|
HC RPL GTUBE REQ REV GSTRST TRC
|
Facility
|
OP
|
$1,134.00
|
|
|
Service Code
|
CPT 43763
|
| Hospital Charge Code |
906043763
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$103.73 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$226.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$321.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$321.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$510.30
|
| Rate for Payer: Cash Price |
$510.30
|
| Rate for Payer: Cash Price |
$510.30
|
| Rate for Payer: Central Health Plan Commercial |
$907.20
|
| Rate for Payer: Cigna of CA HMO |
$725.76
|
| Rate for Payer: Cigna of CA PPO |
$839.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$482.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$353.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$321.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$793.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$530.23
|
| Rate for Payer: EPIC Health Plan Senior |
$353.49
|
| Rate for Payer: Galaxy Health WC |
$963.90
|
| Rate for Payer: Global Benefits Group Commercial |
$680.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,020.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$527.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$103.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$321.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$720.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$114.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$449.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$430.61
|
| Rate for Payer: Multiplan Commercial |
$850.50
|
| Rate for Payer: Networks By Design Commercial |
$737.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$321.35
|
| Rate for Payer: Prime Health Services Commercial |
$963.90
|
| Rate for Payer: Prime Health Services Medicare |
$340.63
|
| Rate for Payer: Riverside University Health System MISP |
$353.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$680.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$385.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$567.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$321.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Vantage Medical Group Senior |
$321.35
|
|
|
HC RPOS PRV CCM DFIB TRNSVNS ELTRD
|
Facility
|
IP
|
$1,688.00
|
|
|
Service Code
|
CPT 0924T
|
| Hospital Charge Code |
906811512
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$337.60 |
| Max. Negotiated Rate |
$1,519.20 |
| Rate for Payer: Adventist Health Commercial |
$337.60
|
| Rate for Payer: Cash Price |
$759.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,350.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,181.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$675.20
|
| Rate for Payer: EPIC Health Plan Senior |
$675.20
|
| Rate for Payer: Galaxy Health WC |
$1,434.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,012.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,519.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,071.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$995.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$337.60
|
| Rate for Payer: Multiplan Commercial |
$1,266.00
|
| Rate for Payer: Networks By Design Commercial |
$1,097.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,434.80
|
|
|
HC RPOS PRV CCM DFIB TRNSVNS ELTRD
|
Facility
|
OP
|
$1,688.00
|
|
|
Service Code
|
CPT 0924T
|
| Hospital Charge Code |
906811512
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$337.60 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$337.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$806.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,025.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$806.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$759.60
|
| Rate for Payer: Cash Price |
$759.60
|
| Rate for Payer: Cash Price |
$759.60
|
| Rate for Payer: Cash Price |
$759.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,350.40
|
| Rate for Payer: Cigna of CA HMO |
$1,080.32
|
| Rate for Payer: Cigna of CA PPO |
$1,249.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$887.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$806.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,181.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,331.25
|
| Rate for Payer: EPIC Health Plan Senior |
$887.50
|
| Rate for Payer: Galaxy Health WC |
$1,434.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,012.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,519.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,323.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$806.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,071.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$612.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,129.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$337.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,081.14
|
| Rate for Payer: Multiplan Commercial |
$1,266.00
|
| Rate for Payer: Networks By Design Commercial |
$1,097.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$806.82
|
| Rate for Payer: Prime Health Services Commercial |
$1,434.80
|
| Rate for Payer: Prime Health Services Medicare |
$855.23
|
| Rate for Payer: Riverside University Health System MISP |
$887.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,012.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,012.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$806.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Vantage Medical Group Senior |
$806.82
|
|
|
HC RPR
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900913675
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Adventist Health Commercial |
$12.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Central Health Plan Commercial |
$51.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$44.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.60
|
| Rate for Payer: EPIC Health Plan Senior |
$25.60
|
| Rate for Payer: Galaxy Health WC |
$54.40
|
| Rate for Payer: Global Benefits Group Commercial |
$38.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$57.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$40.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$37.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.80
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: Networks By Design Commercial |
$41.60
|
| Rate for Payer: Prime Health Services Commercial |
$54.40
|
|
|
HC RPR
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900913675
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$130.94 |
| Rate for Payer: Adventist Health Commercial |
$11.40
|
| Rate for Payer: Adventist Health Commercial |
$12.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$17.27
|
| Rate for Payer: Adventist Health Medi-Cal |
$17.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$95.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$95.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$94.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$94.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.94
|
| Rate for Payer: Blue Shield of California Commercial |
$40.32
|
| Rate for Payer: Blue Shield of California Commercial |
$35.91
|
| Rate for Payer: Blue Shield of California EPN |
$25.41
|
| Rate for Payer: Blue Shield of California EPN |
$22.63
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Central Health Plan Commercial |
$45.60
|
| Rate for Payer: Central Health Plan Commercial |
$51.20
|
| Rate for Payer: Cigna of CA HMO |
$40.96
|
| Rate for Payer: Cigna of CA HMO |
$36.48
|
| Rate for Payer: Cigna of CA PPO |
$47.36
|
| Rate for Payer: Cigna of CA PPO |
$42.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$39.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$44.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.50
|
| Rate for Payer: EPIC Health Plan Senior |
$19.00
|
| Rate for Payer: EPIC Health Plan Senior |
$19.00
|
| Rate for Payer: Galaxy Health WC |
$54.40
|
| Rate for Payer: Galaxy Health WC |
$48.45
|
| Rate for Payer: Global Benefits Group Commercial |
$38.40
|
| Rate for Payer: Global Benefits Group Commercial |
$34.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$57.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$51.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$28.32
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$28.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$36.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$40.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.14
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: Multiplan Commercial |
$42.75
|
| Rate for Payer: Networks By Design Commercial |
$37.05
|
| Rate for Payer: Networks By Design Commercial |
$41.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.27
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.27
|
| Rate for Payer: Prime Health Services Commercial |
$54.40
|
| Rate for Payer: Prime Health Services Commercial |
$48.45
|
| Rate for Payer: Prime Health Services Medicare |
$18.31
|
| Rate for Payer: Prime Health Services Medicare |
$18.31
|
| Rate for Payer: Riverside University Health System MISP |
$19.00
|
| Rate for Payer: Riverside University Health System MISP |
$19.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$38.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$38.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$34.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.99
|
| Rate for Payer: United Healthcare All Other HMO |
$13.99
|
| Rate for Payer: United Healthcare All Other HMO |
$13.99
|
| Rate for Payer: United Healthcare HMO Rider |
$13.99
|
| Rate for Payer: United Healthcare HMO Rider |
$13.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.99
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.27
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.27
|
| Rate for Payer: Vantage Medical Group Senior |
$17.27
|
|
|
HC RPR DETACHED RETINA
|
Facility
|
IP
|
$9,244.00
|
|
|
Service Code
|
CPT 67101
|
| Hospital Charge Code |
900501630
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,848.80 |
| Max. Negotiated Rate |
$8,319.60 |
| Rate for Payer: Adventist Health Commercial |
$1,848.80
|
| Rate for Payer: Cash Price |
$4,159.80
|
| Rate for Payer: Central Health Plan Commercial |
$7,395.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,470.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,697.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,697.60
|
| Rate for Payer: Galaxy Health WC |
$7,857.40
|
| Rate for Payer: Global Benefits Group Commercial |
$5,546.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,319.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,869.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,453.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,848.80
|
| Rate for Payer: Multiplan Commercial |
$6,933.00
|
| Rate for Payer: Networks By Design Commercial |
$6,008.60
|
| Rate for Payer: Prime Health Services Commercial |
$7,857.40
|
|
|
HC RPR DETACHED RETINA
|
Facility
|
OP
|
$9,244.00
|
|
|
Service Code
|
CPT 67101
|
| Hospital Charge Code |
900501630
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$8,924.00 |
| Rate for Payer: Adventist Health Commercial |
$1,848.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,265.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,968.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,924.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$4,617.28
|
| Rate for Payer: Cash Price |
$4,159.80
|
| Rate for Payer: Cash Price |
$4,159.80
|
| Rate for Payer: Cash Price |
$4,159.80
|
| Rate for Payer: Cash Price |
$4,159.80
|
| Rate for Payer: Central Health Plan Commercial |
$7,395.20
|
| Rate for Payer: Cigna of CA HMO |
$5,916.16
|
| Rate for Payer: Cigna of CA PPO |
$6,840.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,265.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,968.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,470.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,897.61
|
| Rate for Payer: EPIC Health Plan Senior |
$3,265.07
|
| Rate for Payer: Galaxy Health WC |
$7,857.40
|
| Rate for Payer: Global Benefits Group Commercial |
$5,546.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,319.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,867.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,968.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,869.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$553.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,190.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,848.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,977.45
|
| Rate for Payer: Multiplan Commercial |
$6,933.00
|
| Rate for Payer: Multiplan WC |
$4,617.28
|
| Rate for Payer: Networks By Design Commercial |
$6,008.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,968.25
|
| Rate for Payer: Preferred Health Network WC |
$4,711.51
|
| Rate for Payer: Prime Health Services Commercial |
$7,857.40
|
| Rate for Payer: Prime Health Services Medicare |
$3,146.34
|
| Rate for Payer: Prime Health Services WC |
$4,570.16
|
| Rate for Payer: Riverside University Health System MISP |
$3,265.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,546.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,622.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,622.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,622.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,622.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,968.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,265.07
|
| Rate for Payer: Vantage Medical Group Senior |
$2,968.25
|
|
|
HC RPR LIP FLL THCK UP TO HLF VER
|
Facility
|
OP
|
$2,198.00
|
|
|
Service Code
|
CPT 40652
|
| Hospital Charge Code |
900540652
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$122.38 |
| Max. Negotiated Rate |
$8,074.00 |
| Rate for Payer: Adventist Health Commercial |
$439.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$763.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$693.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,030.97
|
| Rate for Payer: Cash Price |
$989.10
|
| Rate for Payer: Cash Price |
$989.10
|
| Rate for Payer: Cash Price |
$989.10
|
| Rate for Payer: Cash Price |
$989.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,758.40
|
| Rate for Payer: Cigna of CA HMO |
$1,406.72
|
| Rate for Payer: Cigna of CA PPO |
$1,626.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$763.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$693.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,538.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,144.56
|
| Rate for Payer: EPIC Health Plan Senior |
$763.04
|
| Rate for Payer: Galaxy Health WC |
$1,868.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,318.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,978.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,137.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$693.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,395.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$122.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$745.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$439.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$929.52
|
| Rate for Payer: Multiplan Commercial |
$1,648.50
|
| Rate for Payer: Multiplan WC |
$1,030.97
|
| Rate for Payer: Networks By Design Commercial |
$1,428.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$693.67
|
| Rate for Payer: Preferred Health Network WC |
$1,052.01
|
| Rate for Payer: Prime Health Services Commercial |
$1,868.30
|
| Rate for Payer: Prime Health Services Medicare |
$735.29
|
| Rate for Payer: Prime Health Services WC |
$1,020.45
|
| Rate for Payer: Riverside University Health System MISP |
$763.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,318.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,099.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,099.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,099.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,099.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$693.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$763.04
|
| Rate for Payer: Vantage Medical Group Senior |
$693.67
|
|
|
HC RPR LIP FLL THCK UP TO HLF VER
|
Facility
|
IP
|
$2,198.00
|
|
|
Service Code
|
CPT 40652
|
| Hospital Charge Code |
900540652
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$439.60 |
| Max. Negotiated Rate |
$1,978.20 |
| Rate for Payer: Adventist Health Commercial |
$439.60
|
| Rate for Payer: Cash Price |
$989.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,758.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,538.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$879.20
|
| Rate for Payer: EPIC Health Plan Senior |
$879.20
|
| Rate for Payer: Galaxy Health WC |
$1,868.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,318.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,978.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,395.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,296.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$439.60
|
| Rate for Payer: Multiplan Commercial |
$1,648.50
|
| Rate for Payer: Networks By Design Commercial |
$1,428.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,868.30
|
|
|
HC RPR PROS DEVICE PER 15 MIN
|
Facility
|
IP
|
$311.00
|
|
|
Service Code
|
CPT L7520
|
| Hospital Charge Code |
915357520
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$62.20 |
| Max. Negotiated Rate |
$279.90 |
| Rate for Payer: Adventist Health Commercial |
$62.20
|
| Rate for Payer: Cash Price |
$139.95
|
| Rate for Payer: Central Health Plan Commercial |
$248.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$217.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.40
|
| Rate for Payer: EPIC Health Plan Senior |
$124.40
|
| Rate for Payer: Galaxy Health WC |
$264.35
|
| Rate for Payer: Global Benefits Group Commercial |
$186.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$279.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$197.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$183.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.20
|
| Rate for Payer: Multiplan Commercial |
$233.25
|
| Rate for Payer: Networks By Design Commercial |
$202.15
|
| Rate for Payer: Prime Health Services Commercial |
$264.35
|
|
|
HC RPR PROS DEVICE PER 15 MIN
|
Facility
|
IP
|
$16.00
|
|
|
Service Code
|
CPT L7520
|
| Hospital Charge Code |
905357520
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$14.40 |
| Rate for Payer: Adventist Health Commercial |
$3.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Central Health Plan Commercial |
$12.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6.40
|
| Rate for Payer: Galaxy Health WC |
$13.60
|
| Rate for Payer: Global Benefits Group Commercial |
$9.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.20
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: Networks By Design Commercial |
$10.40
|
| Rate for Payer: Prime Health Services Commercial |
$13.60
|
|
|
HC RPR PROS DEVICE PER 15 MIN
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
CPT L7520
|
| Hospital Charge Code |
905357520
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$98.17 |
| Rate for Payer: Adventist Health Commercial |
$3.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$98.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.31
|
| Rate for Payer: Blue Shield of California Commercial |
$10.14
|
| Rate for Payer: Blue Shield of California EPN |
$6.38
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Central Health Plan Commercial |
$12.80
|
| Rate for Payer: Cigna of CA HMO |
$10.24
|
| Rate for Payer: Cigna of CA PPO |
$11.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6.40
|
| Rate for Payer: Galaxy Health WC |
$13.60
|
| Rate for Payer: Global Benefits Group Commercial |
$9.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11.20
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: Networks By Design Commercial |
$10.40
|
| Rate for Payer: Prime Health Services Commercial |
$13.60
|
| Rate for Payer: Riverside University Health System MISP |
$6.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.60
|
| Rate for Payer: Vantage Medical Group Senior |
$13.60
|
|
|
HC RPR PROS DEVICE PER 15 MIN
|
Facility
|
OP
|
$311.00
|
|
|
Service Code
|
CPT L7520
|
| Hospital Charge Code |
915357520
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$28.33 |
| Max. Negotiated Rate |
$279.90 |
| Rate for Payer: Adventist Health Commercial |
$62.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$98.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$264.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$171.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$233.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$150.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$180.91
|
| Rate for Payer: Blue Shield of California Commercial |
$197.17
|
| Rate for Payer: Blue Shield of California EPN |
$124.09
|
| Rate for Payer: Cash Price |
$139.95
|
| Rate for Payer: Cash Price |
$139.95
|
| Rate for Payer: Central Health Plan Commercial |
$248.80
|
| Rate for Payer: Cigna of CA HMO |
$199.04
|
| Rate for Payer: Cigna of CA PPO |
$230.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$264.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$264.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$264.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$217.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.40
|
| Rate for Payer: EPIC Health Plan Senior |
$124.40
|
| Rate for Payer: Galaxy Health WC |
$264.35
|
| Rate for Payer: Global Benefits Group Commercial |
$186.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$279.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$197.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$183.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$217.70
|
| Rate for Payer: Multiplan Commercial |
$233.25
|
| Rate for Payer: Networks By Design Commercial |
$202.15
|
| Rate for Payer: Prime Health Services Commercial |
$264.35
|
| Rate for Payer: Riverside University Health System MISP |
$124.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$186.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$186.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$264.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$264.35
|
| Rate for Payer: Vantage Medical Group Senior |
$264.35
|
|
|
HC RPR TITER
|
Facility
|
IP
|
$182.00
|
|
|
Service Code
|
CPT 86593
|
| Hospital Charge Code |
900910929
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$163.80 |
| Rate for Payer: Adventist Health Commercial |
$36.40
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Central Health Plan Commercial |
$145.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$127.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.80
|
| Rate for Payer: EPIC Health Plan Senior |
$72.80
|
| Rate for Payer: Galaxy Health WC |
$154.70
|
| Rate for Payer: Global Benefits Group Commercial |
$109.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$163.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$115.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$107.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.40
|
| Rate for Payer: Multiplan Commercial |
$136.50
|
| Rate for Payer: Networks By Design Commercial |
$118.30
|
| Rate for Payer: Prime Health Services Commercial |
$154.70
|
|
|
HC RPR TITER
|
Facility
|
OP
|
$182.00
|
|
|
Service Code
|
CPT 86593
|
| Hospital Charge Code |
900910929
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.56 |
| Max. Negotiated Rate |
$163.80 |
| Rate for Payer: Adventist Health Commercial |
$36.40
|
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$32.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$32.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.53
|
| Rate for Payer: Blue Shield of California Commercial |
$25.20
|
| Rate for Payer: Blue Shield of California Commercial |
$114.66
|
| Rate for Payer: Blue Shield of California EPN |
$15.88
|
| Rate for Payer: Blue Shield of California EPN |
$72.25
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Central Health Plan Commercial |
$145.60
|
| Rate for Payer: Central Health Plan Commercial |
$32.00
|
| Rate for Payer: Cigna of CA HMO |
$25.60
|
| Rate for Payer: Cigna of CA HMO |
$116.48
|
| Rate for Payer: Cigna of CA PPO |
$29.60
|
| Rate for Payer: Cigna of CA PPO |
$134.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$127.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.26
|
| Rate for Payer: EPIC Health Plan Senior |
$4.84
|
| Rate for Payer: EPIC Health Plan Senior |
$4.84
|
| Rate for Payer: Galaxy Health WC |
$34.00
|
| Rate for Payer: Galaxy Health WC |
$154.70
|
| Rate for Payer: Global Benefits Group Commercial |
$24.00
|
| Rate for Payer: Global Benefits Group Commercial |
$109.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$163.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.22
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$115.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.90
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
| Rate for Payer: Multiplan Commercial |
$136.50
|
| Rate for Payer: Networks By Design Commercial |
$118.30
|
| Rate for Payer: Networks By Design Commercial |
$26.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.40
|
| Rate for Payer: Prime Health Services Commercial |
$34.00
|
| Rate for Payer: Prime Health Services Commercial |
$154.70
|
| Rate for Payer: Prime Health Services Medicare |
$4.66
|
| Rate for Payer: Prime Health Services Medicare |
$4.66
|
| Rate for Payer: Riverside University Health System MISP |
$4.84
|
| Rate for Payer: Riverside University Health System MISP |
$4.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$109.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$109.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.56
|
| Rate for Payer: United Healthcare All Other HMO |
$3.56
|
| Rate for Payer: United Healthcare All Other HMO |
$3.56
|
| Rate for Payer: United Healthcare HMO Rider |
$3.56
|
| Rate for Payer: United Healthcare HMO Rider |
$3.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.40
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.84
|
| Rate for Payer: Vantage Medical Group Senior |
$4.40
|
| Rate for Payer: Vantage Medical Group Senior |
$4.40
|
|
|
HC RSPR T-POD PELVIC STBL
|
Facility
|
IP
|
$584.20
|
|
|
Service Code
|
CPT E0944
|
| Hospital Charge Code |
901698449
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$116.84 |
| Max. Negotiated Rate |
$525.78 |
| Rate for Payer: Adventist Health Commercial |
$116.84
|
| Rate for Payer: Cash Price |
$262.89
|
| Rate for Payer: Central Health Plan Commercial |
$467.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$408.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$233.68
|
| Rate for Payer: EPIC Health Plan Senior |
$233.68
|
| Rate for Payer: Galaxy Health WC |
$496.57
|
| Rate for Payer: Global Benefits Group Commercial |
$350.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$525.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$370.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$344.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.84
|
| Rate for Payer: Multiplan Commercial |
$438.15
|
| Rate for Payer: Networks By Design Commercial |
$379.73
|
| Rate for Payer: Prime Health Services Commercial |
$496.57
|
|
|
HC RSPR T-POD PELVIC STBL
|
Facility
|
OP
|
$584.20
|
|
|
Service Code
|
CPT E0944
|
| Hospital Charge Code |
901698449
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$53.66 |
| Max. Negotiated Rate |
$525.78 |
| Rate for Payer: Adventist Health Commercial |
$116.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$120.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$496.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$321.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$438.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$282.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$339.83
|
| Rate for Payer: Blue Shield of California Commercial |
$370.38
|
| Rate for Payer: Blue Shield of California EPN |
$233.10
|
| Rate for Payer: Cash Price |
$262.89
|
| Rate for Payer: Cash Price |
$262.89
|
| Rate for Payer: Central Health Plan Commercial |
$467.36
|
| Rate for Payer: Cigna of CA HMO |
$373.89
|
| Rate for Payer: Cigna of CA PPO |
$432.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$496.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$496.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$496.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$408.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$233.68
|
| Rate for Payer: EPIC Health Plan Senior |
$233.68
|
| Rate for Payer: Galaxy Health WC |
$496.57
|
| Rate for Payer: Global Benefits Group Commercial |
$350.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$525.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$53.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$370.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$59.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$344.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$408.94
|
| Rate for Payer: Multiplan Commercial |
$438.15
|
| Rate for Payer: Networks By Design Commercial |
$379.73
|
| Rate for Payer: Prime Health Services Commercial |
$496.57
|
| Rate for Payer: Riverside University Health System MISP |
$233.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$350.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$350.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$496.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$496.57
|
| Rate for Payer: Vantage Medical Group Senior |
$496.57
|
|
|
HC RSV AG
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
CPT 87420
|
| Hospital Charge Code |
900911613
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$36.80 |
| Max. Negotiated Rate |
$165.60 |
| Rate for Payer: Adventist Health Commercial |
$36.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Central Health Plan Commercial |
$147.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$128.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.60
|
| Rate for Payer: EPIC Health Plan Senior |
$73.60
|
| Rate for Payer: Galaxy Health WC |
$156.40
|
| Rate for Payer: Global Benefits Group Commercial |
$110.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$165.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$116.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$108.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.80
|
| Rate for Payer: Multiplan Commercial |
$138.00
|
| Rate for Payer: Networks By Design Commercial |
$119.60
|
| Rate for Payer: Prime Health Services Commercial |
$156.40
|
|
|
HC RSV AG
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
CPT 87420
|
| Hospital Charge Code |
900911613
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.02 |
| Max. Negotiated Rate |
$165.60 |
| Rate for Payer: Adventist Health Commercial |
$36.80
|
| Rate for Payer: Adventist Health Commercial |
$6.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.91
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$65.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$65.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$90.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$90.90
|
| Rate for Payer: Blue Shield of California Commercial |
$19.53
|
| Rate for Payer: Blue Shield of California Commercial |
$115.92
|
| Rate for Payer: Blue Shield of California EPN |
$12.31
|
| Rate for Payer: Blue Shield of California EPN |
$73.05
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Central Health Plan Commercial |
$147.20
|
| Rate for Payer: Central Health Plan Commercial |
$24.80
|
| Rate for Payer: Cigna of CA HMO |
$19.84
|
| Rate for Payer: Cigna of CA HMO |
$117.76
|
| Rate for Payer: Cigna of CA PPO |
$22.94
|
| Rate for Payer: Cigna of CA PPO |
$136.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.91
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$128.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.95
|
| Rate for Payer: EPIC Health Plan Senior |
$15.30
|
| Rate for Payer: EPIC Health Plan Senior |
$15.30
|
| Rate for Payer: Galaxy Health WC |
$26.35
|
| Rate for Payer: Galaxy Health WC |
$156.40
|
| Rate for Payer: Global Benefits Group Commercial |
$18.60
|
| Rate for Payer: Global Benefits Group Commercial |
$110.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$165.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.81
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$116.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.64
|
| Rate for Payer: Multiplan Commercial |
$23.25
|
| Rate for Payer: Multiplan Commercial |
$138.00
|
| Rate for Payer: Networks By Design Commercial |
$119.60
|
| Rate for Payer: Networks By Design Commercial |
$20.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.91
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.91
|
| Rate for Payer: Prime Health Services Commercial |
$26.35
|
| Rate for Payer: Prime Health Services Commercial |
$156.40
|
| Rate for Payer: Prime Health Services Medicare |
$14.74
|
| Rate for Payer: Prime Health Services Medicare |
$14.74
|
| Rate for Payer: Riverside University Health System MISP |
$15.30
|
| Rate for Payer: Riverside University Health System MISP |
$15.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$110.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$110.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.27
|
| Rate for Payer: United Healthcare All Other HMO |
$11.27
|
| Rate for Payer: United Healthcare All Other HMO |
$11.27
|
| Rate for Payer: United Healthcare HMO Rider |
$11.27
|
| Rate for Payer: United Healthcare HMO Rider |
$11.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.27
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.91
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.30
|
| Rate for Payer: Vantage Medical Group Senior |
$13.91
|
| Rate for Payer: Vantage Medical Group Senior |
$13.91
|
|
|
HC RSV DFA
|
Facility
|
OP
|
$332.00
|
|
|
Service Code
|
CPT 87280
|
| Hospital Charge Code |
900911537
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.87 |
| Max. Negotiated Rate |
$298.80 |
| Rate for Payer: Adventist Health Commercial |
$66.40
|
| Rate for Payer: Adventist Health Commercial |
$7.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.42
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$65.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$65.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$90.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$90.90
|
| Rate for Payer: Blue Shield of California Commercial |
$24.57
|
| Rate for Payer: Blue Shield of California Commercial |
$209.16
|
| Rate for Payer: Blue Shield of California EPN |
$15.48
|
| Rate for Payer: Blue Shield of California EPN |
$131.80
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Central Health Plan Commercial |
$265.60
|
| Rate for Payer: Central Health Plan Commercial |
$31.20
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA HMO |
$212.48
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Cigna of CA PPO |
$245.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$232.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$27.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.14
|
| Rate for Payer: EPIC Health Plan Senior |
$14.76
|
| Rate for Payer: EPIC Health Plan Senior |
$14.76
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Galaxy Health WC |
$282.20
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Global Benefits Group Commercial |
$199.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$298.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.01
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$15.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$15.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$210.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.98
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: Multiplan Commercial |
$249.00
|
| Rate for Payer: Networks By Design Commercial |
$215.80
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.42
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.42
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Prime Health Services Commercial |
$282.20
|
| Rate for Payer: Prime Health Services Medicare |
$14.23
|
| Rate for Payer: Prime Health Services Medicare |
$14.23
|
| Rate for Payer: Riverside University Health System MISP |
$14.76
|
| Rate for Payer: Riverside University Health System MISP |
$14.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$199.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$199.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.87
|
| Rate for Payer: United Healthcare All Other HMO |
$10.87
|
| Rate for Payer: United Healthcare All Other HMO |
$10.87
|
| Rate for Payer: United Healthcare HMO Rider |
$10.87
|
| Rate for Payer: United Healthcare HMO Rider |
$10.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.87
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.76
|
| Rate for Payer: Vantage Medical Group Senior |
$13.42
|
| Rate for Payer: Vantage Medical Group Senior |
$13.42
|
|
|
HC RSV DFA
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
CPT 87280
|
| Hospital Charge Code |
900911537
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$66.40 |
| Max. Negotiated Rate |
$298.80 |
| Rate for Payer: Adventist Health Commercial |
$66.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Central Health Plan Commercial |
$265.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$232.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$132.80
|
| Rate for Payer: EPIC Health Plan Senior |
$132.80
|
| Rate for Payer: Galaxy Health WC |
$282.20
|
| Rate for Payer: Global Benefits Group Commercial |
$199.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$298.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$210.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$195.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.40
|
| Rate for Payer: Multiplan Commercial |
$249.00
|
| Rate for Payer: Networks By Design Commercial |
$215.80
|
| Rate for Payer: Prime Health Services Commercial |
$282.20
|
|
|
HC RT ATTENDANCE AT DELIVERY
|
Facility
|
IP
|
$1,670.00
|
|
|
Service Code
|
CPT 99464
|
| Hospital Charge Code |
900800499
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$334.00 |
| Max. Negotiated Rate |
$1,503.00 |
| Rate for Payer: Adventist Health Commercial |
$334.00
|
| Rate for Payer: Cash Price |
$751.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,336.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,169.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$668.00
|
| Rate for Payer: EPIC Health Plan Senior |
$668.00
|
| Rate for Payer: Galaxy Health WC |
$1,419.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,002.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,503.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,060.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$985.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$334.00
|
| Rate for Payer: Multiplan Commercial |
$1,252.50
|
| Rate for Payer: Networks By Design Commercial |
$1,085.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,419.50
|
|
|
HC RT ATTENDANCE AT DELIVERY
|
Facility
|
OP
|
$1,670.00
|
|
|
Service Code
|
CPT 99464
|
| Hospital Charge Code |
900800499
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$101.82 |
| Max. Negotiated Rate |
$1,503.00 |
| Rate for Payer: Adventist Health Commercial |
$334.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$392.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,419.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$918.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,252.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$808.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$971.44
|
| Rate for Payer: Blue Shield of California Commercial |
$1,052.10
|
| Rate for Payer: Blue Shield of California EPN |
$662.99
|
| Rate for Payer: Cash Price |
$751.50
|
| Rate for Payer: Cash Price |
$751.50
|
| Rate for Payer: Cash Price |
$751.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,336.00
|
| Rate for Payer: Cigna of CA HMO |
$1,068.80
|
| Rate for Payer: Cigna of CA PPO |
$1,235.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,419.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,419.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,419.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,169.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$668.00
|
| Rate for Payer: EPIC Health Plan Senior |
$668.00
|
| Rate for Payer: Galaxy Health WC |
$1,419.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,002.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,503.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$101.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,060.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$112.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$985.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$334.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,169.00
|
| Rate for Payer: Multiplan Commercial |
$1,252.50
|
| Rate for Payer: Networks By Design Commercial |
$1,085.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,419.50
|
| Rate for Payer: Riverside University Health System MISP |
$668.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,002.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,002.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$764.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$731.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$669.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,419.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,419.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,419.50
|
|
|
HC RTNR BANDNET DRSNG 50YD X 6IN
|
Facility
|
IP
|
$6.31
|
|
| Hospital Charge Code |
901698302
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$5.68 |
| Rate for Payer: Adventist Health Commercial |
$1.26
|
| Rate for Payer: Cash Price |
$2.84
|
| Rate for Payer: Central Health Plan Commercial |
$5.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.52
|
| Rate for Payer: EPIC Health Plan Senior |
$2.52
|
| Rate for Payer: Galaxy Health WC |
$5.36
|
| Rate for Payer: Global Benefits Group Commercial |
$3.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.26
|
| Rate for Payer: Multiplan Commercial |
$4.73
|
| Rate for Payer: Networks By Design Commercial |
$4.10
|
| Rate for Payer: Prime Health Services Commercial |
$5.36
|
|
|
HC RTNR BANDNET DRSNG 50YD X 6IN
|
Facility
|
OP
|
$6.31
|
|
| Hospital Charge Code |
901698302
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$5.68 |
| Rate for Payer: Adventist Health Commercial |
$1.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.67
|
| Rate for Payer: Blue Shield of California Commercial |
$4.00
|
| Rate for Payer: Blue Shield of California EPN |
$2.52
|
| Rate for Payer: Cash Price |
$2.84
|
| Rate for Payer: Central Health Plan Commercial |
$5.05
|
| Rate for Payer: Cigna of CA HMO |
$4.04
|
| Rate for Payer: Cigna of CA PPO |
$4.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.52
|
| Rate for Payer: EPIC Health Plan Senior |
$2.52
|
| Rate for Payer: Galaxy Health WC |
$5.36
|
| Rate for Payer: Global Benefits Group Commercial |
$3.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.42
|
| Rate for Payer: Multiplan Commercial |
$4.73
|
| Rate for Payer: Networks By Design Commercial |
$4.10
|
| Rate for Payer: Prime Health Services Commercial |
$5.36
|
| Rate for Payer: Riverside University Health System MISP |
$2.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.15
|
| Rate for Payer: United Healthcare All Other HMO |
$3.15
|
| Rate for Payer: United Healthcare HMO Rider |
$3.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.36
|
| Rate for Payer: Vantage Medical Group Senior |
$5.36
|
|
