|
HC ROUTINE URINALYSIS
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
CPT 81001
|
| Hospital Charge Code |
900910167
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$27.12 |
| Rate for Payer: Adventist Health Medi-Cal |
$3.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.76
|
| 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 |
$27.12
|
| Rate for Payer: Blue Distinction Transplant |
$7.20
|
| Rate for Payer: Blue Shield of California Commercial |
$7.42
|
| Rate for Payer: Blue Shield of California EPN |
$5.83
|
| Rate for Payer: Caremore Medicare Advantage |
$3.17
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Central Health Plan Commercial |
$9.60
|
| Rate for Payer: Cigna of CA HMO |
$7.68
|
| Rate for Payer: Cigna of CA PPO |
$8.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.76
|
| Rate for Payer: Dignity Health Media |
$3.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.17
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.17
|
| Rate for Payer: InnovAge PACE Commercial |
$4.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.00
|
| 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 |
$2.40
|
| 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 |
$9.00
|
| Rate for Payer: Networks By Design Commercial |
$7.80
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
| 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 |
$7.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.20
|
| 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: Vantage Medical Group Commercial/Exchange |
$4.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.49
|
| Rate for Payer: Vantage Medical Group Senior |
$3.17
|
|
|
HC ROUTINE URINALYSIS
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
CPT 81001
|
| Hospital Charge Code |
900910167
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$27.60 |
| Max. Negotiated Rate |
$124.20 |
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Central Health Plan Commercial |
$110.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.20
|
| Rate for Payer: Galaxy Health WC |
$117.30
|
| Rate for Payer: Global Benefits Group Commercial |
$82.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$124.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$92.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.60
|
| Rate for Payer: Multiplan Commercial |
$103.50
|
| Rate for Payer: Networks By Design Commercial |
$89.70
|
| Rate for Payer: Prime Health Services Commercial |
$117.30
|
|
|
HC RPLCMNT GJ TUBE WO FLUORO MOUTH
|
Facility
|
OP
|
$2,781.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906744800
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$556.20 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,132.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,346.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,643.01
|
| Rate for Payer: Blue Distinction Transplant |
$1,668.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$1,132.59
|
| Rate for Payer: Cash Price |
$1,251.45
|
| Rate for Payer: Cash Price |
$1,251.45
|
| Rate for Payer: Central Health Plan Commercial |
$2,224.80
|
| Rate for Payer: Cigna of CA PPO |
$2,057.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Media |
$1,132.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,529.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,132.59
|
| Rate for Payer: Galaxy Health WC |
$2,363.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,668.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,502.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,085.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,857.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,868.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: InnovAge PACE Commercial |
$1,698.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,854.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$556.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,517.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,517.67
|
| Rate for Payer: Multiplan Commercial |
$2,085.75
|
| Rate for Payer: Networks By Design Commercial |
$1,807.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,363.85
|
| Rate for Payer: Prime Health Services Medicare |
$1,200.55
|
| Rate for Payer: Riverside University Health System MISP |
$1,245.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,668.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,359.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC RPLCMNT GJ TUBE WO FLUORO MOUTH
|
Facility
|
IP
|
$2,781.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906744800
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$556.20 |
| Max. Negotiated Rate |
$2,502.90 |
| Rate for Payer: Cash Price |
$1,251.45
|
| Rate for Payer: Central Health Plan Commercial |
$2,224.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,112.40
|
| Rate for Payer: Galaxy Health WC |
$2,363.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,668.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,502.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,854.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,059.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$556.20
|
| Rate for Payer: Multiplan Commercial |
$2,085.75
|
| Rate for Payer: Networks By Design Commercial |
$1,807.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,363.85
|
|
|
HC RPL GTUBE NOT RQ RV GSTRST TRC
|
Facility
|
OP
|
$2,229.00
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
906743760
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$308.79 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$308.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$308.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,337.40
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$308.79
|
| Rate for Payer: Cash Price |
$1,003.05
|
| Rate for Payer: Cash Price |
$1,003.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,783.20
|
| Rate for Payer: Cigna of CA PPO |
$1,649.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.18
|
| Rate for Payer: Dignity Health Media |
$308.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$416.87
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$308.79
|
| Rate for Payer: EPIC Health Plan Transplant |
$308.79
|
| Rate for Payer: Galaxy Health WC |
$1,894.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,337.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,006.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,671.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$506.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$509.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$308.79
|
| Rate for Payer: InnovAge PACE Commercial |
$463.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,486.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$389.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$308.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$445.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$413.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$413.78
|
| Rate for Payer: Multiplan Commercial |
$1,671.75
|
| Rate for Payer: Networks By Design Commercial |
$1,448.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,894.65
|
| Rate for Payer: Prime Health Services Medicare |
$327.32
|
| Rate for Payer: Riverside University Health System MISP |
$339.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,337.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$370.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: Vantage Medical Group Senior |
$308.79
|
|
|
HC RPL GTUBE NOT RQ RV GSTRST TRC
|
Facility
|
OP
|
$2,229.00
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
906743760
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$308.79 |
| Max. Negotiated Rate |
$2,901.00 |
| 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 |
$463.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$308.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,337.40
|
| Rate for Payer: Caremore Medicare Advantage |
$308.79
|
| Rate for Payer: Cash Price |
$1,003.05
|
| Rate for Payer: Cash Price |
$1,003.05
|
| Rate for Payer: Cash Price |
$1,003.05
|
| Rate for Payer: Cash Price |
$1,003.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,783.20
|
| Rate for Payer: Cigna of CA PPO |
$1,649.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.18
|
| Rate for Payer: Dignity Health Media |
$308.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$416.87
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$308.79
|
| Rate for Payer: EPIC Health Plan Transplant |
$308.79
|
| Rate for Payer: Galaxy Health WC |
$1,894.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,337.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,006.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,671.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$506.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$308.79
|
| Rate for Payer: InnovAge PACE Commercial |
$463.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,486.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$389.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$308.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$445.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$413.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$413.78
|
| Rate for Payer: Multiplan Commercial |
$1,671.75
|
| Rate for Payer: Networks By Design Commercial |
$1,448.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,894.65
|
| Rate for Payer: Prime Health Services Medicare |
$327.32
|
| Rate for Payer: Riverside University Health System MISP |
$339.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,337.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,114.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,114.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,114.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,114.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: Vantage Medical Group Senior |
$308.79
|
|
|
HC RPL GTUBE NOT RQ RV GSTRST TRC
|
Facility
|
IP
|
$2,229.00
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
906743760
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$445.80 |
| Max. Negotiated Rate |
$2,006.10 |
| Rate for Payer: Cash Price |
$1,003.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,783.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$891.60
|
| Rate for Payer: Galaxy Health WC |
$1,894.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,337.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,006.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,486.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$849.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$445.80
|
| Rate for Payer: Multiplan Commercial |
$1,671.75
|
| Rate for Payer: Networks By Design Commercial |
$1,448.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,894.65
|
|
|
HC RPL GTUBE NOT RQ RV GSTRST TRC
|
Facility
|
IP
|
$2,229.00
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
906743760
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$445.80 |
| Max. Negotiated Rate |
$2,006.10 |
| Rate for Payer: Cash Price |
$1,003.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,783.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$891.60
|
| Rate for Payer: Galaxy Health WC |
$1,894.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,337.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,006.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,486.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$849.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$445.80
|
| Rate for Payer: Multiplan Commercial |
$1,671.75
|
| Rate for Payer: Networks By Design Commercial |
$1,448.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,894.65
|
|
|
HC RPL GTUBE NOT RQ RV GSTRST TRC
|
Facility
|
OP
|
$2,229.00
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
906743760
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$308.79 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$308.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$308.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,337.40
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$308.79
|
| Rate for Payer: Cash Price |
$1,003.05
|
| Rate for Payer: Cash Price |
$1,003.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,783.20
|
| Rate for Payer: Cigna of CA PPO |
$1,649.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.18
|
| Rate for Payer: Dignity Health Media |
$308.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$416.87
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$308.79
|
| Rate for Payer: EPIC Health Plan Transplant |
$308.79
|
| Rate for Payer: Galaxy Health WC |
$1,894.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,337.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,006.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,671.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$506.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$509.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$308.79
|
| Rate for Payer: InnovAge PACE Commercial |
$463.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,486.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$389.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$308.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$445.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$413.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$413.78
|
| Rate for Payer: Multiplan Commercial |
$1,671.75
|
| Rate for Payer: Networks By Design Commercial |
$1,448.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,894.65
|
| Rate for Payer: Prime Health Services Medicare |
$327.32
|
| Rate for Payer: Riverside University Health System MISP |
$339.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,337.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: Vantage Medical Group Senior |
$308.79
|
|
|
HC RPL GTUBE NOT RQ RV GSTRST TRC
|
Facility
|
IP
|
$2,229.00
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
906743760
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$445.80 |
| Max. Negotiated Rate |
$2,006.10 |
| Rate for Payer: Cash Price |
$1,003.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,783.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$891.60
|
| Rate for Payer: Galaxy Health WC |
$1,894.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,337.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,006.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,486.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$849.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$445.80
|
| Rate for Payer: Multiplan Commercial |
$1,671.75
|
| Rate for Payer: Networks By Design Commercial |
$1,448.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,894.65
|
|
|
HC RPL GTUBE NOT RQ RV GSTRST TRC
|
Facility
|
IP
|
$2,229.00
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
906743760
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$445.80 |
| Max. Negotiated Rate |
$2,006.10 |
| Rate for Payer: Cash Price |
$1,003.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,783.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$891.60
|
| Rate for Payer: Galaxy Health WC |
$1,894.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,337.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,006.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,486.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$849.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$445.80
|
| Rate for Payer: Multiplan Commercial |
$1,671.75
|
| Rate for Payer: Networks By Design Commercial |
$1,448.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,894.65
|
|
|
HC RPL GTUBE NOT RQ RV GSTRST TRC
|
Facility
|
OP
|
$2,229.00
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
906743760
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$308.79 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$308.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$308.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,337.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,402.04
|
| Rate for Payer: Blue Shield of California EPN |
$1,089.98
|
| Rate for Payer: Caremore Medicare Advantage |
$308.79
|
| Rate for Payer: Cash Price |
$1,003.05
|
| Rate for Payer: Cash Price |
$1,003.05
|
| Rate for Payer: Cash Price |
$1,003.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,783.20
|
| Rate for Payer: Cigna of CA HMO |
$1,426.56
|
| Rate for Payer: Cigna of CA PPO |
$1,649.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.18
|
| Rate for Payer: Dignity Health Media |
$308.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$416.87
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$308.79
|
| Rate for Payer: EPIC Health Plan Transplant |
$308.79
|
| Rate for Payer: Galaxy Health WC |
$1,894.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,337.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,006.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,671.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$506.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$509.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$308.79
|
| Rate for Payer: InnovAge PACE Commercial |
$463.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,486.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$389.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$308.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$445.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$413.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$413.78
|
| Rate for Payer: Multiplan Commercial |
$1,671.75
|
| Rate for Payer: Networks By Design Commercial |
$1,448.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,894.65
|
| Rate for Payer: Prime Health Services Medicare |
$327.32
|
| Rate for Payer: Riverside University Health System MISP |
$339.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,337.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,337.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,114.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,114.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,114.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,114.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: Vantage Medical Group Senior |
$308.79
|
|
|
HC RPL GTUBE REQ REV GSTRST TRC
|
Facility
|
IP
|
$857.00
|
|
|
Service Code
|
CPT 43763
|
| Hospital Charge Code |
906043763
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$171.40 |
| Max. Negotiated Rate |
$771.30 |
| Rate for Payer: Cash Price |
$385.65
|
| Rate for Payer: Central Health Plan Commercial |
$685.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$342.80
|
| Rate for Payer: Galaxy Health WC |
$728.45
|
| Rate for Payer: Global Benefits Group Commercial |
$514.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$771.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$571.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$326.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.40
|
| Rate for Payer: Multiplan Commercial |
$642.75
|
| Rate for Payer: Networks By Design Commercial |
$557.05
|
| Rate for Payer: Prime Health Services Commercial |
$728.45
|
|
|
HC RPL GTUBE REQ REV GSTRST TRC
|
Facility
|
OP
|
$857.00
|
|
|
Service Code
|
CPT 43763
|
| Hospital Charge Code |
906043763
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$114.59 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$308.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$308.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$514.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$308.79
|
| Rate for Payer: Cash Price |
$385.65
|
| Rate for Payer: Cash Price |
$385.65
|
| Rate for Payer: Central Health Plan Commercial |
$685.60
|
| Rate for Payer: Cigna of CA PPO |
$634.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.18
|
| Rate for Payer: Dignity Health Media |
$308.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$416.87
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$308.79
|
| Rate for Payer: EPIC Health Plan Transplant |
$308.79
|
| Rate for Payer: Galaxy Health WC |
$728.45
|
| Rate for Payer: Global Benefits Group Commercial |
$514.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$771.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$642.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$506.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$509.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$308.79
|
| Rate for Payer: InnovAge PACE Commercial |
$463.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$571.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$308.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$413.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$413.78
|
| Rate for Payer: Multiplan Commercial |
$642.75
|
| Rate for Payer: Networks By Design Commercial |
$557.05
|
| Rate for Payer: Prime Health Services Commercial |
$728.45
|
| Rate for Payer: Prime Health Services Medicare |
$327.32
|
| Rate for Payer: Riverside University Health System MISP |
$339.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$514.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$370.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: Vantage Medical Group Senior |
$308.79
|
|
|
HC RPR
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900913675
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$114.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$17.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$95.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.90
|
| 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 |
$114.88
|
| Rate for Payer: Blue Distinction Transplant |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$24.10
|
| Rate for Payer: Blue Shield of California EPN |
$18.95
|
| Rate for Payer: Caremore Medicare Advantage |
$17.27
|
| 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 |
$25.90
|
| Rate for Payer: Dignity Health Media |
$17.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.31
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$17.27
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.27
|
| 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: Health Plan of Nevada (Sierra) Other |
$29.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$28.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.27
|
| Rate for Payer: InnovAge PACE Commercial |
$25.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| 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 |
$7.80
|
| 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 |
$29.25
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| 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 |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| 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: Vantage Medical Group Commercial/Exchange |
$25.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.27
|
|
|
HC RPR
|
Facility
|
IP
|
$58.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900913675
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.60 |
| Max. Negotiated Rate |
$52.20 |
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Central Health Plan Commercial |
$46.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.20
|
| Rate for Payer: Galaxy Health WC |
$49.30
|
| Rate for Payer: Global Benefits Group Commercial |
$34.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$52.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.60
|
| Rate for Payer: Multiplan Commercial |
$43.50
|
| Rate for Payer: Networks By Design Commercial |
$37.70
|
| Rate for Payer: Prime Health Services Commercial |
$49.30
|
|
|
HC RPR DETACHED RETINA
|
Facility
|
IP
|
$7,467.00
|
|
|
Service Code
|
CPT 67101
|
| Hospital Charge Code |
900501630
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,493.40 |
| Max. Negotiated Rate |
$6,720.30 |
| Rate for Payer: Cash Price |
$3,360.15
|
| Rate for Payer: Central Health Plan Commercial |
$5,973.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,986.80
|
| Rate for Payer: Galaxy Health WC |
$6,346.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4,480.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,720.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,980.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,844.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,493.40
|
| Rate for Payer: Multiplan Commercial |
$5,600.25
|
| Rate for Payer: Networks By Design Commercial |
$4,853.55
|
| Rate for Payer: Prime Health Services Commercial |
$6,346.95
|
|
|
HC RPR DETACHED RETINA
|
Facility
|
OP
|
$7,467.00
|
|
|
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 Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,911.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,480.20
|
| Rate for Payer: Caremore Medicare Advantage |
$2,911.63
|
| Rate for Payer: Cash Price |
$3,360.15
|
| Rate for Payer: Cash Price |
$3,360.15
|
| Rate for Payer: Cash Price |
$3,360.15
|
| Rate for Payer: Cash Price |
$3,360.15
|
| Rate for Payer: Central Health Plan Commercial |
$5,973.60
|
| Rate for Payer: Cigna of CA PPO |
$5,525.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Dignity Health Media |
$2,911.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,202.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,930.70
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,911.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,911.63
|
| Rate for Payer: Galaxy Health WC |
$6,346.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4,480.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,720.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,600.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,775.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,911.63
|
| Rate for Payer: InnovAge PACE Commercial |
$4,367.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,980.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$553.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,911.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,493.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,901.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,901.58
|
| Rate for Payer: Multiplan Commercial |
$5,600.25
|
| Rate for Payer: Networks By Design Commercial |
$4,853.55
|
| Rate for Payer: Prime Health Services Commercial |
$6,346.95
|
| Rate for Payer: Prime Health Services Medicare |
$3,086.33
|
| Rate for Payer: Riverside University Health System MISP |
$3,202.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,480.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,733.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,733.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,733.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,733.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: Vantage Medical Group Senior |
$2,911.63
|
|
|
HC RPR LIP FLL THCK UP TO HLF VER
|
Facility
|
IP
|
$1,662.00
|
|
|
Service Code
|
CPT 40652
|
| Hospital Charge Code |
900540652
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$332.40 |
| Max. Negotiated Rate |
$1,495.80 |
| Rate for Payer: Cash Price |
$747.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,329.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$664.80
|
| Rate for Payer: Galaxy Health WC |
$1,412.70
|
| Rate for Payer: Global Benefits Group Commercial |
$997.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,495.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,108.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$633.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$332.40
|
| Rate for Payer: Multiplan Commercial |
$1,246.50
|
| Rate for Payer: Networks By Design Commercial |
$1,080.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,412.70
|
|
|
HC RPR LIP FLL THCK UP TO HLF VER
|
Facility
|
OP
|
$1,662.00
|
|
|
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 Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$687.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Distinction Transplant |
$997.20
|
| Rate for Payer: Caremore Medicare Advantage |
$687.44
|
| Rate for Payer: Cash Price |
$747.90
|
| Rate for Payer: Cash Price |
$747.90
|
| Rate for Payer: Cash Price |
$747.90
|
| Rate for Payer: Cash Price |
$747.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,329.60
|
| Rate for Payer: Cigna of CA PPO |
$1,229.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Dignity Health Media |
$687.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$756.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$928.04
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$687.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$687.44
|
| Rate for Payer: Galaxy Health WC |
$1,412.70
|
| Rate for Payer: Global Benefits Group Commercial |
$997.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,495.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,246.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,127.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$687.44
|
| Rate for Payer: InnovAge PACE Commercial |
$1,031.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,108.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$122.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$687.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$332.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$921.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$921.17
|
| Rate for Payer: Multiplan Commercial |
$1,246.50
|
| Rate for Payer: Networks By Design Commercial |
$1,080.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,412.70
|
| Rate for Payer: Prime Health Services Medicare |
$728.69
|
| Rate for Payer: Riverside University Health System MISP |
$756.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$997.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$831.00
|
| Rate for Payer: United Healthcare All Other HMO |
$831.00
|
| Rate for Payer: United Healthcare HMO Rider |
$831.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$831.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: Vantage Medical Group Senior |
$687.44
|
|
|
HC RPR PROS DEVICE PER 15 MIN
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
CPT L7520
|
| Hospital Charge Code |
905357520
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$98.17 |
| Rate for Payer: Aetna of CA HMO/PPO |
$98.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.45
|
| Rate for Payer: Blue Distinction Transplant |
$9.60
|
| Rate for Payer: Blue Shield of California Commercial |
$10.06
|
| Rate for Payer: Blue Shield of California EPN |
$7.82
|
| 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 Media |
$13.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$12.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5.60
|
| 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: 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
|
| 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 Medi-Cal |
$13.60
|
| Rate for Payer: Vantage Medical Group Senior |
$13.60
|
|
|
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: 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: 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: 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 TITER
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
CPT 86593
|
| Hospital Charge Code |
900910929
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$27.40 |
| Max. Negotiated Rate |
$123.30 |
| Rate for Payer: Cash Price |
$61.65
|
| Rate for Payer: Central Health Plan Commercial |
$109.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.80
|
| Rate for Payer: Galaxy Health WC |
$116.45
|
| Rate for Payer: Global Benefits Group Commercial |
$82.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$123.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$91.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.40
|
| Rate for Payer: Multiplan Commercial |
$102.75
|
| Rate for Payer: Networks By Design Commercial |
$89.05
|
| Rate for Payer: Prime Health Services Commercial |
$116.45
|
|
|
HC RPR TITER
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
CPT 86593
|
| Hospital Charge Code |
900910929
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$39.07 |
| Rate for Payer: Adventist Health Medi-Cal |
$4.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.60
|
| Rate for Payer: Alpha Care Medical Group 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 |
$39.07
|
| Rate for Payer: Blue Distinction Transplant |
$10.20
|
| Rate for Payer: Blue Shield of California Commercial |
$10.51
|
| Rate for Payer: Blue Shield of California EPN |
$8.26
|
| Rate for Payer: Caremore Medicare Advantage |
$4.40
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Central Health Plan Commercial |
$13.60
|
| Rate for Payer: Cigna of CA HMO |
$10.88
|
| Rate for Payer: Cigna of CA PPO |
$12.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.60
|
| Rate for Payer: Dignity Health Media |
$4.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.94
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.40
|
| Rate for Payer: Galaxy Health WC |
$14.45
|
| Rate for Payer: Global Benefits Group Commercial |
$10.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.26
|
| 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 |
$11.34
|
| 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 |
$3.40
|
| 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 |
$12.75
|
| Rate for Payer: Networks By Design Commercial |
$11.05
|
| Rate for Payer: Prime Health Services Commercial |
$14.45
|
| 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 |
$10.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.20
|
| 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: 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
|
$585.12
|
|
|
Service Code
|
CPT E0944
|
| Hospital Charge Code |
901698449
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$117.02 |
| Max. Negotiated Rate |
$526.61 |
| Rate for Payer: Cash Price |
$263.30
|
| Rate for Payer: Central Health Plan Commercial |
$468.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$234.05
|
| Rate for Payer: Galaxy Health WC |
$497.35
|
| Rate for Payer: Global Benefits Group Commercial |
$351.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$526.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$390.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$222.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$117.02
|
| Rate for Payer: Multiplan Commercial |
$438.84
|
| Rate for Payer: Networks By Design Commercial |
$380.33
|
| Rate for Payer: Prime Health Services Commercial |
$497.35
|
|
