|
HC RPL GTUBE NOT RQ RV GSTRST TRC
|
Facility
|
IP
|
$2,947.00
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
906743760
|
|
Hospital Revenue Code
|
750
|
| 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 REQ REV GSTRST TRC
|
Facility
|
IP
|
$1,134.00
|
|
|
Service Code
|
CPT 43763
|
| Hospital Charge Code |
906043763
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$226.80 |
| Max. Negotiated Rate |
$1,020.60 |
| Rate for Payer: Adventist Health Commercial |
$226.80
|
| Rate for Payer: Cash Price |
$510.30
|
| Rate for Payer: Central Health Plan Commercial |
$907.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$453.60
|
| Rate for Payer: EPIC Health Plan Senior |
$453.60
|
| Rate for Payer: Galaxy Health WC |
$963.90
|
| Rate for Payer: Global Benefits Group Commercial |
$680.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,020.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$756.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$432.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$701.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.80
|
| Rate for Payer: Multiplan Commercial |
$850.50
|
| Rate for Payer: Networks By Design Commercial |
$737.10
|
| Rate for Payer: Prime Health Services Commercial |
$963.90
|
|
|
HC RPL GTUBE REQ REV GSTRST TRC
|
Facility
|
OP
|
$1,134.00
|
|
|
Service Code
|
CPT 43763
|
| Hospital Charge Code |
906043763
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$103.73 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$226.80
|
| 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 |
$510.30
|
| Rate for Payer: Cash Price |
$510.30
|
| Rate for Payer: Cash Price |
$510.30
|
| Rate for Payer: Central Health Plan Commercial |
$907.20
|
| Rate for Payer: Cigna of CA HMO |
$725.76
|
| Rate for Payer: Cigna of CA PPO |
$839.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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 |
$963.90
|
| Rate for Payer: Global Benefits Group Commercial |
$680.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,020.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$506.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$103.73
|
| 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 |
$756.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$309.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.80
|
| 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 |
$850.50
|
| Rate for Payer: Networks By Design Commercial |
$737.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$309.02
|
| Rate for Payer: Prime Health Services Commercial |
$963.90
|
| 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 |
$680.40
|
| 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 RPOS PRV CCM DFIB TRNSVNS ELTRD
|
Facility
|
IP
|
$1,688.00
|
|
|
Service Code
|
CPT 0924T
|
| Hospital Charge Code |
906811512
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$337.60 |
| Max. Negotiated Rate |
$1,519.20 |
| Rate for Payer: Adventist Health Commercial |
$337.60
|
| Rate for Payer: Cash Price |
$759.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,350.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$675.20
|
| Rate for Payer: EPIC Health Plan Senior |
$675.20
|
| Rate for Payer: Galaxy Health WC |
$1,434.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,012.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,519.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,125.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$643.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,044.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$337.60
|
| Rate for Payer: Multiplan Commercial |
$1,266.00
|
| Rate for Payer: Networks By Design Commercial |
$1,097.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,434.80
|
|
|
HC RPOS PRV CCM DFIB TRNSVNS ELTRD
|
Facility
|
OP
|
$1,688.00
|
|
|
Service Code
|
CPT 0924T
|
| Hospital Charge Code |
906811512
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$337.60 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Commercial |
$337.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$785.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$785.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$817.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$991.36
|
| Rate for Payer: Blue Shield of California Commercial |
$979.68
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$759.60
|
| Rate for Payer: Cash Price |
$759.60
|
| Rate for Payer: Cash Price |
$759.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,350.40
|
| Rate for Payer: Cigna of CA HMO |
$1,080.32
|
| Rate for Payer: Cigna of CA PPO |
$1,249.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$864.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$785.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,060.51
|
| Rate for Payer: EPIC Health Plan Senior |
$785.56
|
| Rate for Payer: Galaxy Health WC |
$1,434.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,012.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,519.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,288.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$785.56
|
| Rate for Payer: InnovAge PACE Commercial |
$1,178.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,125.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$643.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$785.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$337.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,052.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,052.65
|
| Rate for Payer: Multiplan Commercial |
$1,266.00
|
| Rate for Payer: Networks By Design Commercial |
$1,097.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$785.56
|
| Rate for Payer: Prime Health Services Commercial |
$1,434.80
|
| Rate for Payer: Prime Health Services Medicare |
$832.69
|
| Rate for Payer: Riverside University Health System MISP |
$864.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,012.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,012.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$785.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Vantage Medical Group Senior |
$785.56
|
|
|
HC RPR
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900913675
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Adventist Health Commercial |
$12.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Central Health Plan Commercial |
$51.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.60
|
| Rate for Payer: EPIC Health Plan Senior |
$25.60
|
| Rate for Payer: Galaxy Health WC |
$54.40
|
| Rate for Payer: Global Benefits Group Commercial |
$38.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$57.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$39.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.80
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: Networks By Design Commercial |
$41.60
|
| Rate for Payer: Prime Health Services Commercial |
$54.40
|
|
|
HC RPR
|
Facility
|
OP
|
$56.96
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900913675
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.39 |
| Max. Negotiated Rate |
$94.18 |
| Rate for Payer: Adventist Health Commercial |
$11.39
|
| Rate for Payer: Adventist Health Medi-Cal |
$17.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$34.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$94.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.11
|
| Rate for Payer: Blue Shield of California Commercial |
$34.57
|
| Rate for Payer: Blue Shield of California EPN |
$22.61
|
| Rate for Payer: Cash Price |
$25.63
|
| Rate for Payer: Cash Price |
$25.63
|
| Rate for Payer: Central Health Plan Commercial |
$45.57
|
| Rate for Payer: Cigna of CA HMO |
$36.45
|
| Rate for Payer: Cigna of CA PPO |
$42.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.31
|
| Rate for Payer: EPIC Health Plan Senior |
$17.27
|
| Rate for Payer: Galaxy Health WC |
$48.42
|
| Rate for Payer: Global Benefits Group Commercial |
$34.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$51.26
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$28.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.27
|
| Rate for Payer: InnovAge PACE Commercial |
$25.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$37.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.14
|
| Rate for Payer: Multiplan Commercial |
$42.72
|
| Rate for Payer: Networks By Design Commercial |
$37.02
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.27
|
| Rate for Payer: Prime Health Services Commercial |
$48.42
|
| Rate for Payer: Prime Health Services Medicare |
$18.31
|
| Rate for Payer: Riverside University Health System MISP |
$19.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$34.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.99
|
| Rate for Payer: United Healthcare All Other HMO |
$13.99
|
| Rate for Payer: United Healthcare HMO Rider |
$13.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.99
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.27
|
|
|
HC RPR DETACHED RETINA
|
Facility
|
OP
|
$9,244.00
|
|
|
Service Code
|
CPT 67101
|
| Hospital Charge Code |
900501630
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$10,567.00 |
| Rate for Payer: Adventist Health Commercial |
$1,848.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,187.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,897.90
|
| 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 |
$4,617.28
|
| Rate for Payer: Cash Price |
$4,159.80
|
| Rate for Payer: Cash Price |
$4,159.80
|
| Rate for Payer: Cash Price |
$4,159.80
|
| Rate for Payer: Cash Price |
$4,159.80
|
| Rate for Payer: Central Health Plan Commercial |
$7,395.20
|
| Rate for Payer: Cigna of CA HMO |
$5,916.16
|
| Rate for Payer: Cigna of CA PPO |
$6,840.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,187.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,897.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,912.16
|
| Rate for Payer: EPIC Health Plan Senior |
$2,897.90
|
| Rate for Payer: Galaxy Health WC |
$7,857.40
|
| Rate for Payer: Global Benefits Group Commercial |
$5,546.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,319.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,752.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,897.90
|
| Rate for Payer: InnovAge PACE Commercial |
$4,346.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,165.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$553.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,897.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,848.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,883.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,883.19
|
| Rate for Payer: Multiplan Commercial |
$6,933.00
|
| Rate for Payer: Multiplan WC |
$4,617.28
|
| Rate for Payer: Networks By Design Commercial |
$6,008.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,897.90
|
| Rate for Payer: Preferred Health Network WC |
$4,711.51
|
| Rate for Payer: Prime Health Services Commercial |
$7,857.40
|
| Rate for Payer: Prime Health Services Medicare |
$3,071.77
|
| Rate for Payer: Prime Health Services WC |
$4,570.16
|
| Rate for Payer: Riverside University Health System MISP |
$3,187.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,546.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,622.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,622.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,622.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,622.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,897.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,187.69
|
| Rate for Payer: Vantage Medical Group Senior |
$2,897.90
|
|
|
HC RPR DETACHED RETINA
|
Facility
|
IP
|
$9,244.00
|
|
|
Service Code
|
CPT 67101
|
| Hospital Charge Code |
900501630
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,848.80 |
| Max. Negotiated Rate |
$8,319.60 |
| Rate for Payer: Adventist Health Commercial |
$1,848.80
|
| Rate for Payer: Cash Price |
$4,159.80
|
| Rate for Payer: Central Health Plan Commercial |
$7,395.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,697.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,697.60
|
| Rate for Payer: Galaxy Health WC |
$7,857.40
|
| Rate for Payer: Global Benefits Group Commercial |
$5,546.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,319.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,165.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,521.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,722.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,848.80
|
| Rate for Payer: Multiplan Commercial |
$6,933.00
|
| Rate for Payer: Networks By Design Commercial |
$6,008.60
|
| Rate for Payer: Prime Health Services Commercial |
$7,857.40
|
|
|
HC RPR LIP FLL THCK UP TO HLF VER
|
Facility
|
OP
|
$2,198.00
|
|
|
Service Code
|
CPT 40652
|
| Hospital Charge Code |
900540652
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$122.38 |
| Max. Negotiated Rate |
$8,114.00 |
| Rate for Payer: Adventist Health Commercial |
$439.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$970.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$711.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$647.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,764.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,030.97
|
| Rate for Payer: Cash Price |
$989.10
|
| Rate for Payer: Cash Price |
$989.10
|
| Rate for Payer: Cash Price |
$989.10
|
| Rate for Payer: Cash Price |
$989.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,758.40
|
| Rate for Payer: Cigna of CA HMO |
$1,406.72
|
| Rate for Payer: Cigna of CA PPO |
$1,626.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$970.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$711.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$647.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$873.52
|
| Rate for Payer: EPIC Health Plan Senior |
$647.05
|
| Rate for Payer: Galaxy Health WC |
$1,868.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,318.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,978.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,061.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$647.05
|
| Rate for Payer: InnovAge PACE Commercial |
$970.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,466.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$122.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$647.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$439.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$867.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$867.05
|
| Rate for Payer: Multiplan Commercial |
$1,648.50
|
| Rate for Payer: Multiplan WC |
$1,030.97
|
| Rate for Payer: Networks By Design Commercial |
$1,428.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$647.05
|
| Rate for Payer: Preferred Health Network WC |
$1,052.01
|
| Rate for Payer: Prime Health Services Commercial |
$1,868.30
|
| Rate for Payer: Prime Health Services Medicare |
$685.87
|
| Rate for Payer: Prime Health Services WC |
$1,020.45
|
| Rate for Payer: Riverside University Health System MISP |
$711.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,318.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,099.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,099.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,099.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,099.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$647.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$970.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$711.75
|
| Rate for Payer: Vantage Medical Group Senior |
$647.05
|
|
|
HC RPR LIP FLL THCK UP TO HLF VER
|
Facility
|
IP
|
$2,198.00
|
|
|
Service Code
|
CPT 40652
|
| Hospital Charge Code |
900540652
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$439.60 |
| Max. Negotiated Rate |
$1,978.20 |
| Rate for Payer: Adventist Health Commercial |
$439.60
|
| Rate for Payer: Cash Price |
$989.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,758.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$879.20
|
| Rate for Payer: EPIC Health Plan Senior |
$879.20
|
| Rate for Payer: Galaxy Health WC |
$1,868.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,318.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,978.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,466.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$837.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,360.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$439.60
|
| Rate for Payer: Multiplan Commercial |
$1,648.50
|
| Rate for Payer: Networks By Design Commercial |
$1,428.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,868.30
|
|
|
HC RPR PROS DEVICE PER 15 MIN
|
Facility
|
IP
|
$16.00
|
|
|
Service Code
|
CPT L7520
|
| Hospital Charge Code |
905357520
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$14.40 |
| Rate for Payer: Adventist Health Commercial |
$3.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Central Health Plan Commercial |
$12.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6.40
|
| Rate for Payer: Galaxy Health WC |
$13.60
|
| Rate for Payer: Global Benefits Group Commercial |
$9.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.20
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: Networks By Design Commercial |
$10.40
|
| Rate for Payer: Prime Health Services Commercial |
$13.60
|
|
|
HC RPR PROS DEVICE PER 15 MIN
|
Facility
|
OP
|
$311.00
|
|
|
Service Code
|
CPT L7520
|
| Hospital Charge Code |
915357520
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$28.33 |
| Max. Negotiated Rate |
$279.90 |
| Rate for Payer: Adventist Health Commercial |
$62.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$188.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$264.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$171.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$233.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$150.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$182.65
|
| Rate for Payer: Blue Shield of California Commercial |
$190.02
|
| Rate for Payer: Blue Shield of California EPN |
$124.09
|
| Rate for Payer: Cash Price |
$139.95
|
| Rate for Payer: Cash Price |
$139.95
|
| Rate for Payer: Central Health Plan Commercial |
$248.80
|
| Rate for Payer: Cigna of CA HMO |
$199.04
|
| Rate for Payer: Cigna of CA PPO |
$230.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$264.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$264.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$264.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.40
|
| Rate for Payer: EPIC Health Plan Senior |
$124.40
|
| Rate for Payer: Galaxy Health WC |
$264.35
|
| Rate for Payer: Global Benefits Group Commercial |
$186.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$279.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28.33
|
| Rate for Payer: InnovAge PACE Commercial |
$155.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$207.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$192.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$217.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$217.70
|
| Rate for Payer: Multiplan Commercial |
$233.25
|
| Rate for Payer: Networks By Design Commercial |
$202.15
|
| Rate for Payer: Prime Health Services Commercial |
$264.35
|
| Rate for Payer: Riverside University Health System MISP |
$124.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$186.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$186.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$155.50
|
| Rate for Payer: United Healthcare All Other HMO |
$155.50
|
| Rate for Payer: United Healthcare HMO Rider |
$155.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$155.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$264.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$264.35
|
| Rate for Payer: Vantage Medical Group Senior |
$264.35
|
|
|
HC RPR PROS DEVICE PER 15 MIN
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
CPT L7520
|
| Hospital Charge Code |
905357520
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$31.29 |
| Rate for Payer: Adventist Health Commercial |
$3.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.40
|
| Rate for Payer: Blue Shield of California Commercial |
$9.78
|
| Rate for Payer: Blue Shield of California EPN |
$6.38
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Central Health Plan Commercial |
$12.80
|
| Rate for Payer: Cigna of CA HMO |
$10.24
|
| Rate for Payer: Cigna of CA PPO |
$11.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6.40
|
| Rate for Payer: Galaxy Health WC |
$13.60
|
| Rate for Payer: Global Benefits Group Commercial |
$9.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28.33
|
| Rate for Payer: InnovAge PACE Commercial |
$8.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.20
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: Networks By Design Commercial |
$10.40
|
| Rate for Payer: Prime Health Services Commercial |
$13.60
|
| Rate for Payer: Riverside University Health System MISP |
$6.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.60
|
| Rate for Payer: Vantage Medical Group Senior |
$13.60
|
|
|
HC RPR PROS DEVICE PER 15 MIN
|
Facility
|
IP
|
$311.00
|
|
|
Service Code
|
CPT L7520
|
| Hospital Charge Code |
915357520
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$62.20 |
| Max. Negotiated Rate |
$279.90 |
| Rate for Payer: Adventist Health Commercial |
$62.20
|
| Rate for Payer: Cash Price |
$139.95
|
| Rate for Payer: Central Health Plan Commercial |
$248.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.40
|
| Rate for Payer: EPIC Health Plan Senior |
$124.40
|
| Rate for Payer: Galaxy Health WC |
$264.35
|
| Rate for Payer: Global Benefits Group Commercial |
$186.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$279.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$207.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$192.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.20
|
| Rate for Payer: Multiplan Commercial |
$233.25
|
| Rate for Payer: Networks By Design Commercial |
$202.15
|
| Rate for Payer: Prime Health Services Commercial |
$264.35
|
|
|
HC RPR TITER
|
Facility
|
IP
|
$182.00
|
|
|
Service Code
|
CPT 86593
|
| Hospital Charge Code |
900910929
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$163.80 |
| Rate for Payer: Adventist Health Commercial |
$36.40
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Central Health Plan Commercial |
$145.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.80
|
| Rate for Payer: EPIC Health Plan Senior |
$72.80
|
| Rate for Payer: Galaxy Health WC |
$154.70
|
| Rate for Payer: Global Benefits Group Commercial |
$109.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$163.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$121.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$69.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$112.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.40
|
| Rate for Payer: Multiplan Commercial |
$136.50
|
| Rate for Payer: Networks By Design Commercial |
$118.30
|
| Rate for Payer: Prime Health Services Commercial |
$154.70
|
|
|
HC RPR TITER
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 86593
|
| Hospital Charge Code |
900910929
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.56 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$32.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.50
|
| Rate for Payer: Blue Shield of California Commercial |
$24.28
|
| Rate for Payer: Blue Shield of California EPN |
$15.88
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Central Health Plan Commercial |
$32.00
|
| Rate for Payer: Cigna of CA HMO |
$25.60
|
| Rate for Payer: Cigna of CA PPO |
$29.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.94
|
| Rate for Payer: EPIC Health Plan Senior |
$4.40
|
| Rate for Payer: Galaxy Health WC |
$34.00
|
| Rate for Payer: Global Benefits Group Commercial |
$24.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.40
|
| Rate for Payer: InnovAge PACE Commercial |
$6.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.90
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
| Rate for Payer: Networks By Design Commercial |
$26.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.40
|
| Rate for Payer: Prime Health Services Commercial |
$34.00
|
| Rate for Payer: Prime Health Services Medicare |
$4.66
|
| Rate for Payer: Riverside University Health System MISP |
$4.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.56
|
| Rate for Payer: United Healthcare All Other HMO |
$3.56
|
| Rate for Payer: United Healthcare HMO Rider |
$3.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.84
|
| Rate for Payer: Vantage Medical Group Senior |
$4.40
|
|
|
HC RSPR T-POD PELVIC STBL
|
Facility
|
IP
|
$584.20
|
|
|
Service Code
|
CPT E0944
|
| Hospital Charge Code |
901698449
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$116.84 |
| Max. Negotiated Rate |
$525.78 |
| Rate for Payer: Adventist Health Commercial |
$116.84
|
| Rate for Payer: Cash Price |
$262.89
|
| Rate for Payer: Central Health Plan Commercial |
$467.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$233.68
|
| Rate for Payer: EPIC Health Plan Senior |
$233.68
|
| Rate for Payer: Galaxy Health WC |
$496.57
|
| Rate for Payer: Global Benefits Group Commercial |
$350.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$525.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$389.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$222.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$361.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.84
|
| Rate for Payer: Multiplan Commercial |
$438.15
|
| Rate for Payer: Networks By Design Commercial |
$379.73
|
| Rate for Payer: Prime Health Services Commercial |
$496.57
|
|
|
HC RSPR T-POD PELVIC STBL
|
Facility
|
OP
|
$584.20
|
|
|
Service Code
|
CPT E0944
|
| Hospital Charge Code |
901698449
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$53.66 |
| Max. Negotiated Rate |
$525.78 |
| Rate for Payer: Adventist Health Commercial |
$116.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$354.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$496.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$321.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$438.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$282.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$343.10
|
| Rate for Payer: Blue Shield of California Commercial |
$356.95
|
| Rate for Payer: Blue Shield of California EPN |
$233.10
|
| Rate for Payer: Cash Price |
$262.89
|
| Rate for Payer: Cash Price |
$262.89
|
| Rate for Payer: Central Health Plan Commercial |
$467.36
|
| Rate for Payer: Cigna of CA HMO |
$373.89
|
| Rate for Payer: Cigna of CA PPO |
$432.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$496.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$496.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$496.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$233.68
|
| Rate for Payer: EPIC Health Plan Senior |
$233.68
|
| Rate for Payer: Galaxy Health WC |
$496.57
|
| Rate for Payer: Global Benefits Group Commercial |
$350.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$525.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$53.66
|
| Rate for Payer: InnovAge PACE Commercial |
$292.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$389.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$361.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$408.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.94
|
| Rate for Payer: Multiplan Commercial |
$438.15
|
| Rate for Payer: Networks By Design Commercial |
$379.73
|
| Rate for Payer: Prime Health Services Commercial |
$496.57
|
| Rate for Payer: Riverside University Health System MISP |
$233.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$350.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$350.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$292.10
|
| Rate for Payer: United Healthcare All Other HMO |
$292.10
|
| Rate for Payer: United Healthcare HMO Rider |
$292.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$292.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$496.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$496.57
|
| Rate for Payer: Vantage Medical Group Senior |
$496.57
|
|
|
HC RSV AG
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
CPT 87420
|
| Hospital Charge Code |
900911613
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$36.80 |
| Max. Negotiated Rate |
$165.60 |
| Rate for Payer: Adventist Health Commercial |
$36.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Central Health Plan Commercial |
$147.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.60
|
| Rate for Payer: EPIC Health Plan Senior |
$73.60
|
| Rate for Payer: Galaxy Health WC |
$156.40
|
| Rate for Payer: Global Benefits Group Commercial |
$110.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$165.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$122.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.80
|
| Rate for Payer: Multiplan Commercial |
$138.00
|
| Rate for Payer: Networks By Design Commercial |
$119.60
|
| Rate for Payer: Prime Health Services Commercial |
$156.40
|
|
|
HC RSV AG
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
CPT 87420
|
| Hospital Charge Code |
900911613
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.02 |
| Max. Negotiated Rate |
$65.38 |
| Rate for Payer: Adventist Health Commercial |
$6.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$65.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.27
|
| Rate for Payer: Blue Shield of California Commercial |
$18.82
|
| Rate for Payer: Blue Shield of California EPN |
$12.31
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Central Health Plan Commercial |
$24.80
|
| Rate for Payer: Cigna of CA HMO |
$19.84
|
| Rate for Payer: Cigna of CA PPO |
$22.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.78
|
| Rate for Payer: EPIC Health Plan Senior |
$13.91
|
| Rate for Payer: Galaxy Health WC |
$26.35
|
| Rate for Payer: Global Benefits Group Commercial |
$18.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.91
|
| Rate for Payer: InnovAge PACE Commercial |
$20.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.64
|
| Rate for Payer: Multiplan Commercial |
$23.25
|
| Rate for Payer: Networks By Design Commercial |
$20.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.91
|
| Rate for Payer: Prime Health Services Commercial |
$26.35
|
| Rate for Payer: Prime Health Services Medicare |
$14.74
|
| Rate for Payer: Riverside University Health System MISP |
$15.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.27
|
| Rate for Payer: United Healthcare All Other HMO |
$11.27
|
| Rate for Payer: United Healthcare HMO Rider |
$11.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.27
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.30
|
| Rate for Payer: Vantage Medical Group Senior |
$13.91
|
|
|
HC RSV DFA
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 87280
|
| Hospital Charge Code |
900911537
|
|
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 |
$13.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$65.38
|
| Rate for Payer: Anthem Blue Cross of CA 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 |
$20.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.12
|
| Rate for Payer: EPIC Health Plan Senior |
$13.42
|
| 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 |
$22.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$15.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.42
|
| Rate for Payer: InnovAge PACE Commercial |
$20.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.98
|
| 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 |
$13.42
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Prime Health Services Medicare |
$14.23
|
| Rate for Payer: Riverside University Health System MISP |
$14.76
|
| 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 |
$10.87
|
| Rate for Payer: United Healthcare All Other HMO |
$10.87
|
| Rate for Payer: United Healthcare HMO Rider |
$10.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.87
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.76
|
| Rate for Payer: Vantage Medical Group Senior |
$13.42
|
|
|
HC RSV DFA
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
CPT 87280
|
| Hospital Charge Code |
900911537
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$66.40 |
| Max. Negotiated Rate |
$298.80 |
| Rate for Payer: Adventist Health Commercial |
$66.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Central Health Plan Commercial |
$265.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$132.80
|
| Rate for Payer: EPIC Health Plan Senior |
$132.80
|
| Rate for Payer: Galaxy Health WC |
$282.20
|
| Rate for Payer: Global Benefits Group Commercial |
$199.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$298.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$221.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$126.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$205.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.40
|
| Rate for Payer: Multiplan Commercial |
$249.00
|
| Rate for Payer: Networks By Design Commercial |
$215.80
|
| Rate for Payer: Prime Health Services Commercial |
$282.20
|
|
|
HC RT ATTENDANCE AT DELIVERY
|
Facility
|
IP
|
$1,670.00
|
|
|
Service Code
|
CPT 99464
|
| Hospital Charge Code |
900800499
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$334.00 |
| Max. Negotiated Rate |
$1,503.00 |
| Rate for Payer: Adventist Health Commercial |
$334.00
|
| Rate for Payer: Cash Price |
$751.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,336.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$668.00
|
| Rate for Payer: EPIC Health Plan Senior |
$668.00
|
| Rate for Payer: Galaxy Health WC |
$1,419.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,002.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,503.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,113.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$636.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,033.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$334.00
|
| Rate for Payer: Multiplan Commercial |
$1,252.50
|
| Rate for Payer: Networks By Design Commercial |
$1,085.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,419.50
|
|
|
HC RT ATTENDANCE AT DELIVERY
|
Facility
|
OP
|
$1,670.00
|
|
|
Service Code
|
CPT 99464
|
| Hospital Charge Code |
900800499
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$101.82 |
| Max. Negotiated Rate |
$1,503.00 |
| Rate for Payer: Adventist Health Commercial |
$334.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,014.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,419.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$918.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,252.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$808.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$980.79
|
| Rate for Payer: Blue Shield of California Commercial |
$1,013.69
|
| Rate for Payer: Blue Shield of California EPN |
$662.99
|
| Rate for Payer: Cash Price |
$751.50
|
| Rate for Payer: Cash Price |
$751.50
|
| Rate for Payer: Cash Price |
$751.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,336.00
|
| Rate for Payer: Cigna of CA HMO |
$1,068.80
|
| Rate for Payer: Cigna of CA PPO |
$1,235.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,419.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,419.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,419.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$668.00
|
| Rate for Payer: EPIC Health Plan Senior |
$668.00
|
| Rate for Payer: Galaxy Health WC |
$1,419.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,002.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,503.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$101.82
|
| Rate for Payer: InnovAge PACE Commercial |
$835.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,113.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,033.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$334.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,169.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,169.00
|
| Rate for Payer: Multiplan Commercial |
$1,252.50
|
| Rate for Payer: Networks By Design Commercial |
$1,085.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,419.50
|
| Rate for Payer: Riverside University Health System MISP |
$668.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,002.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,002.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$764.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$731.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$669.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,419.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,419.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,419.50
|
|
