|
HC PACKING VAGINAL 15 X 2" X-RAY
|
Facility
|
IP
|
$43.54
|
|
|
Service Code
|
CPT A6216
|
| Hospital Charge Code |
901604813
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.71 |
| Max. Negotiated Rate |
$39.19 |
| Rate for Payer: Cash Price |
$19.59
|
| Rate for Payer: Central Health Plan Commercial |
$34.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.42
|
| Rate for Payer: Galaxy Health WC |
$37.01
|
| Rate for Payer: Global Benefits Group Commercial |
$26.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.71
|
| Rate for Payer: Multiplan Commercial |
$32.66
|
| Rate for Payer: Networks By Design Commercial |
$28.30
|
| Rate for Payer: Prime Health Services Commercial |
$37.01
|
|
|
HC PACKING VAGINAL 15 X 2" X-RAY
|
Facility
|
OP
|
$43.54
|
|
|
Service Code
|
CPT A6216
|
| Hospital Charge Code |
901604813
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$39.19 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.72
|
| Rate for Payer: Blue Distinction Transplant |
$26.12
|
| Rate for Payer: Blue Shield of California Commercial |
$27.39
|
| Rate for Payer: Blue Shield of California EPN |
$21.29
|
| Rate for Payer: Cash Price |
$19.59
|
| Rate for Payer: Cash Price |
$19.59
|
| Rate for Payer: Central Health Plan Commercial |
$34.83
|
| Rate for Payer: Cigna of CA HMO |
$27.87
|
| Rate for Payer: Cigna of CA PPO |
$32.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.01
|
| Rate for Payer: Dignity Health Media |
$37.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$37.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.42
|
| Rate for Payer: Galaxy Health WC |
$37.01
|
| Rate for Payer: Global Benefits Group Commercial |
$26.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.19
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$32.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$15.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.71
|
| Rate for Payer: Multiplan Commercial |
$32.66
|
| Rate for Payer: Networks By Design Commercial |
$28.30
|
| Rate for Payer: Prime Health Services Commercial |
$37.01
|
| Rate for Payer: Riverside University Health System MISP |
$17.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.77
|
| Rate for Payer: United Healthcare All Other HMO |
$21.77
|
| Rate for Payer: United Healthcare HMO Rider |
$21.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$37.01
|
| Rate for Payer: Vantage Medical Group Senior |
$37.01
|
|
|
HC PACKING WEIMERT EPISTAXIS
|
Facility
|
OP
|
$159.46
|
|
| Hospital Charge Code |
901603221
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.89 |
| Max. Negotiated Rate |
$143.51 |
| Rate for Payer: Aetna of CA HMO/PPO |
$96.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$135.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$87.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$87.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$77.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$94.21
|
| Rate for Payer: Blue Distinction Transplant |
$95.68
|
| Rate for Payer: Blue Shield of California Commercial |
$100.30
|
| Rate for Payer: Blue Shield of California EPN |
$77.98
|
| Rate for Payer: Cash Price |
$71.76
|
| Rate for Payer: Central Health Plan Commercial |
$127.57
|
| Rate for Payer: Cigna of CA HMO |
$102.05
|
| Rate for Payer: Cigna of CA PPO |
$118.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$135.54
|
| Rate for Payer: Dignity Health Media |
$135.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$135.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$63.78
|
| Rate for Payer: Galaxy Health WC |
$135.54
|
| Rate for Payer: Global Benefits Group Commercial |
$95.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$143.51
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$119.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$55.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$106.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.89
|
| Rate for Payer: Multiplan Commercial |
$119.60
|
| Rate for Payer: Networks By Design Commercial |
$103.65
|
| Rate for Payer: Prime Health Services Commercial |
$135.54
|
| Rate for Payer: Riverside University Health System MISP |
$63.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$95.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$95.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$79.73
|
| Rate for Payer: United Healthcare All Other HMO |
$79.73
|
| Rate for Payer: United Healthcare HMO Rider |
$79.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$79.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$135.54
|
| Rate for Payer: Vantage Medical Group Senior |
$135.54
|
|
|
HC PACKING WEIMERT EPISTAXIS
|
Facility
|
IP
|
$159.46
|
|
| Hospital Charge Code |
901603221
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.89 |
| Max. Negotiated Rate |
$143.51 |
| Rate for Payer: Cash Price |
$71.76
|
| Rate for Payer: Central Health Plan Commercial |
$127.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.78
|
| Rate for Payer: Galaxy Health WC |
$135.54
|
| Rate for Payer: Global Benefits Group Commercial |
$95.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$143.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$106.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.89
|
| Rate for Payer: Multiplan Commercial |
$119.60
|
| Rate for Payer: Networks By Design Commercial |
$103.65
|
| Rate for Payer: Prime Health Services Commercial |
$135.54
|
|
|
HC PACKING WOUND STRIP 1/4" PLAIN
|
Facility
|
OP
|
$869.40
|
|
| Hospital Charge Code |
901600270
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$173.88 |
| Max. Negotiated Rate |
$782.46 |
| Rate for Payer: Aetna of CA HMO/PPO |
$527.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$738.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$478.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$478.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$420.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$513.64
|
| Rate for Payer: Blue Distinction Transplant |
$521.64
|
| Rate for Payer: Blue Shield of California Commercial |
$546.85
|
| Rate for Payer: Blue Shield of California EPN |
$425.14
|
| Rate for Payer: Cash Price |
$391.23
|
| Rate for Payer: Central Health Plan Commercial |
$695.52
|
| Rate for Payer: Cigna of CA HMO |
$556.42
|
| Rate for Payer: Cigna of CA PPO |
$643.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$738.99
|
| Rate for Payer: Dignity Health Media |
$738.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$738.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$347.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$347.76
|
| Rate for Payer: Galaxy Health WC |
$738.99
|
| Rate for Payer: Global Benefits Group Commercial |
$521.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$782.46
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$652.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$304.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$579.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$331.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$173.88
|
| Rate for Payer: Multiplan Commercial |
$652.05
|
| Rate for Payer: Networks By Design Commercial |
$565.11
|
| Rate for Payer: Prime Health Services Commercial |
$738.99
|
| Rate for Payer: Riverside University Health System MISP |
$347.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$521.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$521.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$434.70
|
| Rate for Payer: United Healthcare All Other HMO |
$434.70
|
| Rate for Payer: United Healthcare HMO Rider |
$434.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$434.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$738.99
|
| Rate for Payer: Vantage Medical Group Senior |
$738.99
|
|
|
HC PACKING WOUND STRIP 1/4" PLAIN
|
Facility
|
IP
|
$869.40
|
|
| Hospital Charge Code |
901600270
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$173.88 |
| Max. Negotiated Rate |
$782.46 |
| Rate for Payer: Cash Price |
$391.23
|
| Rate for Payer: Central Health Plan Commercial |
$695.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$347.76
|
| Rate for Payer: Galaxy Health WC |
$738.99
|
| Rate for Payer: Global Benefits Group Commercial |
$521.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$782.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$579.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$331.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$173.88
|
| Rate for Payer: Multiplan Commercial |
$652.05
|
| Rate for Payer: Networks By Design Commercial |
$565.11
|
| Rate for Payer: Prime Health Services Commercial |
$738.99
|
|
|
HC PACKING WOUND STRIPS 1/2"X 5YD
|
Facility
|
IP
|
$137.94
|
|
| Hospital Charge Code |
901698472
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.59 |
| Max. Negotiated Rate |
$124.15 |
| Rate for Payer: Cash Price |
$62.07
|
| Rate for Payer: Central Health Plan Commercial |
$110.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.18
|
| Rate for Payer: Galaxy Health WC |
$117.25
|
| Rate for Payer: Global Benefits Group Commercial |
$82.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$124.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$92.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.59
|
| Rate for Payer: Multiplan Commercial |
$103.46
|
| Rate for Payer: Networks By Design Commercial |
$89.66
|
| Rate for Payer: Prime Health Services Commercial |
$117.25
|
|
|
HC PACKING WOUND STRIPS 1/2"X 5YD
|
Facility
|
OP
|
$137.94
|
|
| Hospital Charge Code |
901698472
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.59 |
| Max. Negotiated Rate |
$124.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$83.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$117.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$75.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$66.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$81.49
|
| Rate for Payer: Blue Distinction Transplant |
$82.76
|
| Rate for Payer: Blue Shield of California Commercial |
$86.76
|
| Rate for Payer: Blue Shield of California EPN |
$67.45
|
| Rate for Payer: Cash Price |
$62.07
|
| Rate for Payer: Central Health Plan Commercial |
$110.35
|
| Rate for Payer: Cigna of CA HMO |
$88.28
|
| Rate for Payer: Cigna of CA PPO |
$102.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$117.25
|
| Rate for Payer: Dignity Health Media |
$117.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$117.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$55.18
|
| Rate for Payer: Galaxy Health WC |
$117.25
|
| Rate for Payer: Global Benefits Group Commercial |
$82.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$124.15
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$103.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$48.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$92.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.59
|
| Rate for Payer: Multiplan Commercial |
$103.46
|
| Rate for Payer: Networks By Design Commercial |
$89.66
|
| Rate for Payer: Prime Health Services Commercial |
$117.25
|
| Rate for Payer: Riverside University Health System MISP |
$55.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$82.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$82.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$68.97
|
| Rate for Payer: United Healthcare All Other HMO |
$68.97
|
| Rate for Payer: United Healthcare HMO Rider |
$68.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$68.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$117.25
|
| Rate for Payer: Vantage Medical Group Senior |
$117.25
|
|
|
HC PACKING WOUND STRIPS 1"X 5YD
|
Facility
|
OP
|
$14.02
|
|
| Hospital Charge Code |
901698473
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$12.62 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.28
|
| Rate for Payer: Blue Distinction Transplant |
$8.41
|
| Rate for Payer: Blue Shield of California Commercial |
$8.82
|
| Rate for Payer: Blue Shield of California EPN |
$6.86
|
| Rate for Payer: Cash Price |
$6.31
|
| Rate for Payer: Central Health Plan Commercial |
$11.22
|
| Rate for Payer: Cigna of CA HMO |
$8.97
|
| Rate for Payer: Cigna of CA PPO |
$10.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.92
|
| Rate for Payer: Dignity Health Media |
$11.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.61
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.61
|
| Rate for Payer: Galaxy Health WC |
$11.92
|
| Rate for Payer: Global Benefits Group Commercial |
$8.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.62
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.80
|
| Rate for Payer: Multiplan Commercial |
$10.52
|
| Rate for Payer: Networks By Design Commercial |
$9.11
|
| Rate for Payer: Prime Health Services Commercial |
$11.92
|
| Rate for Payer: Riverside University Health System MISP |
$5.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.01
|
| Rate for Payer: United Healthcare All Other HMO |
$7.01
|
| Rate for Payer: United Healthcare HMO Rider |
$7.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.92
|
| Rate for Payer: Vantage Medical Group Senior |
$11.92
|
|
|
HC PACKING WOUND STRIPS 1"X 5YD
|
Facility
|
IP
|
$14.02
|
|
| Hospital Charge Code |
901698473
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$12.62 |
| Rate for Payer: Cash Price |
$6.31
|
| Rate for Payer: Central Health Plan Commercial |
$11.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.61
|
| Rate for Payer: Galaxy Health WC |
$11.92
|
| Rate for Payer: Global Benefits Group Commercial |
$8.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.80
|
| Rate for Payer: Multiplan Commercial |
$10.52
|
| Rate for Payer: Networks By Design Commercial |
$9.11
|
| Rate for Payer: Prime Health Services Commercial |
$11.92
|
|
|
HC PAD REHAB PER SESSION
|
Facility
|
OP
|
$174.00
|
|
|
Service Code
|
CPT 93668
|
| Hospital Charge Code |
900203668
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$34.80 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Adventist Health Medi-Cal |
$76.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$112.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$76.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$84.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$102.80
|
| Rate for Payer: Blue Distinction Transplant |
$104.40
|
| 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 |
$76.42
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Central Health Plan Commercial |
$139.20
|
| Rate for Payer: Cigna of CA HMO |
$111.36
|
| Rate for Payer: Cigna of CA PPO |
$128.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.63
|
| Rate for Payer: Dignity Health Media |
$76.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$76.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$76.42
|
| Rate for Payer: Galaxy Health WC |
$147.90
|
| Rate for Payer: Global Benefits Group Commercial |
$104.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$156.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$130.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$125.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$126.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$76.42
|
| Rate for Payer: InnovAge PACE Commercial |
$114.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$116.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$102.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$102.40
|
| Rate for Payer: Multiplan Commercial |
$130.50
|
| Rate for Payer: Networks By Design Commercial |
$113.10
|
| Rate for Payer: Prime Health Services Commercial |
$147.90
|
| Rate for Payer: Prime Health Services Medicare |
$81.01
|
| Rate for Payer: Riverside University Health System MISP |
$84.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$104.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$104.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,078.00
|
| Rate for Payer: United Healthcare All Other HMO |
$827.00
|
| Rate for Payer: United Healthcare HMO Rider |
$702.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$643.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Vantage Medical Group Senior |
$76.42
|
|
|
HC PAD REHAB PER SESSION
|
Facility
|
IP
|
$174.00
|
|
|
Service Code
|
CPT 93668
|
| Hospital Charge Code |
900203668
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$34.80 |
| Max. Negotiated Rate |
$156.60 |
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Central Health Plan Commercial |
$139.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.60
|
| Rate for Payer: Galaxy Health WC |
$147.90
|
| Rate for Payer: Global Benefits Group Commercial |
$104.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$156.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$116.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.80
|
| Rate for Payer: Multiplan Commercial |
$130.50
|
| Rate for Payer: Networks By Design Commercial |
$113.10
|
| Rate for Payer: Prime Health Services Commercial |
$147.90
|
|
|
HC PAIN MANAGEMENT SERVICES
|
Facility
|
OP
|
$12,161.00
|
|
| Hospital Charge Code |
900700075
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,432.20 |
| Max. Negotiated Rate |
$10,944.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,336.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,688.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,688.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,888.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,184.72
|
| Rate for Payer: Blue Distinction Transplant |
$7,296.60
|
| 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: Cash Price |
$5,472.45
|
| Rate for Payer: Cash Price |
$5,472.45
|
| Rate for Payer: Central Health Plan Commercial |
$9,728.80
|
| Rate for Payer: Cigna of CA PPO |
$8,999.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,336.85
|
| Rate for Payer: Dignity Health Media |
$10,336.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,336.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,864.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,864.40
|
| Rate for Payer: Galaxy Health WC |
$10,336.85
|
| Rate for Payer: Global Benefits Group Commercial |
$7,296.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,944.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9,120.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,256.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,111.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,633.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,432.20
|
| Rate for Payer: Multiplan Commercial |
$9,120.75
|
| Rate for Payer: Networks By Design Commercial |
$7,904.65
|
| Rate for Payer: Prime Health Services Commercial |
$10,336.85
|
| Rate for Payer: Riverside University Health System MISP |
$4,864.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,296.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,080.50
|
| Rate for Payer: United Healthcare All Other HMO |
$6,080.50
|
| Rate for Payer: United Healthcare HMO Rider |
$6,080.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,080.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,336.85
|
| Rate for Payer: Vantage Medical Group Senior |
$10,336.85
|
|
|
HC PAIN MANAGEMENT SERVICES
|
Facility
|
IP
|
$12,161.00
|
|
| Hospital Charge Code |
900700075
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,432.20 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$5,472.45
|
| Rate for Payer: Cash Price |
$5,472.45
|
| Rate for Payer: Central Health Plan Commercial |
$9,728.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,864.40
|
| Rate for Payer: Galaxy Health WC |
$10,336.85
|
| Rate for Payer: Global Benefits Group Commercial |
$7,296.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,944.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,111.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,633.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,432.20
|
| Rate for Payer: Multiplan Commercial |
$9,120.75
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,336.85
|
|
|
HC PALINDROME DIALYS 19CM
|
Facility
|
IP
|
$1,904.40
|
|
|
Service Code
|
CPT C1750
|
| Hospital Charge Code |
901698140
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$380.88 |
| Max. Negotiated Rate |
$1,713.96 |
| Rate for Payer: Cash Price |
$856.98
|
| Rate for Payer: Central Health Plan Commercial |
$1,523.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$761.76
|
| Rate for Payer: Galaxy Health WC |
$1,618.74
|
| Rate for Payer: Global Benefits Group Commercial |
$1,142.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,713.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,270.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$725.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$380.88
|
| Rate for Payer: Multiplan Commercial |
$1,428.30
|
| Rate for Payer: Networks By Design Commercial |
$1,237.86
|
| Rate for Payer: Prime Health Services Commercial |
$1,618.74
|
|
|
HC PALINDROME DIALYS 19CM
|
Facility
|
OP
|
$1,904.40
|
|
|
Service Code
|
CPT C1750
|
| Hospital Charge Code |
901698140
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$380.88 |
| Max. Negotiated Rate |
$2,565.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,565.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,618.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,047.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,047.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$922.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,125.12
|
| Rate for Payer: Blue Distinction Transplant |
$1,142.64
|
| Rate for Payer: Blue Shield of California Commercial |
$1,197.87
|
| Rate for Payer: Blue Shield of California EPN |
$931.25
|
| Rate for Payer: Cash Price |
$856.98
|
| Rate for Payer: Cash Price |
$856.98
|
| Rate for Payer: Central Health Plan Commercial |
$1,523.52
|
| Rate for Payer: Cigna of CA HMO |
$1,218.82
|
| Rate for Payer: Cigna of CA PPO |
$1,409.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,618.74
|
| Rate for Payer: Dignity Health Media |
$1,618.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,618.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$761.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$761.76
|
| Rate for Payer: Galaxy Health WC |
$1,618.74
|
| Rate for Payer: Global Benefits Group Commercial |
$1,142.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,713.96
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,428.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$666.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,270.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$725.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$380.88
|
| Rate for Payer: Multiplan Commercial |
$1,428.30
|
| Rate for Payer: Networks By Design Commercial |
$1,237.86
|
| Rate for Payer: Prime Health Services Commercial |
$1,618.74
|
| Rate for Payer: Riverside University Health System MISP |
$761.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,142.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,142.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$952.20
|
| Rate for Payer: United Healthcare All Other HMO |
$952.20
|
| Rate for Payer: United Healthcare HMO Rider |
$952.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$952.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,618.74
|
| Rate for Payer: Vantage Medical Group Senior |
$1,618.74
|
|
|
HC PANCREAS BIOPSY PERCUTANEOUS
|
Facility
|
IP
|
$3,524.00
|
|
|
Service Code
|
CPT 48102
|
| Hospital Charge Code |
909000153
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$704.80 |
| Max. Negotiated Rate |
$3,171.60 |
| Rate for Payer: Cash Price |
$1,585.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,819.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,409.60
|
| Rate for Payer: Galaxy Health WC |
$2,995.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,114.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,171.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,350.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,342.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$704.80
|
| Rate for Payer: Multiplan Commercial |
$2,643.00
|
| Rate for Payer: Networks By Design Commercial |
$2,290.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,995.40
|
|
|
HC PANCREAS BIOPSY PERCUTANEOUS
|
Facility
|
OP
|
$3,524.00
|
|
|
Service Code
|
CPT 48102
|
| Hospital Charge Code |
909000153
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$704.80 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,025.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,114.40
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$2,025.69
|
| Rate for Payer: Cash Price |
$1,585.80
|
| Rate for Payer: Cash Price |
$1,585.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,819.20
|
| Rate for Payer: Cigna of CA PPO |
$2,607.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Media |
$2,025.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,734.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,025.69
|
| Rate for Payer: Galaxy Health WC |
$2,995.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,114.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,171.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,643.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,322.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,342.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,025.69
|
| Rate for Payer: InnovAge PACE Commercial |
$3,038.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,350.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$719.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$704.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,714.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,714.42
|
| Rate for Payer: Multiplan Commercial |
$2,643.00
|
| Rate for Payer: Networks By Design Commercial |
$2,290.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,995.40
|
| Rate for Payer: Prime Health Services Medicare |
$2,147.23
|
| Rate for Payer: Riverside University Health System MISP |
$2,228.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,114.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC PANCREAS CELLVIZIO
|
Facility
|
IP
|
$1,784.00
|
|
|
Service Code
|
CPT 48999
|
| Hospital Charge Code |
906748999
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$356.80 |
| Max. Negotiated Rate |
$1,605.60 |
| Rate for Payer: Cash Price |
$802.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,427.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$713.60
|
| Rate for Payer: Galaxy Health WC |
$1,516.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,070.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,605.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,189.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$679.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$356.80
|
| Rate for Payer: Multiplan Commercial |
$1,338.00
|
| Rate for Payer: Networks By Design Commercial |
$1,159.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,516.40
|
|
|
HC PANCREAS CELLVIZIO
|
Facility
|
OP
|
$945.00
|
|
|
Service Code
|
CPT 48999
|
| Hospital Charge Code |
906748999
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$189.00 |
| Max. Negotiated Rate |
$4,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$879.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$573.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$457.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$558.31
|
| Rate for Payer: Blue Distinction Transplant |
$567.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$879.07
|
| Rate for Payer: Cash Price |
$425.25
|
| Rate for Payer: Cash Price |
$425.25
|
| Rate for Payer: Central Health Plan Commercial |
$756.00
|
| Rate for Payer: Cigna of CA PPO |
$699.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Media |
$879.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,186.74
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$879.07
|
| Rate for Payer: Galaxy Health WC |
$803.25
|
| Rate for Payer: Global Benefits Group Commercial |
$567.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$850.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$708.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,441.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,450.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.07
|
| Rate for Payer: InnovAge PACE Commercial |
$1,318.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$630.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$189.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,177.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,177.95
|
| Rate for Payer: Multiplan Commercial |
$708.75
|
| Rate for Payer: Networks By Design Commercial |
$614.25
|
| Rate for Payer: Prime Health Services Commercial |
$803.25
|
| Rate for Payer: Prime Health Services Medicare |
$931.81
|
| Rate for Payer: Riverside University Health System MISP |
$966.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$567.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,054.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
HC PANCREATIC PSDOCYST EXT DRN
|
Facility
|
IP
|
$761.00
|
|
|
Service Code
|
CPT 48510
|
| Hospital Charge Code |
909000155
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$152.20 |
| Max. Negotiated Rate |
$684.90 |
| Rate for Payer: Cash Price |
$342.45
|
| Rate for Payer: Central Health Plan Commercial |
$608.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$304.40
|
| Rate for Payer: Galaxy Health WC |
$646.85
|
| Rate for Payer: Global Benefits Group Commercial |
$456.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$684.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$507.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$289.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.20
|
| Rate for Payer: Multiplan Commercial |
$570.75
|
| Rate for Payer: Networks By Design Commercial |
$494.65
|
| Rate for Payer: Prime Health Services Commercial |
$646.85
|
|
|
HC PANCREATIC PSDOCYST EXT DRN
|
Facility
|
OP
|
$761.00
|
|
|
Service Code
|
CPT 48510
|
| Hospital Charge Code |
909000155
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$152.20 |
| Max. Negotiated Rate |
$8,017.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5,444.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$646.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$418.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$418.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,017.00
|
| Rate for Payer: Blue Distinction Transplant |
$456.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Cash Price |
$342.45
|
| Rate for Payer: Cash Price |
$342.45
|
| Rate for Payer: Central Health Plan Commercial |
$608.80
|
| Rate for Payer: Cigna of CA PPO |
$563.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$646.85
|
| Rate for Payer: Dignity Health Media |
$646.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$646.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$304.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$304.40
|
| Rate for Payer: Galaxy Health WC |
$646.85
|
| Rate for Payer: Global Benefits Group Commercial |
$456.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$684.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$570.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$266.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$507.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$241.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.20
|
| Rate for Payer: Multiplan Commercial |
$570.75
|
| Rate for Payer: Networks By Design Commercial |
$494.65
|
| Rate for Payer: Prime Health Services Commercial |
$646.85
|
| Rate for Payer: Riverside University Health System MISP |
$304.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$456.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$646.85
|
| Rate for Payer: Vantage Medical Group Senior |
$646.85
|
|
|
HC PAPOOSE INFANT SPINAL IMOBLIZR
|
Facility
|
OP
|
$858.77
|
|
|
Service Code
|
CPT L0174
|
| Hospital Charge Code |
901606308
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$300.57 |
| Max. Negotiated Rate |
$772.89 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$729.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$472.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$472.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$415.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$507.36
|
| Rate for Payer: Blue Distinction Transplant |
$515.26
|
| Rate for Payer: Blue Shield of California Commercial |
$644.08
|
| Rate for Payer: Blue Shield of California EPN |
$467.17
|
| Rate for Payer: Cash Price |
$386.45
|
| Rate for Payer: Cash Price |
$386.45
|
| Rate for Payer: Central Health Plan Commercial |
$687.02
|
| Rate for Payer: Cigna of CA HMO |
$601.14
|
| Rate for Payer: Cigna of CA PPO |
$601.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$729.95
|
| Rate for Payer: Dignity Health Media |
$729.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$729.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$343.51
|
| Rate for Payer: EPIC Health Plan Transplant |
$343.51
|
| Rate for Payer: Galaxy Health WC |
$729.95
|
| Rate for Payer: Global Benefits Group Commercial |
$515.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$772.89
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$644.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$300.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$572.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$347.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$352.10
|
| Rate for Payer: Multiplan Commercial |
$644.08
|
| Rate for Payer: Networks By Design Commercial |
$429.38
|
| Rate for Payer: Prime Health Services Commercial |
$729.95
|
| Rate for Payer: Riverside University Health System MISP |
$343.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$515.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$515.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$429.38
|
| Rate for Payer: United Healthcare All Other HMO |
$429.38
|
| Rate for Payer: United Healthcare HMO Rider |
$429.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$429.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$729.95
|
| Rate for Payer: Vantage Medical Group Senior |
$729.95
|
|
|
HC PAPOOSE INFANT SPINAL IMOBLIZR
|
Facility
|
IP
|
$858.77
|
|
|
Service Code
|
CPT L0174
|
| Hospital Charge Code |
901606308
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$171.75 |
| Max. Negotiated Rate |
$772.89 |
| Rate for Payer: Blue Shield of California EPN |
$458.58
|
| Rate for Payer: Cash Price |
$386.45
|
| Rate for Payer: Central Health Plan Commercial |
$687.02
|
| Rate for Payer: Cigna of CA HMO |
$601.14
|
| Rate for Payer: Cigna of CA PPO |
$601.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$343.51
|
| Rate for Payer: EPIC Health Plan Transplant |
$343.51
|
| Rate for Payer: Galaxy Health WC |
$729.95
|
| Rate for Payer: Global Benefits Group Commercial |
$515.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$772.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$572.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$327.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.75
|
| Rate for Payer: Multiplan Commercial |
$644.08
|
| Rate for Payer: Networks By Design Commercial |
$429.38
|
| Rate for Payer: Prime Health Services Commercial |
$729.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$324.27
|
| Rate for Payer: United Healthcare All Other HMO |
$316.71
|
| Rate for Payer: United Healthcare HMO Rider |
$309.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$283.39
|
|
|
HC PAP S EAR-THIN PREP PG
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
CPT 88142
|
| Hospital Charge Code |
903800211
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$148.67 |
| Rate for Payer: Adventist Health Medi-Cal |
$20.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$148.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$102.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.45
|
| Rate for Payer: Blue Distinction Transplant |
$36.00
|
| Rate for Payer: Blue Shield of California Commercial |
$37.08
|
| Rate for Payer: Blue Shield of California EPN |
$29.16
|
| Rate for Payer: Caremore Medicare Advantage |
$20.26
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Central Health Plan Commercial |
$48.00
|
| Rate for Payer: Cigna of CA HMO |
$38.40
|
| Rate for Payer: Cigna of CA PPO |
$44.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.39
|
| Rate for Payer: Dignity Health Media |
$20.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.35
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$20.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.26
|
| Rate for Payer: Galaxy Health WC |
$51.00
|
| Rate for Payer: Global Benefits Group Commercial |
$36.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$45.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$33.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$33.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.26
|
| Rate for Payer: InnovAge PACE Commercial |
$30.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.15
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
| Rate for Payer: Networks By Design Commercial |
$39.00
|
| Rate for Payer: Prime Health Services Commercial |
$51.00
|
| Rate for Payer: Prime Health Services Medicare |
$21.48
|
| Rate for Payer: Riverside University Health System MISP |
$22.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.41
|
| Rate for Payer: United Healthcare All Other HMO |
$16.41
|
| Rate for Payer: United Healthcare HMO Rider |
$16.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.29
|
| Rate for Payer: Vantage Medical Group Senior |
$20.26
|
|
