|
HC PORTEX DIC TRACH 7.0MM
|
Facility
|
OP
|
$191.87
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800826
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.37 |
| Max. Negotiated Rate |
$172.68 |
| Rate for Payer: Adventist Health Commercial |
$38.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$116.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$163.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$105.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$143.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$92.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$112.69
|
| Rate for Payer: Blue Shield of California Commercial |
$117.23
|
| Rate for Payer: Blue Shield of California EPN |
$76.56
|
| Rate for Payer: Cash Price |
$105.53
|
| Rate for Payer: Central Health Plan Commercial |
$153.50
|
| Rate for Payer: Cigna of CA HMO |
$122.80
|
| Rate for Payer: Cigna of CA PPO |
$141.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$163.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$163.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.75
|
| Rate for Payer: EPIC Health Plan Senior |
$76.75
|
| Rate for Payer: Galaxy Health WC |
$163.09
|
| Rate for Payer: Global Benefits Group Commercial |
$115.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$172.68
|
| Rate for Payer: InnovAge PACE Commercial |
$95.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$127.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$118.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$134.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$134.31
|
| Rate for Payer: Multiplan Commercial |
$143.90
|
| Rate for Payer: Networks By Design Commercial |
$124.72
|
| Rate for Payer: Prime Health Services Commercial |
$163.09
|
| Rate for Payer: Riverside University Health System MISP |
$76.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$115.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$115.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$95.94
|
| Rate for Payer: United Healthcare All Other HMO |
$95.94
|
| Rate for Payer: United Healthcare HMO Rider |
$95.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$95.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$163.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$163.09
|
| Rate for Payer: Vantage Medical Group Senior |
$163.09
|
|
|
HC PORTEX DIC TRACH 7.0MM
|
Facility
|
IP
|
$191.87
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800826
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.37 |
| Max. Negotiated Rate |
$172.68 |
| Rate for Payer: Adventist Health Commercial |
$38.37
|
| Rate for Payer: Cash Price |
$105.53
|
| Rate for Payer: Central Health Plan Commercial |
$153.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.75
|
| Rate for Payer: EPIC Health Plan Senior |
$76.75
|
| Rate for Payer: Galaxy Health WC |
$163.09
|
| Rate for Payer: Global Benefits Group Commercial |
$115.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$172.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$127.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$118.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.37
|
| Rate for Payer: Multiplan Commercial |
$143.90
|
| Rate for Payer: Networks By Design Commercial |
$124.72
|
| Rate for Payer: Prime Health Services Commercial |
$163.09
|
|
|
HC PORTEX DIC TRACH 8.0MM
|
Facility
|
IP
|
$191.87
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800827
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.37 |
| Max. Negotiated Rate |
$172.68 |
| Rate for Payer: Adventist Health Commercial |
$38.37
|
| Rate for Payer: Cash Price |
$105.53
|
| Rate for Payer: Central Health Plan Commercial |
$153.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.75
|
| Rate for Payer: EPIC Health Plan Senior |
$76.75
|
| Rate for Payer: Galaxy Health WC |
$163.09
|
| Rate for Payer: Global Benefits Group Commercial |
$115.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$172.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$127.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$118.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.37
|
| Rate for Payer: Multiplan Commercial |
$143.90
|
| Rate for Payer: Networks By Design Commercial |
$124.72
|
| Rate for Payer: Prime Health Services Commercial |
$163.09
|
|
|
HC PORTEX DIC TRACH 8.0MM
|
Facility
|
OP
|
$191.87
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800827
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.37 |
| Max. Negotiated Rate |
$172.68 |
| Rate for Payer: Adventist Health Commercial |
$38.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$116.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$163.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$105.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$143.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$92.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$112.69
|
| Rate for Payer: Blue Shield of California Commercial |
$117.23
|
| Rate for Payer: Blue Shield of California EPN |
$76.56
|
| Rate for Payer: Cash Price |
$105.53
|
| Rate for Payer: Central Health Plan Commercial |
$153.50
|
| Rate for Payer: Cigna of CA HMO |
$122.80
|
| Rate for Payer: Cigna of CA PPO |
$141.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$163.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$163.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.75
|
| Rate for Payer: EPIC Health Plan Senior |
$76.75
|
| Rate for Payer: Galaxy Health WC |
$163.09
|
| Rate for Payer: Global Benefits Group Commercial |
$115.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$172.68
|
| Rate for Payer: InnovAge PACE Commercial |
$95.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$127.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$118.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$134.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$134.31
|
| Rate for Payer: Multiplan Commercial |
$143.90
|
| Rate for Payer: Networks By Design Commercial |
$124.72
|
| Rate for Payer: Prime Health Services Commercial |
$163.09
|
| Rate for Payer: Riverside University Health System MISP |
$76.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$115.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$115.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$95.94
|
| Rate for Payer: United Healthcare All Other HMO |
$95.94
|
| Rate for Payer: United Healthcare HMO Rider |
$95.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$95.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$163.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$163.09
|
| Rate for Payer: Vantage Medical Group Senior |
$163.09
|
|
|
HC PORTEX DIC TRACH 9.0MM
|
Facility
|
OP
|
$191.87
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800828
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.37 |
| Max. Negotiated Rate |
$172.68 |
| Rate for Payer: Adventist Health Commercial |
$38.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$116.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$163.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$105.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$143.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$92.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$112.69
|
| Rate for Payer: Blue Shield of California Commercial |
$117.23
|
| Rate for Payer: Blue Shield of California EPN |
$76.56
|
| Rate for Payer: Cash Price |
$105.53
|
| Rate for Payer: Central Health Plan Commercial |
$153.50
|
| Rate for Payer: Cigna of CA HMO |
$122.80
|
| Rate for Payer: Cigna of CA PPO |
$141.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$163.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$163.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.75
|
| Rate for Payer: EPIC Health Plan Senior |
$76.75
|
| Rate for Payer: Galaxy Health WC |
$163.09
|
| Rate for Payer: Global Benefits Group Commercial |
$115.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$172.68
|
| Rate for Payer: InnovAge PACE Commercial |
$95.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$127.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$118.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$134.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$134.31
|
| Rate for Payer: Multiplan Commercial |
$143.90
|
| Rate for Payer: Networks By Design Commercial |
$124.72
|
| Rate for Payer: Prime Health Services Commercial |
$163.09
|
| Rate for Payer: Riverside University Health System MISP |
$76.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$115.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$115.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$95.94
|
| Rate for Payer: United Healthcare All Other HMO |
$95.94
|
| Rate for Payer: United Healthcare HMO Rider |
$95.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$95.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$163.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$163.09
|
| Rate for Payer: Vantage Medical Group Senior |
$163.09
|
|
|
HC PORTEX DIC TRACH 9.0MM
|
Facility
|
IP
|
$191.87
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800828
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.37 |
| Max. Negotiated Rate |
$172.68 |
| Rate for Payer: Adventist Health Commercial |
$38.37
|
| Rate for Payer: Cash Price |
$105.53
|
| Rate for Payer: Central Health Plan Commercial |
$153.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.75
|
| Rate for Payer: EPIC Health Plan Senior |
$76.75
|
| Rate for Payer: Galaxy Health WC |
$163.09
|
| Rate for Payer: Global Benefits Group Commercial |
$115.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$172.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$127.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$118.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.37
|
| Rate for Payer: Multiplan Commercial |
$143.90
|
| Rate for Payer: Networks By Design Commercial |
$124.72
|
| Rate for Payer: Prime Health Services Commercial |
$163.09
|
|
|
HC PORT IMAGE
|
Facility
|
OP
|
$1,213.00
|
|
|
Service Code
|
CPT 77417
|
| Hospital Charge Code |
904810803
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$16.89 |
| Max. Negotiated Rate |
$20,000.00 |
| Rate for Payer: Adventist Health Commercial |
$242.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$736.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,031.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$667.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$909.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$120.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.45
|
| Rate for Payer: Blue Shield of California Commercial |
$736.29
|
| Rate for Payer: Blue Shield of California EPN |
$481.56
|
| Rate for Payer: Cash Price |
$667.15
|
| Rate for Payer: Cash Price |
$667.15
|
| Rate for Payer: Cash Price |
$667.15
|
| Rate for Payer: Central Health Plan Commercial |
$970.40
|
| Rate for Payer: Cigna of CA HMO |
$776.32
|
| Rate for Payer: Cigna of CA PPO |
$897.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,031.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,031.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,031.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$485.20
|
| Rate for Payer: EPIC Health Plan Senior |
$485.20
|
| Rate for Payer: Galaxy Health WC |
$1,031.05
|
| Rate for Payer: Global Benefits Group Commercial |
$727.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,091.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$16.89
|
| Rate for Payer: InnovAge PACE Commercial |
$606.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$809.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$750.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$242.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$849.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$849.10
|
| Rate for Payer: Multiplan Commercial |
$909.75
|
| Rate for Payer: Networks By Design Commercial |
$788.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,031.05
|
| Rate for Payer: Riverside University Health System MISP |
$485.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$727.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,748.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,759.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,332.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,221.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$20,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,031.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,031.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1,031.05
|
|
|
HC PORT IMAGE
|
Facility
|
IP
|
$1,213.00
|
|
|
Service Code
|
CPT 77417
|
| Hospital Charge Code |
904810803
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$242.60 |
| Max. Negotiated Rate |
$1,091.70 |
| Rate for Payer: Adventist Health Commercial |
$242.60
|
| Rate for Payer: Cash Price |
$667.15
|
| Rate for Payer: Central Health Plan Commercial |
$970.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$485.20
|
| Rate for Payer: EPIC Health Plan Senior |
$485.20
|
| Rate for Payer: Galaxy Health WC |
$1,031.05
|
| Rate for Payer: Global Benefits Group Commercial |
$727.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,091.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$809.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$462.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$750.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$242.60
|
| Rate for Payer: Multiplan Commercial |
$909.75
|
| Rate for Payer: Networks By Design Commercial |
$788.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,031.05
|
|
|
HC PORT RENASYS SOFT STAND ALONE
|
Facility
|
IP
|
$231.63
|
|
| Hospital Charge Code |
901698189
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.33 |
| Max. Negotiated Rate |
$208.47 |
| Rate for Payer: Adventist Health Commercial |
$46.33
|
| Rate for Payer: Cash Price |
$127.40
|
| Rate for Payer: Central Health Plan Commercial |
$185.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.65
|
| Rate for Payer: EPIC Health Plan Senior |
$92.65
|
| Rate for Payer: Galaxy Health WC |
$196.89
|
| Rate for Payer: Global Benefits Group Commercial |
$138.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$208.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$154.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$143.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.33
|
| Rate for Payer: Multiplan Commercial |
$173.72
|
| Rate for Payer: Networks By Design Commercial |
$150.56
|
| Rate for Payer: Prime Health Services Commercial |
$196.89
|
|
|
HC PORT RENASYS SOFT STAND ALONE
|
Facility
|
OP
|
$231.63
|
|
| Hospital Charge Code |
901698189
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.33 |
| Max. Negotiated Rate |
$208.47 |
| Rate for Payer: Adventist Health Commercial |
$46.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$140.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$196.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$127.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$173.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$112.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.04
|
| Rate for Payer: Blue Shield of California Commercial |
$141.53
|
| Rate for Payer: Blue Shield of California EPN |
$92.42
|
| Rate for Payer: Cash Price |
$127.40
|
| Rate for Payer: Central Health Plan Commercial |
$185.30
|
| Rate for Payer: Cigna of CA HMO |
$148.24
|
| Rate for Payer: Cigna of CA PPO |
$171.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$196.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$196.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$196.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.65
|
| Rate for Payer: EPIC Health Plan Senior |
$92.65
|
| Rate for Payer: Galaxy Health WC |
$196.89
|
| Rate for Payer: Global Benefits Group Commercial |
$138.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$208.47
|
| Rate for Payer: InnovAge PACE Commercial |
$115.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$154.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$143.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$162.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$162.14
|
| Rate for Payer: Multiplan Commercial |
$173.72
|
| Rate for Payer: Networks By Design Commercial |
$150.56
|
| Rate for Payer: Prime Health Services Commercial |
$196.89
|
| Rate for Payer: Riverside University Health System MISP |
$92.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$138.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$138.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$115.81
|
| Rate for Payer: United Healthcare All Other HMO |
$115.81
|
| Rate for Payer: United Healthcare HMO Rider |
$115.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$115.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$196.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$196.89
|
| Rate for Payer: Vantage Medical Group Senior |
$196.89
|
|
|
HC POS COMBO 43 PANEL ID
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900912490
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
|
|
HC POS COMBO 43 PANEL ID
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900912490
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.54 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$8.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$58.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.92
|
| Rate for Payer: Blue Shield of California Commercial |
$30.35
|
| Rate for Payer: Blue Shield of California EPN |
$19.85
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: Cigna of CA HMO |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.91
|
| Rate for Payer: EPIC Health Plan Senior |
$8.08
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.08
|
| Rate for Payer: InnovAge PACE Commercial |
$12.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.83
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$8.08
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Prime Health Services Medicare |
$8.56
|
| Rate for Payer: Riverside University Health System MISP |
$8.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.54
|
| Rate for Payer: United Healthcare All Other HMO |
$6.54
|
| Rate for Payer: United Healthcare HMO Rider |
$6.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
HC POSITIONING GEL-E DONUT MED
|
Facility
|
IP
|
$70.93
|
|
| Hospital Charge Code |
901604725
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.19 |
| Max. Negotiated Rate |
$63.84 |
| Rate for Payer: Adventist Health Commercial |
$14.19
|
| Rate for Payer: Cash Price |
$39.01
|
| Rate for Payer: Central Health Plan Commercial |
$56.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.37
|
| Rate for Payer: EPIC Health Plan Senior |
$28.37
|
| Rate for Payer: Galaxy Health WC |
$60.29
|
| Rate for Payer: Global Benefits Group Commercial |
$42.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.19
|
| Rate for Payer: Multiplan Commercial |
$53.20
|
| Rate for Payer: Networks By Design Commercial |
$46.10
|
| Rate for Payer: Prime Health Services Commercial |
$60.29
|
|
|
HC POSITIONING GEL-E DONUT MED
|
Facility
|
OP
|
$70.93
|
|
| Hospital Charge Code |
901604725
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.19 |
| Max. Negotiated Rate |
$63.84 |
| Rate for Payer: Adventist Health Commercial |
$14.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$43.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$60.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$53.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.66
|
| Rate for Payer: Blue Shield of California Commercial |
$43.34
|
| Rate for Payer: Blue Shield of California EPN |
$28.30
|
| Rate for Payer: Cash Price |
$39.01
|
| Rate for Payer: Central Health Plan Commercial |
$56.74
|
| Rate for Payer: Cigna of CA HMO |
$45.40
|
| Rate for Payer: Cigna of CA PPO |
$52.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$60.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$60.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$60.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.37
|
| Rate for Payer: EPIC Health Plan Senior |
$28.37
|
| Rate for Payer: Galaxy Health WC |
$60.29
|
| Rate for Payer: Global Benefits Group Commercial |
$42.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.84
|
| Rate for Payer: InnovAge PACE Commercial |
$35.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$49.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.65
|
| Rate for Payer: Multiplan Commercial |
$53.20
|
| Rate for Payer: Networks By Design Commercial |
$46.10
|
| Rate for Payer: Prime Health Services Commercial |
$60.29
|
| Rate for Payer: Riverside University Health System MISP |
$28.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.47
|
| Rate for Payer: United Healthcare All Other HMO |
$35.47
|
| Rate for Payer: United Healthcare HMO Rider |
$35.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$60.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$60.29
|
| Rate for Payer: Vantage Medical Group Senior |
$60.29
|
|
|
HC POSITIONING GEL-E DONUT SMALL
|
Facility
|
OP
|
$70.93
|
|
| Hospital Charge Code |
901604727
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.19 |
| Max. Negotiated Rate |
$63.84 |
| Rate for Payer: Adventist Health Commercial |
$14.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$43.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$60.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$53.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.66
|
| Rate for Payer: Blue Shield of California Commercial |
$43.34
|
| Rate for Payer: Blue Shield of California EPN |
$28.30
|
| Rate for Payer: Cash Price |
$39.01
|
| Rate for Payer: Central Health Plan Commercial |
$56.74
|
| Rate for Payer: Cigna of CA HMO |
$45.40
|
| Rate for Payer: Cigna of CA PPO |
$52.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$60.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$60.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$60.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.37
|
| Rate for Payer: EPIC Health Plan Senior |
$28.37
|
| Rate for Payer: Galaxy Health WC |
$60.29
|
| Rate for Payer: Global Benefits Group Commercial |
$42.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.84
|
| Rate for Payer: InnovAge PACE Commercial |
$35.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$49.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.65
|
| Rate for Payer: Multiplan Commercial |
$53.20
|
| Rate for Payer: Networks By Design Commercial |
$46.10
|
| Rate for Payer: Prime Health Services Commercial |
$60.29
|
| Rate for Payer: Riverside University Health System MISP |
$28.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.47
|
| Rate for Payer: United Healthcare All Other HMO |
$35.47
|
| Rate for Payer: United Healthcare HMO Rider |
$35.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$60.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$60.29
|
| Rate for Payer: Vantage Medical Group Senior |
$60.29
|
|
|
HC POSITIONING GEL-E DONUT SMALL
|
Facility
|
IP
|
$70.93
|
|
| Hospital Charge Code |
901604727
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.19 |
| Max. Negotiated Rate |
$63.84 |
| Rate for Payer: Adventist Health Commercial |
$14.19
|
| Rate for Payer: Cash Price |
$39.01
|
| Rate for Payer: Central Health Plan Commercial |
$56.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.37
|
| Rate for Payer: EPIC Health Plan Senior |
$28.37
|
| Rate for Payer: Galaxy Health WC |
$60.29
|
| Rate for Payer: Global Benefits Group Commercial |
$42.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.19
|
| Rate for Payer: Multiplan Commercial |
$53.20
|
| Rate for Payer: Networks By Design Commercial |
$46.10
|
| Rate for Payer: Prime Health Services Commercial |
$60.29
|
|
|
HC POSITIONING GEL-E DONUT X-SM
|
Facility
|
OP
|
$63.55
|
|
| Hospital Charge Code |
901698581
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.71 |
| Max. Negotiated Rate |
$57.20 |
| Rate for Payer: Adventist Health Commercial |
$12.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$38.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$54.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$47.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$30.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.32
|
| Rate for Payer: Blue Shield of California Commercial |
$38.83
|
| Rate for Payer: Blue Shield of California EPN |
$25.36
|
| Rate for Payer: Cash Price |
$34.95
|
| Rate for Payer: Central Health Plan Commercial |
$50.84
|
| Rate for Payer: Cigna of CA HMO |
$40.67
|
| Rate for Payer: Cigna of CA PPO |
$47.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$54.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$54.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$54.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.42
|
| Rate for Payer: EPIC Health Plan Senior |
$25.42
|
| Rate for Payer: Galaxy Health WC |
$54.02
|
| Rate for Payer: Global Benefits Group Commercial |
$38.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$57.20
|
| Rate for Payer: InnovAge PACE Commercial |
$31.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$39.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44.48
|
| Rate for Payer: Multiplan Commercial |
$47.66
|
| Rate for Payer: Networks By Design Commercial |
$41.31
|
| Rate for Payer: Prime Health Services Commercial |
$54.02
|
| Rate for Payer: Riverside University Health System MISP |
$25.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$38.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$38.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.77
|
| Rate for Payer: United Healthcare All Other HMO |
$31.77
|
| Rate for Payer: United Healthcare HMO Rider |
$31.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$54.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$54.02
|
| Rate for Payer: Vantage Medical Group Senior |
$54.02
|
|
|
HC POSITIONING GEL-E DONUT X-SM
|
Facility
|
IP
|
$63.55
|
|
| Hospital Charge Code |
901698581
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.71 |
| Max. Negotiated Rate |
$57.20 |
| Rate for Payer: Adventist Health Commercial |
$12.71
|
| Rate for Payer: Cash Price |
$34.95
|
| Rate for Payer: Central Health Plan Commercial |
$50.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.42
|
| Rate for Payer: EPIC Health Plan Senior |
$25.42
|
| Rate for Payer: Galaxy Health WC |
$54.02
|
| Rate for Payer: Global Benefits Group Commercial |
$38.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$57.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$39.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.71
|
| Rate for Payer: Multiplan Commercial |
$47.66
|
| Rate for Payer: Networks By Design Commercial |
$41.31
|
| Rate for Payer: Prime Health Services Commercial |
$54.02
|
|
|
HC POST FLUIDIZED ZFLO MED
|
Facility
|
IP
|
$786.60
|
|
| Hospital Charge Code |
901605553
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$157.32 |
| Max. Negotiated Rate |
$707.94 |
| Rate for Payer: Adventist Health Commercial |
$157.32
|
| Rate for Payer: Cash Price |
$432.63
|
| Rate for Payer: Central Health Plan Commercial |
$629.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$314.64
|
| Rate for Payer: EPIC Health Plan Senior |
$314.64
|
| Rate for Payer: Galaxy Health WC |
$668.61
|
| Rate for Payer: Global Benefits Group Commercial |
$471.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$707.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$524.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$299.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$486.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.32
|
| Rate for Payer: Multiplan Commercial |
$589.95
|
| Rate for Payer: Networks By Design Commercial |
$511.29
|
| Rate for Payer: Prime Health Services Commercial |
$668.61
|
|
|
HC POST FLUIDIZED ZFLO MED
|
Facility
|
OP
|
$786.60
|
|
| Hospital Charge Code |
901605553
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$157.32 |
| Max. Negotiated Rate |
$707.94 |
| Rate for Payer: Adventist Health Commercial |
$157.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$477.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$668.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$432.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$589.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$380.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$461.97
|
| Rate for Payer: Blue Shield of California Commercial |
$480.61
|
| Rate for Payer: Blue Shield of California EPN |
$313.85
|
| Rate for Payer: Cash Price |
$432.63
|
| Rate for Payer: Central Health Plan Commercial |
$629.28
|
| Rate for Payer: Cigna of CA HMO |
$503.42
|
| Rate for Payer: Cigna of CA PPO |
$582.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$668.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$668.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$668.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$314.64
|
| Rate for Payer: EPIC Health Plan Senior |
$314.64
|
| Rate for Payer: Galaxy Health WC |
$668.61
|
| Rate for Payer: Global Benefits Group Commercial |
$471.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$707.94
|
| Rate for Payer: InnovAge PACE Commercial |
$393.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$524.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$299.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$486.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$550.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$550.62
|
| Rate for Payer: Multiplan Commercial |
$589.95
|
| Rate for Payer: Networks By Design Commercial |
$511.29
|
| Rate for Payer: Prime Health Services Commercial |
$668.61
|
| Rate for Payer: Riverside University Health System MISP |
$314.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$471.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$471.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$393.30
|
| Rate for Payer: United Healthcare All Other HMO |
$393.30
|
| Rate for Payer: United Healthcare HMO Rider |
$393.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$393.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$668.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$668.61
|
| Rate for Payer: Vantage Medical Group Senior |
$668.61
|
|
|
HC POST MASTECTOMY BRA
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
CPT L8000
|
| Hospital Charge Code |
905358000
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$34.20 |
| Max. Negotiated Rate |
$153.90 |
| Rate for Payer: Adventist Health Commercial |
$34.20
|
| Rate for Payer: Blue Shield of California Commercial |
$132.18
|
| Rate for Payer: Blue Shield of California EPN |
$86.18
|
| Rate for Payer: Cash Price |
$94.05
|
| Rate for Payer: Central Health Plan Commercial |
$136.80
|
| Rate for Payer: Cigna of CA HMO |
$119.70
|
| Rate for Payer: Cigna of CA PPO |
$119.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.40
|
| Rate for Payer: EPIC Health Plan Senior |
$68.40
|
| Rate for Payer: Galaxy Health WC |
$145.35
|
| Rate for Payer: Global Benefits Group Commercial |
$102.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$153.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$114.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$105.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.20
|
| Rate for Payer: Multiplan Commercial |
$128.25
|
| Rate for Payer: Networks By Design Commercial |
$111.15
|
| Rate for Payer: Prime Health Services Commercial |
$145.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$64.18
|
| Rate for Payer: United Healthcare All Other HMO |
$62.47
|
| Rate for Payer: United Healthcare HMO Rider |
$61.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$56.00
|
|
|
HC POST MASTECTOMY BRA
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
CPT L8000
|
| Hospital Charge Code |
915358000
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$52.82 |
| Max. Negotiated Rate |
$153.90 |
| Rate for Payer: Adventist Health Commercial |
$70.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$145.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$94.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$128.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$100.43
|
| Rate for Payer: Blue Shield of California Commercial |
$132.18
|
| Rate for Payer: Blue Shield of California EPN |
$86.18
|
| Rate for Payer: Cash Price |
$94.05
|
| Rate for Payer: Cash Price |
$94.05
|
| Rate for Payer: Central Health Plan Commercial |
$136.80
|
| Rate for Payer: Cigna of CA HMO |
$119.70
|
| Rate for Payer: Cigna of CA PPO |
$119.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$145.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$145.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$145.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.40
|
| Rate for Payer: EPIC Health Plan Senior |
$68.40
|
| Rate for Payer: Galaxy Health WC |
$145.35
|
| Rate for Payer: Global Benefits Group Commercial |
$102.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$153.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$52.82
|
| Rate for Payer: InnovAge PACE Commercial |
$85.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$114.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$105.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$119.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$119.70
|
| Rate for Payer: Multiplan Commercial |
$128.25
|
| Rate for Payer: Networks By Design Commercial |
$85.50
|
| Rate for Payer: Prime Health Services Commercial |
$145.35
|
| Rate for Payer: Riverside University Health System MISP |
$68.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$102.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$102.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$64.18
|
| Rate for Payer: United Healthcare All Other HMO |
$62.47
|
| Rate for Payer: United Healthcare HMO Rider |
$61.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$56.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$145.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$145.35
|
| Rate for Payer: Vantage Medical Group Senior |
$145.35
|
|
|
HC POST MASTECTOMY BRA
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
CPT L8000
|
| Hospital Charge Code |
905358000
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$52.82 |
| Max. Negotiated Rate |
$153.90 |
| Rate for Payer: Adventist Health Commercial |
$70.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$145.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$94.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$128.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$100.43
|
| Rate for Payer: Blue Shield of California Commercial |
$132.18
|
| Rate for Payer: Blue Shield of California EPN |
$86.18
|
| Rate for Payer: Cash Price |
$94.05
|
| Rate for Payer: Cash Price |
$94.05
|
| Rate for Payer: Central Health Plan Commercial |
$136.80
|
| Rate for Payer: Cigna of CA HMO |
$119.70
|
| Rate for Payer: Cigna of CA PPO |
$119.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$145.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$145.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$145.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.40
|
| Rate for Payer: EPIC Health Plan Senior |
$68.40
|
| Rate for Payer: Galaxy Health WC |
$145.35
|
| Rate for Payer: Global Benefits Group Commercial |
$102.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$153.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$52.82
|
| Rate for Payer: InnovAge PACE Commercial |
$85.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$114.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$105.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$119.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$119.70
|
| Rate for Payer: Multiplan Commercial |
$128.25
|
| Rate for Payer: Networks By Design Commercial |
$85.50
|
| Rate for Payer: Prime Health Services Commercial |
$145.35
|
| Rate for Payer: Riverside University Health System MISP |
$68.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$102.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$102.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$64.18
|
| Rate for Payer: United Healthcare All Other HMO |
$62.47
|
| Rate for Payer: United Healthcare HMO Rider |
$61.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$56.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$145.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$145.35
|
| Rate for Payer: Vantage Medical Group Senior |
$145.35
|
|
|
HC POST MASTECTOMY BRA
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
CPT L8000
|
| Hospital Charge Code |
915358000
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$34.20 |
| Max. Negotiated Rate |
$153.90 |
| Rate for Payer: Adventist Health Commercial |
$34.20
|
| Rate for Payer: Blue Shield of California Commercial |
$132.18
|
| Rate for Payer: Blue Shield of California EPN |
$86.18
|
| Rate for Payer: Cash Price |
$94.05
|
| Rate for Payer: Central Health Plan Commercial |
$136.80
|
| Rate for Payer: Cigna of CA HMO |
$119.70
|
| Rate for Payer: Cigna of CA PPO |
$119.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.40
|
| Rate for Payer: EPIC Health Plan Senior |
$68.40
|
| Rate for Payer: Galaxy Health WC |
$145.35
|
| Rate for Payer: Global Benefits Group Commercial |
$102.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$153.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$114.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$105.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.20
|
| Rate for Payer: Multiplan Commercial |
$128.25
|
| Rate for Payer: Networks By Design Commercial |
$111.15
|
| Rate for Payer: Prime Health Services Commercial |
$145.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$64.18
|
| Rate for Payer: United Healthcare All Other HMO |
$62.47
|
| Rate for Payer: United Healthcare HMO Rider |
$61.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$56.00
|
|
|
HC POST PARTUM PERINEAL LAC RPR
|
Facility
|
OP
|
$9,584.00
|
|
|
Service Code
|
CPT 56810
|
| Hospital Charge Code |
902400754
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$427.04 |
| Max. Negotiated Rate |
$11,071.00 |
| Rate for Payer: Adventist Health Commercial |
$1,916.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,039.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,071.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,039.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,786.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,855.82
|
| Rate for Payer: Blue Shield of California EPN |
$3,824.02
|
| Rate for Payer: Cash Price |
$5,271.20
|
| Rate for Payer: Cash Price |
$5,271.20
|
| Rate for Payer: Cash Price |
$5,271.20
|
| Rate for Payer: Central Health Plan Commercial |
$7,667.20
|
| Rate for Payer: Cigna of CA HMO |
$6,133.76
|
| Rate for Payer: Cigna of CA PPO |
$7,092.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,443.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,039.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,453.88
|
| Rate for Payer: EPIC Health Plan Senior |
$4,039.91
|
| Rate for Payer: Galaxy Health WC |
$8,146.40
|
| Rate for Payer: Global Benefits Group Commercial |
$5,750.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,625.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,625.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$427.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,039.91
|
| Rate for Payer: InnovAge PACE Commercial |
$6,059.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,392.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$471.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,039.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,916.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,413.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,413.48
|
| Rate for Payer: Multiplan Commercial |
$7,188.00
|
| Rate for Payer: Networks By Design Commercial |
$6,229.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,039.91
|
| Rate for Payer: Prime Health Services Commercial |
$8,146.40
|
| Rate for Payer: Prime Health Services Medicare |
$4,282.30
|
| Rate for Payer: Riverside University Health System MISP |
$4,443.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,750.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,750.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,091.00
|
| Rate for Payer: United Healthcare All Other HMO |
$839.00
|
| Rate for Payer: United Healthcare HMO Rider |
$635.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$581.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,039.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Vantage Medical Group Senior |
$4,039.91
|
|
