|
HC ROOM TRAUMA ICU ISOLATION
|
Facility
|
IP
|
$28,732.00
|
|
| Hospital Charge Code |
902314715
|
|
Hospital Revenue Code
|
209
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$25,858.80 |
| Rate for Payer: Adventist Health Commercial |
$5,746.40
|
| Rate for Payer: Blue Shield of California Commercial |
$13,860.00
|
| Rate for Payer: Blue Shield of California EPN |
$9,086.00
|
| Rate for Payer: Cash Price |
$12,929.40
|
| Rate for Payer: Cash Price |
$12,929.40
|
| Rate for Payer: Cash Price |
$12,929.40
|
| Rate for Payer: Central Health Plan Commercial |
$22,985.60
|
| Rate for Payer: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,492.80
|
| Rate for Payer: EPIC Health Plan Senior |
$11,492.80
|
| Rate for Payer: Galaxy Health WC |
$24,422.20
|
| Rate for Payer: Global Benefits Group Commercial |
$17,239.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$25,858.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,650.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,164.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,946.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,785.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,746.40
|
| Rate for Payer: Multiplan Commercial |
$21,549.00
|
| Rate for Payer: Prime Health Services Commercial |
$24,422.20
|
|
|
HC ROOM TRAUMA ICU ISOLATION 1:1
|
Facility
|
IP
|
$28,732.00
|
|
| Hospital Charge Code |
992314715
|
|
Hospital Revenue Code
|
209
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$25,858.80 |
| Rate for Payer: Adventist Health Commercial |
$5,746.40
|
| Rate for Payer: Blue Shield of California Commercial |
$13,860.00
|
| Rate for Payer: Blue Shield of California EPN |
$9,086.00
|
| Rate for Payer: Cash Price |
$12,929.40
|
| Rate for Payer: Cash Price |
$12,929.40
|
| Rate for Payer: Cash Price |
$12,929.40
|
| Rate for Payer: Central Health Plan Commercial |
$22,985.60
|
| Rate for Payer: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,492.80
|
| Rate for Payer: EPIC Health Plan Senior |
$11,492.80
|
| Rate for Payer: Galaxy Health WC |
$24,422.20
|
| Rate for Payer: Global Benefits Group Commercial |
$17,239.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$25,858.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,650.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,164.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,946.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,785.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,746.40
|
| Rate for Payer: Multiplan Commercial |
$21,549.00
|
| Rate for Payer: Prime Health Services Commercial |
$24,422.20
|
|
|
HC ROTABLATOR ADVANCER
|
Facility
|
OP
|
$2,201.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081507
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$440.20 |
| Max. Negotiated Rate |
$1,980.90 |
| Rate for Payer: Adventist Health Commercial |
$440.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,870.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,210.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,650.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,004.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,218.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,701.37
|
| Rate for Payer: Blue Shield of California EPN |
$1,109.30
|
| Rate for Payer: Cash Price |
$990.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,760.80
|
| Rate for Payer: Cigna of CA HMO |
$1,540.70
|
| Rate for Payer: Cigna of CA PPO |
$1,540.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,870.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,870.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,870.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$880.40
|
| Rate for Payer: EPIC Health Plan Senior |
$880.40
|
| Rate for Payer: Galaxy Health WC |
$1,870.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,320.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,980.90
|
| Rate for Payer: InnovAge PACE Commercial |
$1,100.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,468.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$838.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,362.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$440.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,540.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,540.70
|
| Rate for Payer: Multiplan Commercial |
$1,650.75
|
| Rate for Payer: Networks By Design Commercial |
$1,100.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,870.85
|
| Rate for Payer: Riverside University Health System MISP |
$880.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,320.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,320.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$826.04
|
| Rate for Payer: United Healthcare All Other HMO |
$804.03
|
| Rate for Payer: United Healthcare HMO Rider |
$786.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$720.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,870.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,870.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,870.85
|
|
|
HC ROTABLATOR ADVANCER
|
Facility
|
IP
|
$2,201.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081507
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$440.20 |
| Max. Negotiated Rate |
$1,980.90 |
| Rate for Payer: Adventist Health Commercial |
$440.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,701.37
|
| Rate for Payer: Blue Shield of California EPN |
$1,109.30
|
| Rate for Payer: Cash Price |
$990.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,760.80
|
| Rate for Payer: Cigna of CA HMO |
$1,540.70
|
| Rate for Payer: Cigna of CA PPO |
$1,540.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$880.40
|
| Rate for Payer: EPIC Health Plan Senior |
$880.40
|
| Rate for Payer: Galaxy Health WC |
$1,870.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,320.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,980.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,468.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$838.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,362.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$440.20
|
| Rate for Payer: Multiplan Commercial |
$1,650.75
|
| Rate for Payer: Networks By Design Commercial |
$1,100.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,870.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$826.04
|
| Rate for Payer: United Healthcare All Other HMO |
$804.03
|
| Rate for Payer: United Healthcare HMO Rider |
$786.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$720.83
|
|
|
HC ROTABLATOR GUIDE WIRE
|
Facility
|
OP
|
$535.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081508
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$107.00 |
| Max. Negotiated Rate |
$481.50 |
| Rate for Payer: Adventist Health Commercial |
$107.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$324.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$454.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$401.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$259.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$314.21
|
| Rate for Payer: Blue Shield of California Commercial |
$326.88
|
| Rate for Payer: Blue Shield of California EPN |
$213.47
|
| Rate for Payer: Cash Price |
$240.75
|
| Rate for Payer: Central Health Plan Commercial |
$428.00
|
| Rate for Payer: Cigna of CA HMO |
$342.40
|
| Rate for Payer: Cigna of CA PPO |
$395.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$454.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$454.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$454.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$214.00
|
| Rate for Payer: EPIC Health Plan Senior |
$214.00
|
| Rate for Payer: Galaxy Health WC |
$454.75
|
| Rate for Payer: Global Benefits Group Commercial |
$321.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$481.50
|
| Rate for Payer: InnovAge PACE Commercial |
$267.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$356.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$203.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$331.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$374.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$374.50
|
| Rate for Payer: Multiplan Commercial |
$401.25
|
| Rate for Payer: Networks By Design Commercial |
$347.75
|
| Rate for Payer: Prime Health Services Commercial |
$454.75
|
| Rate for Payer: Riverside University Health System MISP |
$214.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$321.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$321.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$267.50
|
| Rate for Payer: United Healthcare All Other HMO |
$267.50
|
| Rate for Payer: United Healthcare HMO Rider |
$267.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$267.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$454.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$454.75
|
| Rate for Payer: Vantage Medical Group Senior |
$454.75
|
|
|
HC ROTABLATOR GUIDE WIRE
|
Facility
|
IP
|
$535.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081508
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$107.00 |
| Max. Negotiated Rate |
$481.50 |
| Rate for Payer: Adventist Health Commercial |
$107.00
|
| Rate for Payer: Cash Price |
$240.75
|
| Rate for Payer: Central Health Plan Commercial |
$428.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$214.00
|
| Rate for Payer: EPIC Health Plan Senior |
$214.00
|
| Rate for Payer: Galaxy Health WC |
$454.75
|
| Rate for Payer: Global Benefits Group Commercial |
$321.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$481.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$356.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$203.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$331.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.00
|
| Rate for Payer: Multiplan Commercial |
$401.25
|
| Rate for Payer: Networks By Design Commercial |
$347.75
|
| Rate for Payer: Prime Health Services Commercial |
$454.75
|
|
|
HC ROTATABLE OVAL SNARE
|
Facility
|
OP
|
$1,404.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
900803816
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$280.80 |
| Max. Negotiated Rate |
$1,263.60 |
| Rate for Payer: Adventist Health Commercial |
$280.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$852.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,193.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$772.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,053.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$679.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$824.57
|
| Rate for Payer: Blue Shield of California Commercial |
$857.84
|
| Rate for Payer: Blue Shield of California EPN |
$560.20
|
| Rate for Payer: Cash Price |
$631.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,123.20
|
| Rate for Payer: Cigna of CA HMO |
$898.56
|
| Rate for Payer: Cigna of CA PPO |
$1,038.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,193.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,193.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,193.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$561.60
|
| Rate for Payer: EPIC Health Plan Senior |
$561.60
|
| Rate for Payer: Galaxy Health WC |
$1,193.40
|
| Rate for Payer: Global Benefits Group Commercial |
$842.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,263.60
|
| Rate for Payer: InnovAge PACE Commercial |
$702.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$936.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$534.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$869.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$280.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$982.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$982.80
|
| Rate for Payer: Multiplan Commercial |
$1,053.00
|
| Rate for Payer: Networks By Design Commercial |
$912.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,193.40
|
| Rate for Payer: Riverside University Health System MISP |
$561.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$842.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$842.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$702.00
|
| Rate for Payer: United Healthcare All Other HMO |
$702.00
|
| Rate for Payer: United Healthcare HMO Rider |
$702.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$702.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,193.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,193.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,193.40
|
|
|
HC ROTATABLE OVAL SNARE
|
Facility
|
IP
|
$1,404.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
900803816
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$280.80 |
| Max. Negotiated Rate |
$1,263.60 |
| Rate for Payer: Adventist Health Commercial |
$280.80
|
| Rate for Payer: Cash Price |
$631.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,123.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$561.60
|
| Rate for Payer: EPIC Health Plan Senior |
$561.60
|
| Rate for Payer: Galaxy Health WC |
$1,193.40
|
| Rate for Payer: Global Benefits Group Commercial |
$842.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,263.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$936.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$534.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$869.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$280.80
|
| Rate for Payer: Multiplan Commercial |
$1,053.00
|
| Rate for Payer: Networks By Design Commercial |
$912.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,193.40
|
|
|
HC ROTOVIRUS AG
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 87425
|
| Hospital Charge Code |
900910976
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$65.38 |
| Rate for Payer: Adventist Health Commercial |
$7.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$11.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$65.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.27
|
| Rate for Payer: Blue Shield of California Commercial |
$23.67
|
| Rate for Payer: Blue Shield of California EPN |
$15.48
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Central Health Plan Commercial |
$31.20
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.17
|
| Rate for Payer: EPIC Health Plan Senior |
$11.98
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$15.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.98
|
| Rate for Payer: InnovAge PACE Commercial |
$17.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.05
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11.98
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Prime Health Services Medicare |
$12.70
|
| Rate for Payer: Riverside University Health System MISP |
$13.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.70
|
| Rate for Payer: United Healthcare All Other HMO |
$9.70
|
| Rate for Payer: United Healthcare HMO Rider |
$9.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
|
|
HC ROTOVIRUS AG
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
CPT 87425
|
| Hospital Charge Code |
900910976
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$34.40 |
| Max. Negotiated Rate |
$154.80 |
| Rate for Payer: Adventist Health Commercial |
$34.40
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Central Health Plan Commercial |
$137.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.80
|
| Rate for Payer: EPIC Health Plan Senior |
$68.80
|
| Rate for Payer: Galaxy Health WC |
$146.20
|
| Rate for Payer: Global Benefits Group Commercial |
$103.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$154.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$114.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$106.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.40
|
| Rate for Payer: Multiplan Commercial |
$129.00
|
| Rate for Payer: Networks By Design Commercial |
$111.80
|
| Rate for Payer: Prime Health Services Commercial |
$146.20
|
|
|
HC ROUND CALIPER AND PLATE ADDITION LE
|
Facility
|
IP
|
$401.00
|
|
|
Service Code
|
CPT L2240
|
| Hospital Charge Code |
905352240
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$80.20 |
| Max. Negotiated Rate |
$360.90 |
| Rate for Payer: Adventist Health Commercial |
$80.20
|
| Rate for Payer: Blue Shield of California Commercial |
$309.97
|
| Rate for Payer: Blue Shield of California EPN |
$202.10
|
| Rate for Payer: Cash Price |
$180.45
|
| Rate for Payer: Central Health Plan Commercial |
$320.80
|
| Rate for Payer: Cigna of CA HMO |
$280.70
|
| Rate for Payer: Cigna of CA PPO |
$280.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.40
|
| Rate for Payer: EPIC Health Plan Senior |
$160.40
|
| Rate for Payer: Galaxy Health WC |
$340.85
|
| Rate for Payer: Global Benefits Group Commercial |
$240.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$360.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$267.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$152.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$248.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.20
|
| Rate for Payer: Multiplan Commercial |
$300.75
|
| Rate for Payer: Networks By Design Commercial |
$260.65
|
| Rate for Payer: Prime Health Services Commercial |
$340.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$150.50
|
| Rate for Payer: United Healthcare All Other HMO |
$146.49
|
| Rate for Payer: United Healthcare HMO Rider |
$143.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$131.33
|
|
|
HC ROUND CALIPER AND PLATE ADDITION LE
|
Facility
|
OP
|
$401.00
|
|
|
Service Code
|
CPT L2240
|
| Hospital Charge Code |
905352240
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$87.46 |
| Max. Negotiated Rate |
$360.90 |
| Rate for Payer: Adventist Health Commercial |
$164.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$340.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$220.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$300.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$235.51
|
| Rate for Payer: Blue Shield of California Commercial |
$309.97
|
| Rate for Payer: Blue Shield of California EPN |
$202.10
|
| Rate for Payer: Cash Price |
$180.45
|
| Rate for Payer: Cash Price |
$180.45
|
| Rate for Payer: Central Health Plan Commercial |
$320.80
|
| Rate for Payer: Cigna of CA HMO |
$280.70
|
| Rate for Payer: Cigna of CA PPO |
$280.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$340.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$340.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$340.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.40
|
| Rate for Payer: EPIC Health Plan Senior |
$160.40
|
| Rate for Payer: Galaxy Health WC |
$340.85
|
| Rate for Payer: Global Benefits Group Commercial |
$240.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$360.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$87.46
|
| Rate for Payer: InnovAge PACE Commercial |
$200.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$267.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$248.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$280.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$280.70
|
| Rate for Payer: Multiplan Commercial |
$300.75
|
| Rate for Payer: Networks By Design Commercial |
$200.50
|
| Rate for Payer: Prime Health Services Commercial |
$340.85
|
| Rate for Payer: Riverside University Health System MISP |
$160.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$240.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$240.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$150.50
|
| Rate for Payer: United Healthcare All Other HMO |
$146.49
|
| Rate for Payer: United Healthcare HMO Rider |
$143.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$131.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$340.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$340.85
|
| Rate for Payer: Vantage Medical Group Senior |
$340.85
|
|
|
HC ROUND CALIPER AND PLATE ADDITION LE
|
Facility
|
IP
|
$401.00
|
|
|
Service Code
|
CPT L2240
|
| Hospital Charge Code |
915352240
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$80.20 |
| Max. Negotiated Rate |
$360.90 |
| Rate for Payer: Adventist Health Commercial |
$80.20
|
| Rate for Payer: Blue Shield of California Commercial |
$309.97
|
| Rate for Payer: Blue Shield of California EPN |
$202.10
|
| Rate for Payer: Cash Price |
$180.45
|
| Rate for Payer: Central Health Plan Commercial |
$320.80
|
| Rate for Payer: Cigna of CA HMO |
$280.70
|
| Rate for Payer: Cigna of CA PPO |
$280.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.40
|
| Rate for Payer: EPIC Health Plan Senior |
$160.40
|
| Rate for Payer: Galaxy Health WC |
$340.85
|
| Rate for Payer: Global Benefits Group Commercial |
$240.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$360.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$267.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$152.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$248.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.20
|
| Rate for Payer: Multiplan Commercial |
$300.75
|
| Rate for Payer: Networks By Design Commercial |
$260.65
|
| Rate for Payer: Prime Health Services Commercial |
$340.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$150.50
|
| Rate for Payer: United Healthcare All Other HMO |
$146.49
|
| Rate for Payer: United Healthcare HMO Rider |
$143.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$131.33
|
|
|
HC ROUND CALIPER AND PLATE ADDITION LE
|
Facility
|
OP
|
$401.00
|
|
|
Service Code
|
CPT L2240
|
| Hospital Charge Code |
915352240
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$87.46 |
| Max. Negotiated Rate |
$360.90 |
| Rate for Payer: Adventist Health Commercial |
$164.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$340.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$220.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$300.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$235.51
|
| Rate for Payer: Blue Shield of California Commercial |
$309.97
|
| Rate for Payer: Blue Shield of California EPN |
$202.10
|
| Rate for Payer: Cash Price |
$180.45
|
| Rate for Payer: Cash Price |
$180.45
|
| Rate for Payer: Central Health Plan Commercial |
$320.80
|
| Rate for Payer: Cigna of CA HMO |
$280.70
|
| Rate for Payer: Cigna of CA PPO |
$280.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$340.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$340.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$340.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.40
|
| Rate for Payer: EPIC Health Plan Senior |
$160.40
|
| Rate for Payer: Galaxy Health WC |
$340.85
|
| Rate for Payer: Global Benefits Group Commercial |
$240.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$360.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$87.46
|
| Rate for Payer: InnovAge PACE Commercial |
$200.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$267.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$248.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$280.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$280.70
|
| Rate for Payer: Multiplan Commercial |
$300.75
|
| Rate for Payer: Networks By Design Commercial |
$200.50
|
| Rate for Payer: Prime Health Services Commercial |
$340.85
|
| Rate for Payer: Riverside University Health System MISP |
$160.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$240.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$240.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$150.50
|
| Rate for Payer: United Healthcare All Other HMO |
$146.49
|
| Rate for Payer: United Healthcare HMO Rider |
$143.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$131.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$340.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$340.85
|
| Rate for Payer: Vantage Medical Group Senior |
$340.85
|
|
|
HC ROUTINE URINALYSIS
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
CPT 81001
|
| Hospital Charge Code |
900910167
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$2.56 |
| Max. Negotiated Rate |
$29.70 |
| Rate for Payer: Adventist Health Commercial |
$6.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$3.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$20.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$22.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.51
|
| Rate for Payer: Blue Shield of California Commercial |
$20.03
|
| Rate for Payer: Blue Shield of California EPN |
$13.10
|
| Rate for Payer: Cash Price |
$14.85
|
| Rate for Payer: Cash Price |
$14.85
|
| Rate for Payer: Central Health Plan Commercial |
$26.40
|
| Rate for Payer: Cigna of CA HMO |
$21.12
|
| Rate for Payer: Cigna of CA PPO |
$24.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.28
|
| Rate for Payer: EPIC Health Plan Senior |
$3.17
|
| Rate for Payer: Galaxy Health WC |
$28.05
|
| Rate for Payer: Global Benefits Group Commercial |
$19.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$29.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.17
|
| Rate for Payer: InnovAge PACE Commercial |
$4.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.25
|
| Rate for Payer: Multiplan Commercial |
$24.75
|
| Rate for Payer: Networks By Design Commercial |
$21.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3.17
|
| Rate for Payer: Prime Health Services Commercial |
$28.05
|
| Rate for Payer: Prime Health Services Medicare |
$3.36
|
| Rate for Payer: Riverside University Health System MISP |
$3.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.56
|
| Rate for Payer: United Healthcare All Other HMO |
$2.56
|
| Rate for Payer: United Healthcare HMO Rider |
$2.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.49
|
| Rate for Payer: Vantage Medical Group Senior |
$3.17
|
|
|
HC ROUTINE URINALYSIS
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
CPT 81001
|
| Hospital Charge Code |
900910167
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Central Health Plan Commercial |
$108.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.00
|
| Rate for Payer: EPIC Health Plan Senior |
$54.00
|
| Rate for Payer: Galaxy Health WC |
$114.75
|
| Rate for Payer: Global Benefits Group Commercial |
$81.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$121.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$90.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$83.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.00
|
| Rate for Payer: Multiplan Commercial |
$101.25
|
| Rate for Payer: Networks By Design Commercial |
$87.75
|
| Rate for Payer: Prime Health Services Commercial |
$114.75
|
|
|
HC RPLCMNT GJ TUBE WO FLUORO MOUTH
|
Facility
|
IP
|
$3,678.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906744800
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$735.60 |
| Max. Negotiated Rate |
$3,310.20 |
| Rate for Payer: Adventist Health Commercial |
$735.60
|
| Rate for Payer: Cash Price |
$1,655.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,942.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,471.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,471.20
|
| Rate for Payer: Galaxy Health WC |
$3,126.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,206.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,310.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,453.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,401.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,276.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$735.60
|
| Rate for Payer: Multiplan Commercial |
$2,758.50
|
| Rate for Payer: Networks By Design Commercial |
$2,390.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,126.30
|
|
|
HC RPLCMNT GJ TUBE WO FLUORO MOUTH
|
Facility
|
OP
|
$3,678.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906744800
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$735.60 |
| Max. Negotiated Rate |
$7,378.00 |
| Rate for Payer: Adventist Health Commercial |
$735.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,191.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,655.10
|
| Rate for Payer: Cash Price |
$1,655.10
|
| Rate for Payer: Cash Price |
$1,655.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,942.40
|
| Rate for Payer: Cigna of CA HMO |
$2,353.92
|
| Rate for Payer: Cigna of CA PPO |
$2,721.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,310.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,191.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,608.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,191.26
|
| Rate for Payer: Galaxy Health WC |
$3,126.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,206.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,310.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,953.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: InnovAge PACE Commercial |
$1,786.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,453.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,191.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$735.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,596.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,596.29
|
| Rate for Payer: Multiplan Commercial |
$2,758.50
|
| Rate for Payer: Networks By Design Commercial |
$2,390.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Prime Health Services Commercial |
$3,126.30
|
| Rate for Payer: Prime Health Services Medicare |
$1,262.74
|
| Rate for Payer: Riverside University Health System MISP |
$1,310.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,206.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,429.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,191.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1,191.26
|
|
|
HC RPL GTUBE NOT RQ RV GSTRST TRC
|
Facility
|
IP
|
$2,947.00
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
906743760
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$589.40 |
| Max. Negotiated Rate |
$2,652.30 |
| Rate for Payer: Adventist Health Commercial |
$589.40
|
| Rate for Payer: Cash Price |
$1,326.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,357.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,178.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,178.80
|
| Rate for Payer: Galaxy Health WC |
$2,504.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,768.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,652.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,965.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,122.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,824.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$589.40
|
| Rate for Payer: Multiplan Commercial |
$2,210.25
|
| Rate for Payer: Networks By Design Commercial |
$1,915.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,504.95
|
|
|
HC RPL GTUBE NOT RQ RV GSTRST TRC
|
Facility
|
OP
|
$2,947.00
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
906743760
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$309.02 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$589.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$309.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$309.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,326.15
|
| Rate for Payer: Cash Price |
$1,326.15
|
| Rate for Payer: Cash Price |
$1,326.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,357.60
|
| Rate for Payer: Cigna of CA HMO |
$1,886.08
|
| Rate for Payer: Cigna of CA PPO |
$2,180.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$309.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$417.18
|
| Rate for Payer: EPIC Health Plan Senior |
$309.02
|
| Rate for Payer: Galaxy Health WC |
$2,504.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,768.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,652.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$506.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$352.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$309.02
|
| Rate for Payer: InnovAge PACE Commercial |
$463.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,965.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$389.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$309.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$589.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$414.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$414.09
|
| Rate for Payer: Multiplan Commercial |
$2,210.25
|
| Rate for Payer: Networks By Design Commercial |
$1,915.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$309.02
|
| Rate for Payer: Prime Health Services Commercial |
$2,504.95
|
| Rate for Payer: Prime Health Services Medicare |
$327.56
|
| Rate for Payer: Riverside University Health System MISP |
$339.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,768.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$370.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| 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 |
$309.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Vantage Medical Group Senior |
$309.02
|
|
|
HC RPL GTUBE NOT RQ RV GSTRST TRC
|
Facility
|
OP
|
$2,947.00
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
906743760
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$309.02 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$589.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$309.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$309.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$492.37
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,326.15
|
| Rate for Payer: Cash Price |
$1,326.15
|
| Rate for Payer: Cash Price |
$1,326.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,357.60
|
| Rate for Payer: Cigna of CA HMO |
$1,886.08
|
| Rate for Payer: Cigna of CA PPO |
$2,180.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$309.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$417.18
|
| Rate for Payer: EPIC Health Plan Senior |
$309.02
|
| Rate for Payer: Galaxy Health WC |
$2,504.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,768.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,652.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$506.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$352.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$309.02
|
| Rate for Payer: InnovAge PACE Commercial |
$463.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,965.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$389.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$309.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$589.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$414.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$414.09
|
| Rate for Payer: Multiplan Commercial |
$2,210.25
|
| Rate for Payer: Multiplan WC |
$492.37
|
| Rate for Payer: Networks By Design Commercial |
$1,915.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$309.02
|
| Rate for Payer: Preferred Health Network WC |
$502.42
|
| Rate for Payer: Prime Health Services Commercial |
$2,504.95
|
| Rate for Payer: Prime Health Services Medicare |
$327.56
|
| Rate for Payer: Prime Health Services WC |
$487.35
|
| Rate for Payer: Riverside University Health System MISP |
$339.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,768.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| 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 |
$309.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Vantage Medical Group Senior |
$309.02
|
|
|
HC RPL GTUBE NOT RQ RV GSTRST TRC
|
Facility
|
IP
|
$2,947.00
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
906743760
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$589.40 |
| Max. Negotiated Rate |
$2,652.30 |
| Rate for Payer: Adventist Health Commercial |
$589.40
|
| Rate for Payer: Cash Price |
$1,326.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,357.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,178.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,178.80
|
| Rate for Payer: Galaxy Health WC |
$2,504.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,768.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,652.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,965.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,122.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,824.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$589.40
|
| Rate for Payer: Multiplan Commercial |
$2,210.25
|
| Rate for Payer: Networks By Design Commercial |
$1,915.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,504.95
|
|
|
HC RPL GTUBE NOT RQ RV GSTRST TRC
|
Facility
|
OP
|
$2,947.00
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
906743760
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$309.02 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$589.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$309.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$492.37
|
| Rate for Payer: Cash Price |
$1,326.15
|
| Rate for Payer: Cash Price |
$1,326.15
|
| Rate for Payer: Cash Price |
$1,326.15
|
| Rate for Payer: Cash Price |
$1,326.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,357.60
|
| Rate for Payer: Cigna of CA HMO |
$1,886.08
|
| Rate for Payer: Cigna of CA PPO |
$2,180.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$309.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$417.18
|
| Rate for Payer: EPIC Health Plan Senior |
$309.02
|
| Rate for Payer: Galaxy Health WC |
$2,504.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,768.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,652.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$506.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$309.02
|
| Rate for Payer: InnovAge PACE Commercial |
$463.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,965.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$389.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$309.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$589.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$414.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$414.09
|
| Rate for Payer: Multiplan Commercial |
$2,210.25
|
| Rate for Payer: Multiplan WC |
$492.37
|
| Rate for Payer: Networks By Design Commercial |
$1,915.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$309.02
|
| Rate for Payer: Preferred Health Network WC |
$502.42
|
| Rate for Payer: Prime Health Services Commercial |
$2,504.95
|
| Rate for Payer: Prime Health Services Medicare |
$327.56
|
| Rate for Payer: Prime Health Services WC |
$487.35
|
| Rate for Payer: Riverside University Health System MISP |
$339.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,768.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,473.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,473.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,473.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,473.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$309.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Vantage Medical Group Senior |
$309.02
|
|
|
HC RPL GTUBE NOT RQ RV GSTRST TRC
|
Facility
|
IP
|
$2,947.00
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
906743760
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$589.40 |
| Max. Negotiated Rate |
$2,652.30 |
| Rate for Payer: Adventist Health Commercial |
$589.40
|
| Rate for Payer: Cash Price |
$1,326.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,357.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,178.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,178.80
|
| Rate for Payer: Galaxy Health WC |
$2,504.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,768.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,652.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,965.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,122.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,824.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$589.40
|
| Rate for Payer: Multiplan Commercial |
$2,210.25
|
| Rate for Payer: Networks By Design Commercial |
$1,915.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,504.95
|
|
|
HC RPL GTUBE NOT RQ RV GSTRST TRC
|
Facility
|
OP
|
$2,947.00
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
906743760
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$309.02 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$1,208.27
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$309.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$492.37
|
| Rate for Payer: Cash Price |
$1,326.15
|
| Rate for Payer: Cash Price |
$1,326.15
|
| Rate for Payer: Cash Price |
$1,326.15
|
| Rate for Payer: Cash Price |
$1,326.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,357.60
|
| Rate for Payer: Cigna of CA HMO |
$1,886.08
|
| Rate for Payer: Cigna of CA PPO |
$2,180.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$309.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$417.18
|
| Rate for Payer: EPIC Health Plan Senior |
$309.02
|
| Rate for Payer: Galaxy Health WC |
$2,504.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,768.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,652.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$506.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$309.02
|
| Rate for Payer: InnovAge PACE Commercial |
$463.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,965.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$389.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$309.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$589.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$414.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$414.09
|
| Rate for Payer: Multiplan Commercial |
$2,210.25
|
| Rate for Payer: Multiplan WC |
$492.37
|
| Rate for Payer: Networks By Design Commercial |
$1,915.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$309.02
|
| Rate for Payer: Preferred Health Network WC |
$502.42
|
| Rate for Payer: Prime Health Services Commercial |
$2,504.95
|
| Rate for Payer: Prime Health Services Medicare |
$327.56
|
| Rate for Payer: Prime Health Services WC |
$487.35
|
| Rate for Payer: Riverside University Health System MISP |
$339.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,768.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,768.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$309.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Vantage Medical Group Senior |
$309.02
|
|
