|
HC RANGE OF MOTION MEAS LIMB/TRUNK MCAL
|
Facility
|
OP
|
$308.00
|
|
|
Service Code
|
CPT 95851
|
| Hospital Charge Code |
901300031
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$28.23 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$44.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$261.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$169.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$169.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$133.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$184.80
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Central Health Plan Commercial |
$246.40
|
| Rate for Payer: Cigna of CA HMO |
$197.12
|
| Rate for Payer: Cigna of CA PPO |
$227.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$261.80
|
| Rate for Payer: Dignity Health Media |
$261.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$261.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$123.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$123.20
|
| Rate for Payer: Galaxy Health WC |
$261.80
|
| Rate for Payer: Global Benefits Group Commercial |
$184.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$277.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$231.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$107.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$205.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.28
|
| Rate for Payer: Multiplan Commercial |
$231.00
|
| Rate for Payer: Networks By Design Commercial |
$200.20
|
| Rate for Payer: Prime Health Services Commercial |
$261.80
|
| Rate for Payer: Riverside University Health System MISP |
$123.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$184.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$184.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$261.80
|
| Rate for Payer: Vantage Medical Group Senior |
$261.80
|
|
|
HC RANGE OF MOTION MEAS LIMB TRUNK OT
|
Facility
|
OP
|
$308.00
|
|
|
Service Code
|
CPT 95851
|
| Hospital Charge Code |
905104406
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$28.23 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$44.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$261.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$169.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$169.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$133.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$184.80
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Central Health Plan Commercial |
$246.40
|
| Rate for Payer: Cigna of CA HMO |
$197.12
|
| Rate for Payer: Cigna of CA PPO |
$227.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$261.80
|
| Rate for Payer: Dignity Health Media |
$261.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$261.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$123.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$123.20
|
| Rate for Payer: Galaxy Health WC |
$261.80
|
| Rate for Payer: Global Benefits Group Commercial |
$184.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$277.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$231.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$107.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$205.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.28
|
| Rate for Payer: Multiplan Commercial |
$231.00
|
| Rate for Payer: Networks By Design Commercial |
$200.20
|
| Rate for Payer: Prime Health Services Commercial |
$261.80
|
| Rate for Payer: Riverside University Health System MISP |
$123.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$184.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$184.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$261.80
|
| Rate for Payer: Vantage Medical Group Senior |
$261.80
|
|
|
HC RANGE OF MOTION MEAS LIMB TRUNK OT
|
Facility
|
IP
|
$308.00
|
|
|
Service Code
|
CPT 95851
|
| Hospital Charge Code |
905104406
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$61.60 |
| Max. Negotiated Rate |
$277.20 |
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Central Health Plan Commercial |
$246.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$123.20
|
| Rate for Payer: Galaxy Health WC |
$261.80
|
| Rate for Payer: Global Benefits Group Commercial |
$184.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$277.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$205.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$117.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.60
|
| Rate for Payer: Multiplan Commercial |
$231.00
|
| Rate for Payer: Networks By Design Commercial |
$200.20
|
| Rate for Payer: Prime Health Services Commercial |
$261.80
|
|
|
HC RAPID RHINO 4.5CM W/OUT AIRWAY
|
Facility
|
OP
|
$256.90
|
|
| Hospital Charge Code |
901607371
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$51.38 |
| Max. Negotiated Rate |
$231.21 |
| Rate for Payer: Aetna of CA HMO/PPO |
$156.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$218.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$141.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$141.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$124.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$151.78
|
| Rate for Payer: Blue Distinction Transplant |
$154.14
|
| Rate for Payer: Blue Shield of California Commercial |
$161.59
|
| Rate for Payer: Blue Shield of California EPN |
$125.62
|
| Rate for Payer: Cash Price |
$115.61
|
| Rate for Payer: Central Health Plan Commercial |
$205.52
|
| Rate for Payer: Cigna of CA HMO |
$164.42
|
| Rate for Payer: Cigna of CA PPO |
$190.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$218.36
|
| Rate for Payer: Dignity Health Media |
$218.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$102.76
|
| Rate for Payer: Galaxy Health WC |
$218.36
|
| Rate for Payer: Global Benefits Group Commercial |
$154.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$231.21
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$192.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$89.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$171.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.38
|
| Rate for Payer: Multiplan Commercial |
$192.68
|
| Rate for Payer: Networks By Design Commercial |
$166.98
|
| Rate for Payer: Prime Health Services Commercial |
$218.36
|
| Rate for Payer: Riverside University Health System MISP |
$102.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$154.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$154.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$128.45
|
| Rate for Payer: United Healthcare All Other HMO |
$128.45
|
| Rate for Payer: United Healthcare HMO Rider |
$128.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$128.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.36
|
| Rate for Payer: Vantage Medical Group Senior |
$218.36
|
|
|
HC RAPID RHINO 4.5CM W/OUT AIRWAY
|
Facility
|
IP
|
$256.90
|
|
| Hospital Charge Code |
901607371
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$51.38 |
| Max. Negotiated Rate |
$231.21 |
| Rate for Payer: Cash Price |
$115.61
|
| Rate for Payer: Central Health Plan Commercial |
$205.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.76
|
| Rate for Payer: Galaxy Health WC |
$218.36
|
| Rate for Payer: Global Benefits Group Commercial |
$154.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$231.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$171.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.38
|
| Rate for Payer: Multiplan Commercial |
$192.68
|
| Rate for Payer: Networks By Design Commercial |
$166.98
|
| Rate for Payer: Prime Health Services Commercial |
$218.36
|
|
|
HC RBC ANTIBODY ADSORPTION
|
Facility
|
IP
|
$641.00
|
|
|
Service Code
|
CPT 86978
|
| Hospital Charge Code |
900904453
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$128.20 |
| Max. Negotiated Rate |
$576.90 |
| Rate for Payer: Cash Price |
$288.45
|
| Rate for Payer: Central Health Plan Commercial |
$512.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$256.40
|
| Rate for Payer: Galaxy Health WC |
$544.85
|
| Rate for Payer: Global Benefits Group Commercial |
$384.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$576.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$427.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$244.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.20
|
| Rate for Payer: Multiplan Commercial |
$480.75
|
| Rate for Payer: Networks By Design Commercial |
$416.65
|
| Rate for Payer: Prime Health Services Commercial |
$544.85
|
|
|
HC RBC ANTIBODY ADSORPTION
|
Facility
|
OP
|
$641.00
|
|
|
Service Code
|
CPT 86978
|
| Hospital Charge Code |
900904453
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$576.90 |
| Rate for Payer: Adventist Health Medi-Cal |
$76.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$131.79
|
| 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 |
$130.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$159.69
|
| Rate for Payer: Blue Distinction Transplant |
$384.60
|
| Rate for Payer: Blue Shield of California Commercial |
$396.14
|
| Rate for Payer: Blue Shield of California EPN |
$311.53
|
| Rate for Payer: Caremore Medicare Advantage |
$76.42
|
| Rate for Payer: Cash Price |
$288.45
|
| Rate for Payer: Cash Price |
$288.45
|
| Rate for Payer: Central Health Plan Commercial |
$512.80
|
| Rate for Payer: Cigna of CA HMO |
$410.24
|
| Rate for Payer: Cigna of CA PPO |
$474.34
|
| 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 |
$544.85
|
| Rate for Payer: Global Benefits Group Commercial |
$384.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$576.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$480.75
|
| 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 |
$427.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.20
|
| 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 |
$480.75
|
| Rate for Payer: Networks By Design Commercial |
$416.65
|
| Rate for Payer: Prime Health Services Commercial |
$544.85
|
| 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 |
$384.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$384.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28.00
|
| Rate for Payer: United Healthcare HMO Rider |
$28.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.00
|
| 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 RBC ANTIBODY ELUTION
|
Facility
|
OP
|
$641.00
|
|
|
Service Code
|
CPT 86860
|
| Hospital Charge Code |
900904452
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.68 |
| Max. Negotiated Rate |
$576.90 |
| Rate for Payer: Adventist Health Medi-Cal |
$213.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$118.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$320.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$234.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$213.41
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$196.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$239.56
|
| Rate for Payer: Blue Distinction Transplant |
$384.60
|
| Rate for Payer: Blue Shield of California Commercial |
$396.14
|
| Rate for Payer: Blue Shield of California EPN |
$311.53
|
| Rate for Payer: Caremore Medicare Advantage |
$213.41
|
| Rate for Payer: Cash Price |
$288.45
|
| Rate for Payer: Cash Price |
$288.45
|
| Rate for Payer: Central Health Plan Commercial |
$512.80
|
| Rate for Payer: Cigna of CA HMO |
$410.24
|
| Rate for Payer: Cigna of CA PPO |
$474.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$320.12
|
| Rate for Payer: Dignity Health Media |
$213.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$234.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$288.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$213.41
|
| Rate for Payer: EPIC Health Plan Transplant |
$213.41
|
| Rate for Payer: Galaxy Health WC |
$544.85
|
| Rate for Payer: Global Benefits Group Commercial |
$384.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$576.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$480.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$349.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$352.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$213.41
|
| Rate for Payer: InnovAge PACE Commercial |
$320.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$427.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$213.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$285.97
|
| Rate for Payer: Multiplan Commercial |
$480.75
|
| Rate for Payer: Networks By Design Commercial |
$416.65
|
| Rate for Payer: Prime Health Services Commercial |
$544.85
|
| Rate for Payer: Prime Health Services Medicare |
$226.21
|
| Rate for Payer: Riverside University Health System MISP |
$234.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$384.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$384.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.38
|
| Rate for Payer: United Healthcare All Other HMO |
$123.38
|
| Rate for Payer: United Healthcare HMO Rider |
$123.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$320.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$234.75
|
| Rate for Payer: Vantage Medical Group Senior |
$213.41
|
|
|
HC RBC ANTIBODY ELUTION
|
Facility
|
IP
|
$641.00
|
|
|
Service Code
|
CPT 86860
|
| Hospital Charge Code |
900904452
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$128.20 |
| Max. Negotiated Rate |
$576.90 |
| Rate for Payer: Cash Price |
$288.45
|
| Rate for Payer: Central Health Plan Commercial |
$512.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$256.40
|
| Rate for Payer: Galaxy Health WC |
$544.85
|
| Rate for Payer: Global Benefits Group Commercial |
$384.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$576.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$427.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$244.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.20
|
| Rate for Payer: Multiplan Commercial |
$480.75
|
| Rate for Payer: Networks By Design Commercial |
$416.65
|
| Rate for Payer: Prime Health Services Commercial |
$544.85
|
|
|
HC RBC PED PAK ALIQUOT
|
Facility
|
IP
|
$677.00
|
|
|
Service Code
|
CPT P9011
|
| Hospital Charge Code |
900904531
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$135.40 |
| Max. Negotiated Rate |
$609.30 |
| Rate for Payer: Cash Price |
$304.65
|
| Rate for Payer: Central Health Plan Commercial |
$541.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$270.80
|
| Rate for Payer: Galaxy Health WC |
$575.45
|
| Rate for Payer: Global Benefits Group Commercial |
$406.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$609.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$451.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$257.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.40
|
| Rate for Payer: Multiplan Commercial |
$507.75
|
| Rate for Payer: Networks By Design Commercial |
$440.05
|
| Rate for Payer: Prime Health Services Commercial |
$575.45
|
|
|
HC RBC PED PAK ALIQUOT
|
Facility
|
OP
|
$677.00
|
|
|
Service Code
|
CPT P9011
|
| Hospital Charge Code |
900904531
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$135.40 |
| Max. Negotiated Rate |
$642.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$195.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$338.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$293.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$215.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$195.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$327.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$399.97
|
| Rate for Payer: Blue Distinction Transplant |
$406.20
|
| Rate for Payer: Blue Shield of California Commercial |
$425.83
|
| Rate for Payer: Blue Shield of California EPN |
$331.05
|
| Rate for Payer: Caremore Medicare Advantage |
$195.48
|
| Rate for Payer: Cash Price |
$304.65
|
| Rate for Payer: Cash Price |
$304.65
|
| Rate for Payer: Cash Price |
$304.65
|
| Rate for Payer: Central Health Plan Commercial |
$541.60
|
| Rate for Payer: Cigna of CA HMO |
$433.28
|
| Rate for Payer: Cigna of CA PPO |
$500.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$293.22
|
| Rate for Payer: Dignity Health Media |
$195.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$215.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$263.90
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$195.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$195.48
|
| Rate for Payer: Galaxy Health WC |
$575.45
|
| Rate for Payer: Global Benefits Group Commercial |
$406.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$609.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$507.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$320.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$322.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$195.48
|
| Rate for Payer: InnovAge PACE Commercial |
$293.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$451.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$283.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$195.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$261.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$261.94
|
| Rate for Payer: Multiplan Commercial |
$507.75
|
| Rate for Payer: Networks By Design Commercial |
$440.05
|
| Rate for Payer: Prime Health Services Commercial |
$575.45
|
| Rate for Payer: Prime Health Services Medicare |
$207.21
|
| Rate for Payer: Riverside University Health System MISP |
$215.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$406.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$406.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$642.00
|
| Rate for Payer: United Healthcare All Other HMO |
$631.00
|
| Rate for Payer: United Healthcare HMO Rider |
$630.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$575.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$293.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$215.03
|
| Rate for Payer: Vantage Medical Group Senior |
$195.48
|
|
|
HC RDLGC SM INT FLW THRGH STDY
|
Facility
|
IP
|
$954.00
|
|
|
Service Code
|
CPT 74248
|
| Hospital Charge Code |
909004248
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$190.80 |
| Max. Negotiated Rate |
$858.60 |
| Rate for Payer: Cash Price |
$429.30
|
| Rate for Payer: Central Health Plan Commercial |
$763.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$381.60
|
| Rate for Payer: Galaxy Health WC |
$810.90
|
| Rate for Payer: Global Benefits Group Commercial |
$572.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$858.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$636.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$363.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.80
|
| Rate for Payer: Multiplan Commercial |
$715.50
|
| Rate for Payer: Networks By Design Commercial |
$620.10
|
| Rate for Payer: Prime Health Services Commercial |
$810.90
|
|
|
HC RDLGC SM INT FLW THRGH STDY
|
Facility
|
OP
|
$954.00
|
|
|
Service Code
|
CPT 74248
|
| Hospital Charge Code |
909004248
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$142.04 |
| Max. Negotiated Rate |
$858.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$271.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$810.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$524.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$524.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$264.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$323.19
|
| Rate for Payer: Blue Distinction Transplant |
$572.40
|
| Rate for Payer: Blue Shield of California Commercial |
$589.57
|
| Rate for Payer: Blue Shield of California EPN |
$463.64
|
| Rate for Payer: Cash Price |
$429.30
|
| Rate for Payer: Cash Price |
$429.30
|
| Rate for Payer: Central Health Plan Commercial |
$763.20
|
| Rate for Payer: Cigna of CA HMO |
$610.56
|
| Rate for Payer: Cigna of CA PPO |
$705.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$810.90
|
| Rate for Payer: Dignity Health Media |
$810.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$810.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$381.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$381.60
|
| Rate for Payer: Galaxy Health WC |
$810.90
|
| Rate for Payer: Global Benefits Group Commercial |
$572.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$858.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$715.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$333.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$636.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.80
|
| Rate for Payer: Multiplan Commercial |
$715.50
|
| Rate for Payer: Networks By Design Commercial |
$620.10
|
| Rate for Payer: Prime Health Services Commercial |
$810.90
|
| Rate for Payer: Riverside University Health System MISP |
$381.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$572.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$572.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$477.00
|
| Rate for Payer: United Healthcare All Other HMO |
$477.00
|
| Rate for Payer: United Healthcare HMO Rider |
$477.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$477.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$810.90
|
| Rate for Payer: Vantage Medical Group Senior |
$810.90
|
|
|
HC RDLGC XM ESPHGS DBL CNTST STY
|
Facility
|
IP
|
$1,198.00
|
|
|
Service Code
|
CPT 74221
|
| Hospital Charge Code |
909004221
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$239.60 |
| Max. Negotiated Rate |
$1,078.20 |
| Rate for Payer: Cash Price |
$539.10
|
| Rate for Payer: Central Health Plan Commercial |
$958.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$479.20
|
| Rate for Payer: Galaxy Health WC |
$1,018.30
|
| Rate for Payer: Global Benefits Group Commercial |
$718.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,078.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$799.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$456.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$239.60
|
| Rate for Payer: Multiplan Commercial |
$898.50
|
| Rate for Payer: Networks By Design Commercial |
$778.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,018.30
|
|
|
HC RDLGC XM ESPHGS DBL CNTST STY
|
Facility
|
OP
|
$1,198.00
|
|
|
Service Code
|
CPT 74221
|
| Hospital Charge Code |
909004221
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$188.84 |
| Max. Negotiated Rate |
$1,078.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$229.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$421.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$411.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$502.17
|
| Rate for Payer: Blue Distinction Transplant |
$718.80
|
| Rate for Payer: Blue Shield of California Commercial |
$740.36
|
| Rate for Payer: Blue Shield of California EPN |
$582.23
|
| Rate for Payer: Caremore Medicare Advantage |
$229.56
|
| Rate for Payer: Cash Price |
$539.10
|
| Rate for Payer: Cash Price |
$539.10
|
| Rate for Payer: Central Health Plan Commercial |
$958.40
|
| Rate for Payer: Cigna of CA HMO |
$766.72
|
| Rate for Payer: Cigna of CA PPO |
$886.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: Dignity Health Media |
$229.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$229.56
|
| Rate for Payer: Galaxy Health WC |
$1,018.30
|
| Rate for Payer: Global Benefits Group Commercial |
$718.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,078.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$898.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$376.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$378.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$229.56
|
| Rate for Payer: InnovAge PACE Commercial |
$344.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$799.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$188.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$239.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$307.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$307.61
|
| Rate for Payer: Multiplan Commercial |
$898.50
|
| Rate for Payer: Networks By Design Commercial |
$778.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,018.30
|
| Rate for Payer: Prime Health Services Medicare |
$243.33
|
| Rate for Payer: Riverside University Health System MISP |
$252.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$718.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$718.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$466.43
|
| Rate for Payer: United Healthcare All Other HMO |
$466.43
|
| Rate for Payer: United Healthcare HMO Rider |
$466.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$466.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
HC RDLGC XM ESPHGS SNGL CNTST STY
|
Facility
|
OP
|
$1,198.00
|
|
|
Service Code
|
CPT 74220
|
| Hospital Charge Code |
909004220
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$72.37 |
| Max. Negotiated Rate |
$1,078.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$229.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$379.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$231.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$282.33
|
| Rate for Payer: Blue Distinction Transplant |
$718.80
|
| Rate for Payer: Blue Shield of California Commercial |
$740.36
|
| Rate for Payer: Blue Shield of California EPN |
$582.23
|
| Rate for Payer: Caremore Medicare Advantage |
$229.56
|
| Rate for Payer: Cash Price |
$539.10
|
| Rate for Payer: Cash Price |
$539.10
|
| Rate for Payer: Central Health Plan Commercial |
$958.40
|
| Rate for Payer: Cigna of CA HMO |
$766.72
|
| Rate for Payer: Cigna of CA PPO |
$886.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: Dignity Health Media |
$229.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$229.56
|
| Rate for Payer: Galaxy Health WC |
$1,018.30
|
| Rate for Payer: Global Benefits Group Commercial |
$718.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,078.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$898.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$376.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$378.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$229.56
|
| Rate for Payer: InnovAge PACE Commercial |
$344.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$799.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$239.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$307.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$307.61
|
| Rate for Payer: Multiplan Commercial |
$898.50
|
| Rate for Payer: Networks By Design Commercial |
$778.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,018.30
|
| Rate for Payer: Prime Health Services Medicare |
$243.33
|
| Rate for Payer: Riverside University Health System MISP |
$252.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$718.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$718.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$219.73
|
| Rate for Payer: United Healthcare All Other HMO |
$219.73
|
| Rate for Payer: United Healthcare HMO Rider |
$219.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$219.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
HC RDLGC XM ESPHGS SNGL CNTST STY
|
Facility
|
IP
|
$1,198.00
|
|
|
Service Code
|
CPT 74220
|
| Hospital Charge Code |
909004220
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$239.60 |
| Max. Negotiated Rate |
$1,078.20 |
| Rate for Payer: Cash Price |
$539.10
|
| Rate for Payer: Central Health Plan Commercial |
$958.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$479.20
|
| Rate for Payer: Galaxy Health WC |
$1,018.30
|
| Rate for Payer: Global Benefits Group Commercial |
$718.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,078.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$799.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$456.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$239.60
|
| Rate for Payer: Multiplan Commercial |
$898.50
|
| Rate for Payer: Networks By Design Commercial |
$778.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,018.30
|
|
|
HC RDLGC XM UPR GI TRC DBL CNTST
|
Facility
|
IP
|
$996.00
|
|
|
Service Code
|
CPT 74246
|
| Hospital Charge Code |
909004246
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$199.20 |
| Max. Negotiated Rate |
$896.40 |
| Rate for Payer: Cash Price |
$448.20
|
| Rate for Payer: Central Health Plan Commercial |
$796.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$398.40
|
| Rate for Payer: Galaxy Health WC |
$846.60
|
| Rate for Payer: Global Benefits Group Commercial |
$597.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$896.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$664.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$379.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$199.20
|
| Rate for Payer: Multiplan Commercial |
$747.00
|
| Rate for Payer: Networks By Design Commercial |
$647.40
|
| Rate for Payer: Prime Health Services Commercial |
$846.60
|
|
|
HC RDLGC XM UPR GI TRC DBL CNTST
|
Facility
|
OP
|
$996.00
|
|
|
Service Code
|
CPT 74246
|
| Hospital Charge Code |
909004246
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$199.20 |
| Max. Negotiated Rate |
$896.40 |
| Rate for Payer: Adventist Health Medi-Cal |
$229.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$486.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$344.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$419.85
|
| Rate for Payer: Blue Distinction Transplant |
$597.60
|
| Rate for Payer: Blue Shield of California Commercial |
$615.53
|
| Rate for Payer: Blue Shield of California EPN |
$484.06
|
| Rate for Payer: Caremore Medicare Advantage |
$229.56
|
| Rate for Payer: Cash Price |
$448.20
|
| Rate for Payer: Cash Price |
$448.20
|
| Rate for Payer: Central Health Plan Commercial |
$796.80
|
| Rate for Payer: Cigna of CA HMO |
$637.44
|
| Rate for Payer: Cigna of CA PPO |
$737.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: Dignity Health Media |
$229.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$229.56
|
| Rate for Payer: Galaxy Health WC |
$846.60
|
| Rate for Payer: Global Benefits Group Commercial |
$597.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$896.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$747.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$376.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$378.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$229.56
|
| Rate for Payer: InnovAge PACE Commercial |
$344.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$664.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$218.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$199.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$307.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$307.61
|
| Rate for Payer: Multiplan Commercial |
$747.00
|
| Rate for Payer: Networks By Design Commercial |
$647.40
|
| Rate for Payer: Prime Health Services Commercial |
$846.60
|
| Rate for Payer: Prime Health Services Medicare |
$243.33
|
| Rate for Payer: Riverside University Health System MISP |
$252.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$597.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$597.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$219.73
|
| Rate for Payer: United Healthcare All Other HMO |
$219.73
|
| Rate for Payer: United Healthcare HMO Rider |
$219.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$219.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
HC RDLGC XM UPR GI TRC SNGL CNTST
|
Facility
|
OP
|
$1,115.00
|
|
|
Service Code
|
CPT 74240
|
| Hospital Charge Code |
909004240
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$193.86 |
| Max. Negotiated Rate |
$1,003.50 |
| Rate for Payer: Adventist Health Medi-Cal |
$229.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$436.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$305.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$372.12
|
| Rate for Payer: Blue Distinction Transplant |
$669.00
|
| Rate for Payer: Blue Shield of California Commercial |
$689.07
|
| Rate for Payer: Blue Shield of California EPN |
$541.89
|
| Rate for Payer: Caremore Medicare Advantage |
$229.56
|
| Rate for Payer: Cash Price |
$501.75
|
| Rate for Payer: Cash Price |
$501.75
|
| Rate for Payer: Central Health Plan Commercial |
$892.00
|
| Rate for Payer: Cigna of CA HMO |
$713.60
|
| Rate for Payer: Cigna of CA PPO |
$825.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: Dignity Health Media |
$229.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$229.56
|
| Rate for Payer: Galaxy Health WC |
$947.75
|
| Rate for Payer: Global Benefits Group Commercial |
$669.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,003.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$836.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$376.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$378.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$229.56
|
| Rate for Payer: InnovAge PACE Commercial |
$344.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$743.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$193.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$307.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$307.61
|
| Rate for Payer: Multiplan Commercial |
$836.25
|
| Rate for Payer: Networks By Design Commercial |
$724.75
|
| Rate for Payer: Prime Health Services Commercial |
$947.75
|
| Rate for Payer: Prime Health Services Medicare |
$243.33
|
| Rate for Payer: Riverside University Health System MISP |
$252.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$669.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$669.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$219.73
|
| Rate for Payer: United Healthcare All Other HMO |
$219.73
|
| Rate for Payer: United Healthcare HMO Rider |
$219.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$219.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
HC RDLGC XM UPR GI TRC SNGL CNTST
|
Facility
|
IP
|
$1,115.00
|
|
|
Service Code
|
CPT 74240
|
| Hospital Charge Code |
909004240
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$223.00 |
| Max. Negotiated Rate |
$1,003.50 |
| Rate for Payer: Cash Price |
$501.75
|
| Rate for Payer: Central Health Plan Commercial |
$892.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$446.00
|
| Rate for Payer: Galaxy Health WC |
$947.75
|
| Rate for Payer: Global Benefits Group Commercial |
$669.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,003.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$743.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$424.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.00
|
| Rate for Payer: Multiplan Commercial |
$836.25
|
| Rate for Payer: Networks By Design Commercial |
$724.75
|
| Rate for Payer: Prime Health Services Commercial |
$947.75
|
|
|
HC RECLINING MOBILE ARM SUPPORT
|
Facility
|
IP
|
$1,107.00
|
|
|
Service Code
|
CPT L3966
|
| Hospital Charge Code |
903203966
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$221.40 |
| Max. Negotiated Rate |
$996.30 |
| Rate for Payer: Cash Price |
$498.15
|
| Rate for Payer: Central Health Plan Commercial |
$885.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$442.80
|
| Rate for Payer: Galaxy Health WC |
$940.95
|
| Rate for Payer: Global Benefits Group Commercial |
$664.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$996.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$738.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$421.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.40
|
| Rate for Payer: Multiplan Commercial |
$830.25
|
| Rate for Payer: Networks By Design Commercial |
$719.55
|
| Rate for Payer: Prime Health Services Commercial |
$940.95
|
|
|
HC RECLINING MOBILE ARM SUPPORT
|
Facility
|
OP
|
$1,107.00
|
|
|
Service Code
|
CPT L3966
|
| Hospital Charge Code |
903203966
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$221.40 |
| Max. Negotiated Rate |
$996.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$672.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$940.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$608.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$608.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$536.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$654.02
|
| Rate for Payer: Blue Distinction Transplant |
$664.20
|
| Rate for Payer: Blue Shield of California Commercial |
$696.30
|
| Rate for Payer: Blue Shield of California EPN |
$541.32
|
| Rate for Payer: Cash Price |
$498.15
|
| Rate for Payer: Central Health Plan Commercial |
$885.60
|
| Rate for Payer: Cigna of CA HMO |
$708.48
|
| Rate for Payer: Cigna of CA PPO |
$819.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$940.95
|
| Rate for Payer: Dignity Health Media |
$940.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$940.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$442.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$442.80
|
| Rate for Payer: Galaxy Health WC |
$940.95
|
| Rate for Payer: Global Benefits Group Commercial |
$664.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$996.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$830.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$387.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$738.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$421.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.40
|
| Rate for Payer: Multiplan Commercial |
$830.25
|
| Rate for Payer: Networks By Design Commercial |
$719.55
|
| Rate for Payer: Prime Health Services Commercial |
$940.95
|
| Rate for Payer: Riverside University Health System MISP |
$442.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$664.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$664.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$553.50
|
| Rate for Payer: United Healthcare All Other HMO |
$553.50
|
| Rate for Payer: United Healthcare HMO Rider |
$553.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$553.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$940.95
|
| Rate for Payer: Vantage Medical Group Senior |
$940.95
|
|
|
HC RECOVERY LEVEL I FIRST HR
|
Facility
|
OP
|
$1,853.00
|
|
| Hospital Charge Code |
907201701
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$370.60 |
| Max. Negotiated Rate |
$1,667.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,125.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,575.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,019.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,019.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$897.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,094.75
|
| Rate for Payer: Blue Distinction Transplant |
$1,111.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,165.54
|
| Rate for Payer: Blue Shield of California EPN |
$906.12
|
| Rate for Payer: Cash Price |
$833.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,482.40
|
| Rate for Payer: Cigna of CA HMO |
$1,185.92
|
| Rate for Payer: Cigna of CA PPO |
$1,371.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,575.05
|
| Rate for Payer: Dignity Health Media |
$1,575.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,575.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$741.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$741.20
|
| Rate for Payer: Galaxy Health WC |
$1,575.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,111.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,667.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,389.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$648.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,235.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$705.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$370.60
|
| Rate for Payer: Multiplan Commercial |
$1,389.75
|
| Rate for Payer: Networks By Design Commercial |
$1,204.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,575.05
|
| Rate for Payer: Riverside University Health System MISP |
$741.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,111.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,111.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$926.50
|
| Rate for Payer: United Healthcare All Other HMO |
$926.50
|
| Rate for Payer: United Healthcare HMO Rider |
$926.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$926.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,575.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1,575.05
|
|
|
HC RECOVERY LEVEL I FIRST HR
|
Facility
|
IP
|
$1,853.00
|
|
| Hospital Charge Code |
907201701
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$370.60 |
| Max. Negotiated Rate |
$1,667.70 |
| Rate for Payer: Cash Price |
$833.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,482.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$741.20
|
| Rate for Payer: Galaxy Health WC |
$1,575.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,111.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,667.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,235.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$705.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$370.60
|
| Rate for Payer: Multiplan Commercial |
$1,389.75
|
| Rate for Payer: Networks By Design Commercial |
$1,204.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,575.05
|
|
