|
HC MATRIX 3D FIRM/STD 10 COIL
|
Facility
|
OP
|
$2,325.00
|
|
| Hospital Charge Code |
909081831
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$465.00 |
| Max. Negotiated Rate |
$2,092.50 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,976.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,278.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,278.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,061.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,295.02
|
| Rate for Payer: Blue Distinction Transplant |
$1,395.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,743.75
|
| Rate for Payer: Blue Shield of California EPN |
$1,264.80
|
| Rate for Payer: Cash Price |
$1,046.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,860.00
|
| Rate for Payer: Cigna of CA HMO |
$1,627.50
|
| Rate for Payer: Cigna of CA PPO |
$1,627.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,976.25
|
| Rate for Payer: Dignity Health Media |
$1,976.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,976.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$930.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$930.00
|
| Rate for Payer: Galaxy Health WC |
$1,976.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,395.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,092.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,743.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$813.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,550.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$885.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$465.00
|
| Rate for Payer: Multiplan Commercial |
$1,743.75
|
| Rate for Payer: Networks By Design Commercial |
$1,162.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,976.25
|
| Rate for Payer: Riverside University Health System MISP |
$930.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,395.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,395.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,162.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,162.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,162.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,162.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,976.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,976.25
|
|
|
HC MATRIX 3D FIRM/STD 10 COIL
|
Facility
|
IP
|
$2,325.00
|
|
| Hospital Charge Code |
909081831
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$465.00 |
| Max. Negotiated Rate |
$2,092.50 |
| Rate for Payer: Blue Shield of California EPN |
$1,241.55
|
| Rate for Payer: Cash Price |
$1,046.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,860.00
|
| Rate for Payer: Cigna of CA HMO |
$1,627.50
|
| Rate for Payer: Cigna of CA PPO |
$1,627.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$930.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$930.00
|
| Rate for Payer: Galaxy Health WC |
$1,976.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,395.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,092.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,550.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$885.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$465.00
|
| Rate for Payer: Multiplan Commercial |
$1,743.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,976.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$877.92
|
| Rate for Payer: United Healthcare All Other HMO |
$857.46
|
| Rate for Payer: United Healthcare HMO Rider |
$838.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$767.25
|
|
|
HC MATRIX 3D STANDARD 3-8 COIL
|
Facility
|
OP
|
$3,985.00
|
|
| Hospital Charge Code |
909081832
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$797.00 |
| Max. Negotiated Rate |
$3,586.50 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,387.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,191.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,191.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,819.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,219.64
|
| Rate for Payer: Blue Distinction Transplant |
$2,391.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,988.75
|
| Rate for Payer: Blue Shield of California EPN |
$2,167.84
|
| Rate for Payer: Cash Price |
$1,793.25
|
| Rate for Payer: Central Health Plan Commercial |
$3,188.00
|
| Rate for Payer: Cigna of CA HMO |
$2,789.50
|
| Rate for Payer: Cigna of CA PPO |
$2,789.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,387.25
|
| Rate for Payer: Dignity Health Media |
$3,387.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,387.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,594.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,594.00
|
| Rate for Payer: Galaxy Health WC |
$3,387.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,391.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,586.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,988.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,394.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,658.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,518.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$797.00
|
| Rate for Payer: Multiplan Commercial |
$2,988.75
|
| Rate for Payer: Networks By Design Commercial |
$1,992.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,387.25
|
| Rate for Payer: Riverside University Health System MISP |
$1,594.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,391.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,391.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,992.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,992.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,992.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,992.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,387.25
|
| Rate for Payer: Vantage Medical Group Senior |
$3,387.25
|
|
|
HC MATRIX 3D STANDARD 3-8 COIL
|
Facility
|
IP
|
$3,985.00
|
|
| Hospital Charge Code |
909081832
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$797.00 |
| Max. Negotiated Rate |
$3,586.50 |
| Rate for Payer: Blue Shield of California EPN |
$2,127.99
|
| Rate for Payer: Cash Price |
$1,793.25
|
| Rate for Payer: Central Health Plan Commercial |
$3,188.00
|
| Rate for Payer: Cigna of CA HMO |
$2,789.50
|
| Rate for Payer: Cigna of CA PPO |
$2,789.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,594.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,594.00
|
| Rate for Payer: Galaxy Health WC |
$3,387.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,391.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,586.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,658.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,518.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$797.00
|
| Rate for Payer: Multiplan Commercial |
$2,988.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,387.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,504.74
|
| Rate for Payer: United Healthcare All Other HMO |
$1,469.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1,437.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,315.05
|
|
|
HC MATRIX 3D X-FIRM COIL
|
Facility
|
IP
|
$4,400.00
|
|
| Hospital Charge Code |
909081830
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$880.00 |
| Max. Negotiated Rate |
$3,960.00 |
| Rate for Payer: Blue Shield of California EPN |
$2,349.60
|
| Rate for Payer: Cash Price |
$1,980.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,520.00
|
| Rate for Payer: Cigna of CA HMO |
$3,080.00
|
| Rate for Payer: Cigna of CA PPO |
$3,080.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,760.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,760.00
|
| Rate for Payer: Galaxy Health WC |
$3,740.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,640.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,960.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,934.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,676.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$880.00
|
| Rate for Payer: Multiplan Commercial |
$3,300.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,740.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,661.44
|
| Rate for Payer: United Healthcare All Other HMO |
$1,622.72
|
| Rate for Payer: United Healthcare HMO Rider |
$1,587.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,452.00
|
|
|
HC MATRIX 3D X-FIRM COIL
|
Facility
|
OP
|
$4,400.00
|
|
| Hospital Charge Code |
909081830
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$880.00 |
| Max. Negotiated Rate |
$3,960.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,740.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,420.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,420.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,009.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,450.80
|
| Rate for Payer: Blue Distinction Transplant |
$2,640.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,300.00
|
| Rate for Payer: Blue Shield of California EPN |
$2,393.60
|
| Rate for Payer: Cash Price |
$1,980.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,520.00
|
| Rate for Payer: Cigna of CA HMO |
$3,080.00
|
| Rate for Payer: Cigna of CA PPO |
$3,080.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,740.00
|
| Rate for Payer: Dignity Health Media |
$3,740.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,740.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,760.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,760.00
|
| Rate for Payer: Galaxy Health WC |
$3,740.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,640.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,960.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,300.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,540.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,934.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,676.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$880.00
|
| Rate for Payer: Multiplan Commercial |
$3,300.00
|
| Rate for Payer: Networks By Design Commercial |
$2,200.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,740.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,760.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,640.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,640.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,200.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,200.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,200.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,200.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,740.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,740.00
|
|
|
HC MAXILLOFACIAL FIXATION
|
Facility
|
OP
|
$14,982.00
|
|
|
Service Code
|
CPT 21100
|
| Hospital Charge Code |
900501456
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$290.74 |
| Max. Negotiated Rate |
$13,483.80 |
| 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 |
$10,975.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,316.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$10,003.24
|
| Rate for Payer: Blue Distinction Transplant |
$8,989.20
|
| Rate for Payer: Caremore Medicare Advantage |
$7,316.90
|
| Rate for Payer: Cash Price |
$6,741.90
|
| Rate for Payer: Cash Price |
$6,741.90
|
| Rate for Payer: Cash Price |
$6,741.90
|
| Rate for Payer: Cash Price |
$6,741.90
|
| Rate for Payer: Central Health Plan Commercial |
$11,985.60
|
| Rate for Payer: Cigna of CA PPO |
$11,086.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,975.35
|
| Rate for Payer: Dignity Health Media |
$7,316.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,048.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,877.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7,316.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,316.90
|
| Rate for Payer: Galaxy Health WC |
$12,734.70
|
| Rate for Payer: Global Benefits Group Commercial |
$8,989.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,483.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11,236.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,999.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,316.90
|
| Rate for Payer: InnovAge PACE Commercial |
$10,975.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,992.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$290.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,316.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,996.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,804.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,804.65
|
| Rate for Payer: Multiplan Commercial |
$11,236.50
|
| Rate for Payer: Multiplan WC |
$10,003.24
|
| Rate for Payer: Networks By Design Commercial |
$9,738.30
|
| Rate for Payer: Preferred Health Network WC |
$10,207.39
|
| Rate for Payer: Prime Health Services Commercial |
$12,734.70
|
| Rate for Payer: Prime Health Services Medicare |
$7,755.91
|
| Rate for Payer: Prime Health Services WC |
$9,901.17
|
| Rate for Payer: Riverside University Health System MISP |
$8,048.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,989.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,491.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,491.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,491.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,491.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: Vantage Medical Group Senior |
$7,316.90
|
|
|
HC MAXILLOFACIAL FIXATION
|
Facility
|
IP
|
$14,982.00
|
|
|
Service Code
|
CPT 21100
|
| Hospital Charge Code |
900501456
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,996.40 |
| Max. Negotiated Rate |
$13,483.80 |
| Rate for Payer: Cash Price |
$6,741.90
|
| Rate for Payer: Central Health Plan Commercial |
$11,985.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,992.80
|
| Rate for Payer: Galaxy Health WC |
$12,734.70
|
| Rate for Payer: Global Benefits Group Commercial |
$8,989.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,483.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,992.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,708.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,996.40
|
| Rate for Payer: Multiplan Commercial |
$11,236.50
|
| Rate for Payer: Networks By Design Commercial |
$9,738.30
|
| Rate for Payer: Prime Health Services Commercial |
$12,734.70
|
|
|
HC MEASLES AB
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
900913530
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.40 |
| Max. Negotiated Rate |
$114.34 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.55
|
| 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 |
$114.34
|
| Rate for Payer: Blue Distinction Transplant |
$16.20
|
| Rate for Payer: Blue Shield of California Commercial |
$16.69
|
| Rate for Payer: Blue Shield of California EPN |
$13.12
|
| Rate for Payer: Caremore Medicare Advantage |
$12.88
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Central Health Plan Commercial |
$21.60
|
| Rate for Payer: Cigna of CA HMO |
$17.28
|
| Rate for Payer: Cigna of CA PPO |
$19.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.32
|
| Rate for Payer: Dignity Health Media |
$12.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.39
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.88
|
| Rate for Payer: Galaxy Health WC |
$22.95
|
| Rate for Payer: Global Benefits Group Commercial |
$16.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$24.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$20.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.25
|
| 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 |
$18.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.40
|
| 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 |
$20.25
|
| Rate for Payer: Networks By Design Commercial |
$17.55
|
| Rate for Payer: Prime Health Services Commercial |
$22.95
|
| 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 |
$16.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.20
|
| 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: 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 AB
|
Facility
|
IP
|
$204.00
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
900913530
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$183.60 |
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Central Health Plan Commercial |
$163.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.60
|
| Rate for Payer: Galaxy Health WC |
$173.40
|
| Rate for Payer: Global Benefits Group Commercial |
$122.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$183.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$136.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.80
|
| Rate for Payer: Multiplan Commercial |
$153.00
|
| Rate for Payer: Networks By Design Commercial |
$132.60
|
| Rate for Payer: Prime Health Services Commercial |
$173.40
|
|
|
HC MEASLES ADMINISTRATION
|
Facility
|
IP
|
$23.00
|
|
| Hospital Charge Code |
902890243
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$4.60 |
| Max. Negotiated Rate |
$20.70 |
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Central Health Plan Commercial |
$18.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.20
|
| Rate for Payer: Galaxy Health WC |
$19.55
|
| Rate for Payer: Global Benefits Group Commercial |
$13.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.60
|
| Rate for Payer: Multiplan Commercial |
$17.25
|
| Rate for Payer: Networks By Design Commercial |
$14.95
|
| Rate for Payer: Prime Health Services Commercial |
$19.55
|
|
|
HC MEASLES ADMINISTRATION
|
Facility
|
OP
|
$23.00
|
|
| Hospital Charge Code |
902890243
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$4.60 |
| Max. Negotiated Rate |
$2,356.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$13.80
|
| Rate for Payer: Blue Shield of California Commercial |
$14.47
|
| Rate for Payer: Blue Shield of California EPN |
$11.25
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Central Health Plan Commercial |
$18.40
|
| Rate for Payer: Cigna of CA HMO |
$14.72
|
| Rate for Payer: Cigna of CA PPO |
$17.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.55
|
| Rate for Payer: Dignity Health Media |
$19.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.20
|
| Rate for Payer: Galaxy Health WC |
$19.55
|
| Rate for Payer: Global Benefits Group Commercial |
$13.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$17.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.60
|
| Rate for Payer: Multiplan Commercial |
$17.25
|
| Rate for Payer: Networks By Design Commercial |
$14.95
|
| Rate for Payer: Prime Health Services Commercial |
$19.55
|
| Rate for Payer: Riverside University Health System MISP |
$9.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.50
|
| Rate for Payer: United Healthcare All Other HMO |
$11.50
|
| Rate for Payer: United Healthcare HMO Rider |
$11.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.55
|
| Rate for Payer: Vantage Medical Group Senior |
$19.55
|
|
|
HC MECHANICAL CHEST WALL OSCILL
|
Facility
|
IP
|
$388.00
|
|
|
Service Code
|
CPT 94669
|
| Hospital Charge Code |
900100003
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$77.60 |
| Max. Negotiated Rate |
$349.20 |
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Central Health Plan Commercial |
$310.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$155.20
|
| Rate for Payer: Galaxy Health WC |
$329.80
|
| Rate for Payer: Global Benefits Group Commercial |
$232.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$349.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$258.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$147.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.60
|
| Rate for Payer: Multiplan Commercial |
$291.00
|
| Rate for Payer: Networks By Design Commercial |
$252.20
|
| Rate for Payer: Prime Health Services Commercial |
$329.80
|
|
|
HC MECHANICAL CHEST WALL OSCILL
|
Facility
|
OP
|
$388.00
|
|
|
Service Code
|
CPT 94669
|
| Hospital Charge Code |
900100003
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$49.32 |
| Max. Negotiated Rate |
$509.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$266.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$216.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$399.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$293.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$266.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$208.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$232.80
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Caremore Medicare Advantage |
$266.49
|
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Central Health Plan Commercial |
$310.40
|
| Rate for Payer: Cigna of CA HMO |
$248.32
|
| Rate for Payer: Cigna of CA PPO |
$287.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$399.74
|
| Rate for Payer: Dignity Health Media |
$266.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$293.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$359.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$266.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$266.49
|
| Rate for Payer: Galaxy Health WC |
$329.80
|
| Rate for Payer: Global Benefits Group Commercial |
$232.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$349.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$291.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$437.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$439.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$266.49
|
| Rate for Payer: InnovAge PACE Commercial |
$399.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$258.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$266.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$357.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$357.10
|
| Rate for Payer: Multiplan Commercial |
$291.00
|
| Rate for Payer: Networks By Design Commercial |
$252.20
|
| Rate for Payer: Prime Health Services Commercial |
$329.80
|
| Rate for Payer: Prime Health Services Medicare |
$282.48
|
| Rate for Payer: Riverside University Health System MISP |
$293.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$232.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$232.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$509.00
|
| Rate for Payer: United Healthcare All Other HMO |
$478.00
|
| Rate for Payer: United Healthcare HMO Rider |
$428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$391.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$399.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$293.14
|
| Rate for Payer: Vantage Medical Group Senior |
$266.49
|
|
|
HC MECH CORO THROMBECTOMY UNLIST
|
Facility
|
IP
|
$12,895.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906820328
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,579.00 |
| Max. Negotiated Rate |
$11,605.50 |
| Rate for Payer: Cash Price |
$5,802.75
|
| Rate for Payer: Central Health Plan Commercial |
$10,316.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,158.00
|
| Rate for Payer: Galaxy Health WC |
$10,960.75
|
| Rate for Payer: Global Benefits Group Commercial |
$7,737.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,605.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,600.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,913.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,579.00
|
| Rate for Payer: Multiplan Commercial |
$9,671.25
|
| Rate for Payer: Networks By Design Commercial |
$8,381.75
|
| Rate for Payer: Prime Health Services Commercial |
$10,960.75
|
|
|
HC MECH CORO THROMBECTOMY UNLIST
|
Facility
|
OP
|
$12,895.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906820328
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$195.17 |
| Max. Negotiated Rate |
$11,605.50 |
| Rate for Payer: Adventist Health Medi-Cal |
$195.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,831.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$195.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,243.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,618.37
|
| Rate for Payer: Blue Distinction Transplant |
$7,737.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Caremore Medicare Advantage |
$195.17
|
| Rate for Payer: Cash Price |
$5,802.75
|
| Rate for Payer: Cash Price |
$5,802.75
|
| Rate for Payer: Cash Price |
$5,802.75
|
| Rate for Payer: Central Health Plan Commercial |
$10,316.00
|
| Rate for Payer: Cigna of CA PPO |
$9,542.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$292.76
|
| Rate for Payer: Dignity Health Media |
$195.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$214.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$263.48
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$195.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$195.17
|
| Rate for Payer: Galaxy Health WC |
$10,960.75
|
| Rate for Payer: Global Benefits Group Commercial |
$7,737.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,605.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9,671.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$320.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$322.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$195.17
|
| Rate for Payer: InnovAge PACE Commercial |
$292.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,600.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$195.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,579.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$261.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$261.53
|
| Rate for Payer: Multiplan Commercial |
$9,671.25
|
| Rate for Payer: Networks By Design Commercial |
$8,381.75
|
| Rate for Payer: Prime Health Services Commercial |
$10,960.75
|
| Rate for Payer: Prime Health Services Medicare |
$206.88
|
| Rate for Payer: Riverside University Health System MISP |
$214.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,737.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,737.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Vantage Medical Group Senior |
$195.17
|
|
|
HC MECH CORO THROMBECTOMY UNLIST
|
Facility
|
OP
|
$12,895.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906819770
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$195.17 |
| Max. Negotiated Rate |
$11,605.50 |
| Rate for Payer: Adventist Health Medi-Cal |
$195.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,831.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$195.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,243.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,618.37
|
| Rate for Payer: Blue Distinction Transplant |
$7,737.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Caremore Medicare Advantage |
$195.17
|
| Rate for Payer: Cash Price |
$5,802.75
|
| Rate for Payer: Cash Price |
$5,802.75
|
| Rate for Payer: Cash Price |
$5,802.75
|
| Rate for Payer: Central Health Plan Commercial |
$10,316.00
|
| Rate for Payer: Cigna of CA PPO |
$9,542.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$292.76
|
| Rate for Payer: Dignity Health Media |
$195.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$214.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$263.48
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$195.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$195.17
|
| Rate for Payer: Galaxy Health WC |
$10,960.75
|
| Rate for Payer: Global Benefits Group Commercial |
$7,737.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,605.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9,671.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$320.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$322.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$195.17
|
| Rate for Payer: InnovAge PACE Commercial |
$292.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,600.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$195.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,579.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$261.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$261.53
|
| Rate for Payer: Multiplan Commercial |
$9,671.25
|
| Rate for Payer: Networks By Design Commercial |
$8,381.75
|
| Rate for Payer: Prime Health Services Commercial |
$10,960.75
|
| Rate for Payer: Prime Health Services Medicare |
$206.88
|
| Rate for Payer: Riverside University Health System MISP |
$214.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,737.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,737.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Vantage Medical Group Senior |
$195.17
|
|
|
HC MECH CORO THROMBECTOMY UNLIST
|
Facility
|
IP
|
$12,895.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906819770
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,579.00 |
| Max. Negotiated Rate |
$11,605.50 |
| Rate for Payer: Cash Price |
$5,802.75
|
| Rate for Payer: Central Health Plan Commercial |
$10,316.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,158.00
|
| Rate for Payer: Galaxy Health WC |
$10,960.75
|
| Rate for Payer: Global Benefits Group Commercial |
$7,737.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,605.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,600.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,913.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,579.00
|
| Rate for Payer: Multiplan Commercial |
$9,671.25
|
| Rate for Payer: Networks By Design Commercial |
$8,381.75
|
| Rate for Payer: Prime Health Services Commercial |
$10,960.75
|
|
|
HC MECKELS SCAN
|
Facility
|
OP
|
$3,814.00
|
|
|
Service Code
|
CPT 78290
|
| Hospital Charge Code |
909301366
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$205.47 |
| Max. Negotiated Rate |
$3,432.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$515.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,343.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$633.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,253.31
|
| Rate for Payer: Blue Distinction Transplant |
$2,288.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,357.05
|
| Rate for Payer: Blue Shield of California EPN |
$1,853.60
|
| Rate for Payer: Caremore Medicare Advantage |
$515.32
|
| Rate for Payer: Cash Price |
$1,716.30
|
| Rate for Payer: Cash Price |
$1,716.30
|
| Rate for Payer: Central Health Plan Commercial |
$3,051.20
|
| Rate for Payer: Cigna of CA HMO |
$2,440.96
|
| Rate for Payer: Cigna of CA PPO |
$2,822.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: Dignity Health Media |
$515.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$566.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$695.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$515.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$515.32
|
| Rate for Payer: Galaxy Health WC |
$3,241.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,288.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,432.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,860.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$845.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$850.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$515.32
|
| Rate for Payer: InnovAge PACE Commercial |
$772.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,543.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$515.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$762.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$690.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$690.53
|
| Rate for Payer: Multiplan Commercial |
$2,860.50
|
| Rate for Payer: Networks By Design Commercial |
$2,479.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,241.90
|
| Rate for Payer: Prime Health Services Medicare |
$546.24
|
| Rate for Payer: Riverside University Health System MISP |
$566.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,288.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,288.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$623.82
|
| Rate for Payer: United Healthcare All Other HMO |
$623.82
|
| Rate for Payer: United Healthcare HMO Rider |
$623.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$623.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Vantage Medical Group Senior |
$515.32
|
|
|
HC MECKELS SCAN
|
Facility
|
IP
|
$3,814.00
|
|
|
Service Code
|
CPT 78290
|
| Hospital Charge Code |
909301366
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$762.80 |
| Max. Negotiated Rate |
$3,432.60 |
| Rate for Payer: Cash Price |
$1,716.30
|
| Rate for Payer: Central Health Plan Commercial |
$3,051.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,525.60
|
| Rate for Payer: Galaxy Health WC |
$3,241.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,288.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,432.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,543.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,453.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$762.80
|
| Rate for Payer: Multiplan Commercial |
$2,860.50
|
| Rate for Payer: Networks By Design Commercial |
$2,479.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,241.90
|
|
|
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: Blue Shield of California EPN |
$235.81
|
| Rate for Payer: Cash Price |
$198.72
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$88.32
|
| Rate for Payer: Multiplan Commercial |
$331.20
|
| Rate for Payer: Prime Health Services Commercial |
$375.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$166.75
|
| Rate for Payer: United Healthcare All Other HMO |
$162.86
|
| Rate for Payer: United Healthcare HMO Rider |
$159.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$145.73
|
|
|
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: 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 |
$242.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$201.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$245.97
|
| Rate for Payer: Blue Distinction Transplant |
$264.96
|
| Rate for Payer: Blue Shield of California Commercial |
$331.20
|
| Rate for Payer: Blue Shield of California EPN |
$240.23
|
| Rate for Payer: Cash Price |
$198.72
|
| 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 Media |
$375.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$375.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$176.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$331.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$154.56
|
| 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: 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: 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 |
$220.80
|
| Rate for Payer: United Healthcare All Other HMO |
$220.80
|
| Rate for Payer: United Healthcare HMO Rider |
$220.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$220.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$375.36
|
| Rate for Payer: Vantage Medical Group Senior |
$375.36
|
|
|
HC MENINGITIS PANEL NUCLEIC ACID
|
Facility
|
OP
|
$644.00
|
|
|
Service Code
|
CPT 87483
|
| Hospital Charge Code |
900913643
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$128.80 |
| Max. Negotiated Rate |
$3,096.38 |
| Rate for Payer: Adventist Health Medi-Cal |
$416.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,981.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$625.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$458.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$416.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,538.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,096.38
|
| Rate for Payer: Blue Distinction Transplant |
$386.40
|
| Rate for Payer: Blue Shield of California Commercial |
$397.99
|
| Rate for Payer: Blue Shield of California EPN |
$312.98
|
| Rate for Payer: Caremore Medicare Advantage |
$416.78
|
| Rate for Payer: Cash Price |
$289.80
|
| Rate for Payer: Cash Price |
$289.80
|
| Rate for Payer: Central Health Plan Commercial |
$515.20
|
| Rate for Payer: Cigna of CA HMO |
$412.16
|
| Rate for Payer: Cigna of CA PPO |
$476.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$625.17
|
| Rate for Payer: Dignity Health Media |
$416.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$458.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$562.65
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$416.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$416.78
|
| Rate for Payer: Galaxy Health WC |
$547.40
|
| Rate for Payer: Global Benefits Group Commercial |
$386.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$579.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$483.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$683.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$687.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$416.78
|
| Rate for Payer: InnovAge PACE Commercial |
$625.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$429.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$703.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$416.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$558.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$558.49
|
| Rate for Payer: Multiplan Commercial |
$483.00
|
| Rate for Payer: Networks By Design Commercial |
$418.60
|
| Rate for Payer: Prime Health Services Commercial |
$547.40
|
| Rate for Payer: Prime Health Services Medicare |
$441.79
|
| Rate for Payer: Riverside University Health System MISP |
$458.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$386.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$386.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$337.59
|
| Rate for Payer: United Healthcare All Other HMO |
$337.59
|
| Rate for Payer: United Healthcare HMO Rider |
$337.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$337.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$625.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$458.46
|
| Rate for Payer: Vantage Medical Group Senior |
$416.78
|
|
|
HC MENINGITIS PANEL NUCLEIC ACID
|
Facility
|
IP
|
$766.00
|
|
|
Service Code
|
CPT 87483
|
| Hospital Charge Code |
900913643
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$153.20 |
| Max. Negotiated Rate |
$689.40 |
| Rate for Payer: Cash Price |
$344.70
|
| Rate for Payer: Central Health Plan Commercial |
$612.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$306.40
|
| Rate for Payer: Galaxy Health WC |
$651.10
|
| Rate for Payer: Global Benefits Group Commercial |
$459.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$689.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$510.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$291.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.20
|
| Rate for Payer: Multiplan Commercial |
$574.50
|
| Rate for Payer: Networks By Design Commercial |
$497.90
|
| Rate for Payer: Prime Health Services Commercial |
$651.10
|
|
|
HC MEPILEX FOAM WC DRSNG 4X4"
|
Facility
|
OP
|
$22.63
|
|
| Hospital Charge Code |
901698254
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$20.37 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.37
|
| Rate for Payer: Blue Distinction Transplant |
$13.58
|
| Rate for Payer: Blue Shield of California Commercial |
$14.23
|
| Rate for Payer: Blue Shield of California EPN |
$11.07
|
| Rate for Payer: Cash Price |
$10.18
|
| Rate for Payer: Central Health Plan Commercial |
$18.10
|
| Rate for Payer: Cigna of CA HMO |
$14.48
|
| Rate for Payer: Cigna of CA PPO |
$16.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.24
|
| Rate for Payer: Dignity Health Media |
$19.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.05
|
| Rate for Payer: Galaxy Health WC |
$19.24
|
| Rate for Payer: Global Benefits Group Commercial |
$13.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.37
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$16.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.53
|
| Rate for Payer: Multiplan Commercial |
$16.97
|
| Rate for Payer: Networks By Design Commercial |
$14.71
|
| Rate for Payer: Prime Health Services Commercial |
$19.24
|
| Rate for Payer: Riverside University Health System MISP |
$9.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.32
|
| Rate for Payer: United Healthcare All Other HMO |
$11.32
|
| Rate for Payer: United Healthcare HMO Rider |
$11.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.24
|
| Rate for Payer: Vantage Medical Group Senior |
$19.24
|
|
