50.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
| Rate for Payer: Riverside University Health System MISP |
$40.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.53
|
| Rate for Payer: United Healthcare All Other HMO |
$36.53
|
| Rate for Payer: United Healthcare HMO Rider |
$35.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$85.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$85.00
|
| Rate for Payer: Vantage Medical Group Senior |
$85.00
|
|
|
HC OUTFLARE WEDGE
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT L3390
|
| Hospital Charge Code |
905353390
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Blue Shield of California Commercial |
$77.30
|
| Rate for Payer: Blue Shield of California EPN |
$50.40
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Central Health Plan Commercial |
$80.00
|
| Rate for Payer: Cigna of CA HMO |
$70.00
|
| Rate for Payer: Cigna of CA PPO |
$70.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Senior |
$40.00
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$61.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.00
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
| Rate for Payer: Networks By Design Commercial |
$65.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.53
|
| Rate for Payer: United Healthcare All Other HMO |
$36.53
|
| Rate for Payer: United Healthcare HMO Rider |
$35.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.75
|
|
|
HC OUTFLARE WEDGE
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT L3390
|
| Hospital Charge Code |
915353390
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$32.75 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Adventist Health Commercial |
$41.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$85.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$58.73
|
| Rate for Payer: Blue Shield of California Commercial |
$77.30
|
| Rate for Payer: Blue Shield of California EPN |
$50.40
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Central Health Plan Commercial |
$80.00
|
| Rate for Payer: Cigna of CA HMO |
$70.00
|
| Rate for Payer: Cigna of CA PPO |
$70.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$85.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$85.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$85.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Senior |
$40.00
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$32.75
|
| Rate for Payer: InnovAge PACE Commercial |
$50.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$61.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$70.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
| Rate for Payer: Networks By Design Commercial |
$50.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
| Rate for Payer: Riverside University Health System MISP |
$40.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.53
|
| Rate for Payer: United Healthcare All Other HMO |
$36.53
|
| Rate for Payer: United Healthcare HMO Rider |
$35.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$85.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$85.00
|
| Rate for Payer: Vantage Medical Group Senior |
$85.00
|
|
|
HC OUTFLARE WEDGE
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT L3390
|
| Hospital Charge Code |
915353390
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Blue Shield of California Commercial |
$77.30
|
| Rate for Payer: Blue Shield of California EPN |
$50.40
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Central Health Plan Commercial |
$80.00
|
| Rate for Payer: Cigna of CA HMO |
$70.00
|
| Rate for Payer: Cigna of CA PPO |
$70.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Senior |
$40.00
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$61.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.00
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
| Rate for Payer: Networks By Design Commercial |
$65.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.53
|
| Rate for Payer: United Healthcare All Other HMO |
$36.53
|
| Rate for Payer: United Healthcare HMO Rider |
$35.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.75
|
|
|
HC OVA & PARASITES, PRESERVED
|
Facility
|
IP
|
$142.00
|
|
|
Service Code
|
CPT 87177
|
| Hospital Charge Code |
900911726
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$28.40 |
| Max. Negotiated Rate |
$127.80 |
| Rate for Payer: Adventist Health Commercial |
$28.40
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Central Health Plan Commercial |
$113.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.80
|
| Rate for Payer: EPIC Health Plan Senior |
$56.80
|
| Rate for Payer: Galaxy Health WC |
$120.70
|
| Rate for Payer: Global Benefits Group Commercial |
$85.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$127.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$94.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$87.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.40
|
| Rate for Payer: Multiplan Commercial |
$106.50
|
| Rate for Payer: Networks By Design Commercial |
$92.30
|
| Rate for Payer: Prime Health Services Commercial |
$120.70
|
|
|
HC OVA & PARASITES, PRESERVED
|
Facility
|
OP
|
$95.00
|
|
|
Service Code
|
CPT 87177
|
| Hospital Charge Code |
900911726
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.21 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Adventist Health Commercial |
$19.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$8.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$57.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$64.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.07
|
| Rate for Payer: Blue Shield of California Commercial |
$57.66
|
| Rate for Payer: Blue Shield of California EPN |
$37.72
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Central Health Plan Commercial |
$76.00
|
| Rate for Payer: Cigna of CA HMO |
$60.80
|
| Rate for Payer: Cigna of CA PPO |
$70.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.79
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.02
|
| Rate for Payer: EPIC Health Plan Senior |
$8.90
|
| Rate for Payer: Galaxy Health WC |
$80.75
|
| Rate for Payer: Global Benefits Group Commercial |
$57.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$85.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.90
|
| Rate for Payer: InnovAge PACE Commercial |
$13.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$63.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.93
|
| Rate for Payer: Multiplan Commercial |
$71.25
|
| Rate for Payer: Networks By Design Commercial |
$61.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$8.90
|
| Rate for Payer: Prime Health Services Commercial |
$80.75
|
| Rate for Payer: Prime Health Services Medicare |
$9.43
|
| Rate for Payer: Riverside University Health System MISP |
$9.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.21
|
| Rate for Payer: United Healthcare All Other HMO |
$7.21
|
| Rate for Payer: United Healthcare HMO Rider |
$7.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.21
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.79
|
| Rate for Payer: Vantage Medical Group Senior |
$8.90
|
|
|
HC OVARIAN DIAGNOSTIC VENOGRAPHY
|
Facility
|
OP
|
$6,571.00
|
|
|
Service Code
|
CPT 76496
|
| Hospital Charge Code |
906811500
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$111.88 |
| Max. Negotiated Rate |
$5,913.90 |
| Rate for Payer: Adventist Health Commercial |
$1,314.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,990.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,181.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,859.15
|
| Rate for Payer: Blue Shield of California Commercial |
$3,988.60
|
| Rate for Payer: Blue Shield of California EPN |
$2,608.69
|
| Rate for Payer: Cash Price |
$2,956.95
|
| Rate for Payer: Cash Price |
$2,956.95
|
| Rate for Payer: Central Health Plan Commercial |
$5,256.80
|
| Rate for Payer: Cigna of CA HMO |
$4,205.44
|
| Rate for Payer: Cigna of CA PPO |
$4,862.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$5,585.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,942.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,913.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: InnovAge PACE Commercial |
$167.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,382.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,314.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$149.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$4,928.25
|
| Rate for Payer: Networks By Design Commercial |
$4,271.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.88
|
| Rate for Payer: Prime Health Services Commercial |
$5,585.35
|
| Rate for Payer: Prime Health Services Medicare |
$118.59
|
| Rate for Payer: Riverside University Health System MISP |
$123.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,942.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,942.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$225.63
|
| Rate for Payer: United Healthcare All Other HMO |
$225.63
|
| Rate for Payer: United Healthcare HMO Rider |
$225.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$225.63
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC OVARIAN DIAGNOSTIC VENOGRAPHY
|
Facility
|
IP
|
$6,571.00
|
|
|
Service Code
|
CPT 76496
|
| Hospital Charge Code |
906811500
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,314.20 |
| Max. Negotiated Rate |
$5,913.90 |
| Rate for Payer: Adventist Health Commercial |
$1,314.20
|
| Rate for Payer: Cash Price |
$2,956.95
|
| Rate for Payer: Central Health Plan Commercial |
$5,256.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,628.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,628.40
|
| Rate for Payer: Galaxy Health WC |
$5,585.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,942.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,913.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,382.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,503.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,067.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,314.20
|
| Rate for Payer: Multiplan Commercial |
$4,928.25
|
| Rate for Payer: Networks By Design Commercial |
$4,271.15
|
| Rate for Payer: Prime Health Services Commercial |
$5,585.35
|
|
|
HC OVERTUBE ENDOSCOPIC 16.7X19.5MMX25CM
|
Facility
|
OP
|
$774.33
|
|
| Hospital Charge Code |
900100328
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$154.87 |
| Max. Negotiated Rate |
$696.90 |
| Rate for Payer: Adventist Health Commercial |
$154.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$470.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$658.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$425.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$580.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$374.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$454.76
|
| Rate for Payer: Blue Shield of California Commercial |
$473.12
|
| Rate for Payer: Blue Shield of California EPN |
$308.96
|
| Rate for Payer: Cash Price |
$348.45
|
| Rate for Payer: Central Health Plan Commercial |
$619.46
|
| Rate for Payer: Cigna of CA HMO |
$495.57
|
| Rate for Payer: Cigna of CA PPO |
$573.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$658.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$658.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$658.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.73
|
| Rate for Payer: EPIC Health Plan Senior |
$309.73
|
| Rate for Payer: Galaxy Health WC |
$658.18
|
| Rate for Payer: Global Benefits Group Commercial |
$464.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$696.90
|
| Rate for Payer: InnovAge PACE Commercial |
$387.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$516.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$295.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$479.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$542.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$542.03
|
| Rate for Payer: Multiplan Commercial |
$580.75
|
| Rate for Payer: Networks By Design Commercial |
$503.31
|
| Rate for Payer: Prime Health Services Commercial |
$658.18
|
| Rate for Payer: Riverside University Health System MISP |
$309.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$464.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$464.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$387.17
|
| Rate for Payer: United Healthcare All Other HMO |
$387.17
|
| Rate for Payer: United Healthcare HMO Rider |
$387.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$387.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$658.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$658.18
|
| Rate for Payer: Vantage Medical Group Senior |
$658.18
|
|
|
HC OVERTUBE ENDOSCOPIC 16.7X19.5MMX25CM
|
Facility
|
IP
|
$774.33
|
|
| Hospital Charge Code |
900100328
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$154.87 |
| Max. Negotiated Rate |
$696.90 |
| Rate for Payer: Adventist Health Commercial |
$154.87
|
| Rate for Payer: Cash Price |
$348.45
|
| Rate for Payer: Central Health Plan Commercial |
$619.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.73
|
| Rate for Payer: EPIC Health Plan Senior |
$309.73
|
| Rate for Payer: Galaxy Health WC |
$658.18
|
| Rate for Payer: Global Benefits Group Commercial |
$464.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$696.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$516.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$295.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$479.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.87
|
| Rate for Payer: Multiplan Commercial |
$580.75
|
| Rate for Payer: Networks By Design Commercial |
$503.31
|
| Rate for Payer: Prime Health Services Commercial |
$658.18
|
|
