|
HC SIALOGRAPHY DUCT DILATION
|
Facility
|
IP
|
$4,009.00
|
|
|
Service Code
|
CPT 42660
|
| Hospital Charge Code |
909000133
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$801.80 |
| Max. Negotiated Rate |
$3,608.10 |
| Rate for Payer: Adventist Health Commercial |
$801.80
|
| Rate for Payer: Cash Price |
$1,804.05
|
| Rate for Payer: Central Health Plan Commercial |
$3,207.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,603.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,603.60
|
| Rate for Payer: Galaxy Health WC |
$3,407.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,405.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,608.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,674.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,527.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,481.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$801.80
|
| Rate for Payer: Multiplan Commercial |
$3,006.75
|
| Rate for Payer: Networks By Design Commercial |
$2,605.85
|
| Rate for Payer: Prime Health Services Commercial |
$3,407.65
|
|
|
HC SIALOGRAPHY INJECTION
|
Facility
|
IP
|
$445.00
|
|
|
Service Code
|
CPT 42550
|
| Hospital Charge Code |
909000132
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$89.00 |
| Max. Negotiated Rate |
$400.50 |
| Rate for Payer: Adventist Health Commercial |
$89.00
|
| Rate for Payer: Cash Price |
$200.25
|
| Rate for Payer: Central Health Plan Commercial |
$356.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$178.00
|
| Rate for Payer: EPIC Health Plan Senior |
$178.00
|
| Rate for Payer: Galaxy Health WC |
$378.25
|
| Rate for Payer: Global Benefits Group Commercial |
$267.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$400.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$296.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$169.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$275.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.00
|
| Rate for Payer: Multiplan Commercial |
$333.75
|
| Rate for Payer: Networks By Design Commercial |
$289.25
|
| Rate for Payer: Prime Health Services Commercial |
$378.25
|
|
|
HC SIALOGRAPHY INJECTION
|
Facility
|
OP
|
$445.00
|
|
|
Service Code
|
CPT 42550
|
| Hospital Charge Code |
909000132
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$89.00 |
| Max. Negotiated Rate |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$89.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$244.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$333.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$215.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$261.35
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$200.25
|
| Rate for Payer: Cash Price |
$200.25
|
| Rate for Payer: Cash Price |
$200.25
|
| Rate for Payer: Central Health Plan Commercial |
$356.00
|
| Rate for Payer: Cigna of CA HMO |
$284.80
|
| Rate for Payer: Cigna of CA PPO |
$329.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$378.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$378.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$178.00
|
| Rate for Payer: EPIC Health Plan Senior |
$178.00
|
| Rate for Payer: Galaxy Health WC |
$378.25
|
| Rate for Payer: Global Benefits Group Commercial |
$267.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$400.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$375.89
|
| Rate for Payer: InnovAge PACE Commercial |
$222.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$296.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$415.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$275.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$311.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$311.50
|
| Rate for Payer: Multiplan Commercial |
$333.75
|
| Rate for Payer: Networks By Design Commercial |
$289.25
|
| Rate for Payer: Prime Health Services Commercial |
$378.25
|
| Rate for Payer: Riverside University Health System MISP |
$178.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$267.00
|
| 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: Vantage Medical Group Commercial/Exchange |
$378.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$378.25
|
| Rate for Payer: Vantage Medical Group Senior |
$378.25
|
|
|
HC SIALOLITHOTOMY, SUBMANDIBULAR
|
Facility
|
OP
|
$10,189.00
|
|
|
Service Code
|
CPT 42330
|
| Hospital Charge Code |
900501646
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$154.91 |
| Max. Negotiated Rate |
$9,170.10 |
| Rate for Payer: Adventist Health Commercial |
$2,037.80
|
| 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 |
$6,180.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,532.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,120.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,565.51
|
| Rate for Payer: Cash Price |
$4,585.05
|
| Rate for Payer: Cash Price |
$4,585.05
|
| Rate for Payer: Cash Price |
$4,585.05
|
| Rate for Payer: Cash Price |
$4,585.05
|
| Rate for Payer: Central Health Plan Commercial |
$8,151.20
|
| Rate for Payer: Cigna of CA HMO |
$6,520.96
|
| Rate for Payer: Cigna of CA PPO |
$7,539.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,180.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,532.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,120.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,562.86
|
| Rate for Payer: EPIC Health Plan Senior |
$4,120.64
|
| Rate for Payer: Galaxy Health WC |
$8,660.65
|
| Rate for Payer: Global Benefits Group Commercial |
$6,113.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,170.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,757.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,120.64
|
| Rate for Payer: InnovAge PACE Commercial |
$6,180.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,796.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$154.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,120.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,037.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,521.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,521.66
|
| Rate for Payer: Multiplan Commercial |
$7,641.75
|
| Rate for Payer: Multiplan WC |
$6,565.51
|
| Rate for Payer: Networks By Design Commercial |
$6,622.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,120.64
|
| Rate for Payer: Preferred Health Network WC |
$6,699.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,660.65
|
| Rate for Payer: Prime Health Services Medicare |
$4,367.88
|
| Rate for Payer: Prime Health Services WC |
$6,498.52
|
| Rate for Payer: Riverside University Health System MISP |
$4,532.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,113.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,094.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5,094.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5,094.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,094.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,120.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,180.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,532.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4,120.64
|
|
|
HC SIALOLITHOTOMY, SUBMANDIBULAR
|
Facility
|
IP
|
$10,189.00
|
|
|
Service Code
|
CPT 42330
|
| Hospital Charge Code |
900501646
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,037.80 |
| Max. Negotiated Rate |
$9,170.10 |
| Rate for Payer: Adventist Health Commercial |
$2,037.80
|
| Rate for Payer: Cash Price |
$4,585.05
|
| Rate for Payer: Central Health Plan Commercial |
$8,151.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,075.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,075.60
|
| Rate for Payer: Galaxy Health WC |
$8,660.65
|
| Rate for Payer: Global Benefits Group Commercial |
$6,113.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,170.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,796.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,882.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,306.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,037.80
|
| Rate for Payer: Multiplan Commercial |
$7,641.75
|
| Rate for Payer: Networks By Design Commercial |
$6,622.85
|
| Rate for Payer: Prime Health Services Commercial |
$8,660.65
|
|
|
HC S-ICD GEN&LEAD TEST POST IMPL
|
Facility
|
IP
|
$4,367.00
|
|
|
Service Code
|
CPT 93644
|
| Hospital Charge Code |
906820024
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$873.40 |
| Max. Negotiated Rate |
$3,930.30 |
| Rate for Payer: Adventist Health Commercial |
$873.40
|
| Rate for Payer: Cash Price |
$1,965.15
|
| Rate for Payer: Central Health Plan Commercial |
$3,493.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,746.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,746.80
|
| Rate for Payer: Galaxy Health WC |
$3,711.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,620.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,930.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,912.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,663.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,703.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$873.40
|
| Rate for Payer: Multiplan Commercial |
$3,275.25
|
| Rate for Payer: Networks By Design Commercial |
$2,838.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,711.95
|
|
|
HC S-ICD GEN&LEAD TEST POST IMPL
|
Facility
|
OP
|
$5,022.00
|
|
|
Service Code
|
CPT 93644
|
| Hospital Charge Code |
906811490
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$448.30 |
| Max. Negotiated Rate |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$1,004.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,049.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,268.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,762.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,766.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,431.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,949.42
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$2,259.90
|
| Rate for Payer: Cash Price |
$2,259.90
|
| Rate for Payer: Cash Price |
$2,259.90
|
| Rate for Payer: Central Health Plan Commercial |
$4,017.60
|
| Rate for Payer: Cigna of CA HMO |
$3,214.08
|
| Rate for Payer: Cigna of CA PPO |
$3,716.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,268.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,268.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,268.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,008.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,008.80
|
| Rate for Payer: Galaxy Health WC |
$4,268.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,013.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,519.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$448.30
|
| Rate for Payer: InnovAge PACE Commercial |
$2,511.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,349.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$495.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,108.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,004.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,515.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,515.40
|
| Rate for Payer: Multiplan Commercial |
$3,766.50
|
| Rate for Payer: Networks By Design Commercial |
$3,264.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,268.70
|
| Rate for Payer: Riverside University Health System MISP |
$2,008.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,013.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,013.20
|
| 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: Vantage Medical Group Commercial/Exchange |
$4,268.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,268.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4,268.70
|
|
|
HC S-ICD GEN&LEAD TEST POST IMPL
|
Facility
|
IP
|
$5,022.00
|
|
|
Service Code
|
CPT 93644
|
| Hospital Charge Code |
906811490
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,004.40 |
| Max. Negotiated Rate |
$4,519.80 |
| Rate for Payer: Adventist Health Commercial |
$1,004.40
|
| Rate for Payer: Cash Price |
$2,259.90
|
| Rate for Payer: Central Health Plan Commercial |
$4,017.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,008.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,008.80
|
| Rate for Payer: Galaxy Health WC |
$4,268.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,013.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,519.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,349.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,913.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,108.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,004.40
|
| Rate for Payer: Multiplan Commercial |
$3,766.50
|
| Rate for Payer: Networks By Design Commercial |
$3,264.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,268.70
|
|
|
HC S-ICD GEN&LEAD TEST POST IMPL
|
Facility
|
OP
|
$4,367.00
|
|
|
Service Code
|
CPT 93644
|
| Hospital Charge Code |
906820024
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$448.30 |
| Max. Negotiated Rate |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$873.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,652.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,711.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,401.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,275.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,114.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,564.74
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$1,965.15
|
| Rate for Payer: Cash Price |
$1,965.15
|
| Rate for Payer: Cash Price |
$1,965.15
|
| Rate for Payer: Central Health Plan Commercial |
$3,493.60
|
| Rate for Payer: Cigna of CA HMO |
$2,794.88
|
| Rate for Payer: Cigna of CA PPO |
$3,231.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,711.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,711.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,711.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,746.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,746.80
|
| Rate for Payer: Galaxy Health WC |
$3,711.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,620.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,930.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$448.30
|
| Rate for Payer: InnovAge PACE Commercial |
$2,183.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,912.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$495.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,703.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$873.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,056.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,056.90
|
| Rate for Payer: Multiplan Commercial |
$3,275.25
|
| Rate for Payer: Networks By Design Commercial |
$2,838.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,711.95
|
| Rate for Payer: Riverside University Health System MISP |
$1,746.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,620.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,620.20
|
| 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: Vantage Medical Group Commercial/Exchange |
$3,711.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,711.95
|
| Rate for Payer: Vantage Medical Group Senior |
$3,711.95
|
|
|
HC SICKLE CELL SCREEN
|
Facility
|
OP
|
$59.00
|
|
|
Service Code
|
CPT 85660
|
| Hospital Charge Code |
900910034
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.46 |
| Max. Negotiated Rate |
$53.10 |
| Rate for Payer: Adventist Health Commercial |
$11.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$35.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.51
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$40.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.17
|
| Rate for Payer: Blue Shield of California Commercial |
$35.81
|
| Rate for Payer: Blue Shield of California EPN |
$23.42
|
| Rate for Payer: Cash Price |
$26.55
|
| Rate for Payer: Cash Price |
$26.55
|
| Rate for Payer: Central Health Plan Commercial |
$47.20
|
| Rate for Payer: Cigna of CA HMO |
$37.76
|
| Rate for Payer: Cigna of CA PPO |
$43.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.44
|
| Rate for Payer: EPIC Health Plan Senior |
$5.51
|
| Rate for Payer: Galaxy Health WC |
$50.15
|
| Rate for Payer: Global Benefits Group Commercial |
$35.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.51
|
| Rate for Payer: InnovAge PACE Commercial |
$8.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.38
|
| Rate for Payer: Multiplan Commercial |
$44.25
|
| Rate for Payer: Networks By Design Commercial |
$38.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.51
|
| Rate for Payer: Prime Health Services Commercial |
$50.15
|
| Rate for Payer: Prime Health Services Medicare |
$5.84
|
| Rate for Payer: Riverside University Health System MISP |
$6.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.46
|
| Rate for Payer: United Healthcare All Other HMO |
$4.46
|
| Rate for Payer: United Healthcare HMO Rider |
$4.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.06
|
| Rate for Payer: Vantage Medical Group Senior |
$5.51
|
|
|
HC SICKLE CELL SCREEN
|
Facility
|
IP
|
$96.00
|
|
|
Service Code
|
CPT 85660
|
| Hospital Charge Code |
900910034
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$86.40 |
| Rate for Payer: Adventist Health Commercial |
$19.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Central Health Plan Commercial |
$76.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.40
|
| Rate for Payer: EPIC Health Plan Senior |
$38.40
|
| Rate for Payer: Galaxy Health WC |
$81.60
|
| Rate for Payer: Global Benefits Group Commercial |
$57.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$86.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.20
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: Networks By Design Commercial |
$62.40
|
| Rate for Payer: Prime Health Services Commercial |
$81.60
|
|
|
HC SIGMDSCPY DX W WO COLLECT
|
Facility
|
IP
|
$4,910.00
|
|
|
Service Code
|
CPT 45330
|
| Hospital Charge Code |
906745330
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$982.00 |
| Max. Negotiated Rate |
$4,419.00 |
| Rate for Payer: Adventist Health Commercial |
$982.00
|
| Rate for Payer: Cash Price |
$2,209.50
|
| Rate for Payer: Central Health Plan Commercial |
$3,928.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,964.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,964.00
|
| Rate for Payer: Galaxy Health WC |
$4,173.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,946.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,419.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,274.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,870.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,039.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$982.00
|
| Rate for Payer: Multiplan Commercial |
$3,682.50
|
| Rate for Payer: Networks By Design Commercial |
$3,191.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,173.50
|
|
|
HC SIGMDSCPY DX W WO COLLECT
|
Facility
|
OP
|
$2,899.00
|
|
|
Service Code
|
CPT 45330
|
| Hospital Charge Code |
906745330
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$94.14 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$579.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,158.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,274.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,158.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,304.55
|
| Rate for Payer: Cash Price |
$1,304.55
|
| Rate for Payer: Cash Price |
$1,304.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,319.20
|
| Rate for Payer: Cigna of CA HMO |
$1,855.36
|
| Rate for Payer: Cigna of CA PPO |
$2,145.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,274.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,158.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,563.87
|
| Rate for Payer: EPIC Health Plan Senior |
$1,158.42
|
| Rate for Payer: Galaxy Health WC |
$2,464.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,739.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,609.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,899.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$94.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,158.42
|
| Rate for Payer: InnovAge PACE Commercial |
$1,737.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,933.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$103.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,158.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$579.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,552.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,552.28
|
| Rate for Payer: Multiplan Commercial |
$2,174.25
|
| Rate for Payer: Networks By Design Commercial |
$1,884.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,158.42
|
| Rate for Payer: Prime Health Services Commercial |
$2,464.15
|
| Rate for Payer: Prime Health Services Medicare |
$1,227.93
|
| Rate for Payer: Riverside University Health System MISP |
$1,274.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,739.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,390.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,158.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,274.26
|
| Rate for Payer: Vantage Medical Group Senior |
$1,158.42
|
|
|
HC SIGMDSCPY DX W WO COLLECT
|
Facility
|
IP
|
$4,910.00
|
|
|
Service Code
|
CPT 45330
|
| Hospital Charge Code |
906745330
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$982.00 |
| Max. Negotiated Rate |
$4,419.00 |
| Rate for Payer: Adventist Health Commercial |
$982.00
|
| Rate for Payer: Cash Price |
$2,209.50
|
| Rate for Payer: Central Health Plan Commercial |
$3,928.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,964.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,964.00
|
| Rate for Payer: Galaxy Health WC |
$4,173.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,946.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,419.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,274.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,870.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,039.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$982.00
|
| Rate for Payer: Multiplan Commercial |
$3,682.50
|
| Rate for Payer: Networks By Design Commercial |
$3,191.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,173.50
|
|
|
HC SIGMDSCPY DX W WO COLLECT
|
Facility
|
OP
|
$2,899.00
|
|
|
Service Code
|
CPT 45330
|
| Hospital Charge Code |
906745330
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$94.14 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$579.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,158.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,274.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,158.42
|
| 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 |
$1,771.29
|
| Rate for Payer: Blue Shield of California EPN |
$1,156.70
|
| Rate for Payer: Cash Price |
$1,304.55
|
| Rate for Payer: Cash Price |
$1,304.55
|
| Rate for Payer: Cash Price |
$1,304.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,319.20
|
| Rate for Payer: Cigna of CA HMO |
$1,855.36
|
| Rate for Payer: Cigna of CA PPO |
$2,145.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,274.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,158.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,563.87
|
| Rate for Payer: EPIC Health Plan Senior |
$1,158.42
|
| Rate for Payer: Galaxy Health WC |
$2,464.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,739.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,609.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,899.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$94.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,158.42
|
| Rate for Payer: InnovAge PACE Commercial |
$1,737.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,933.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$103.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,158.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$579.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,552.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,552.28
|
| Rate for Payer: Multiplan Commercial |
$2,174.25
|
| Rate for Payer: Networks By Design Commercial |
$1,884.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,158.42
|
| Rate for Payer: Prime Health Services Commercial |
$2,464.15
|
| Rate for Payer: Prime Health Services Medicare |
$1,227.93
|
| Rate for Payer: Riverside University Health System MISP |
$1,274.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,739.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,739.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,449.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,449.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,449.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,449.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,158.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,274.26
|
| Rate for Payer: Vantage Medical Group Senior |
$1,158.42
|
|
|
HC SIGMDSCPY FLEX W POLYPECTOMY
|
Facility
|
OP
|
$3,396.00
|
|
|
Service Code
|
CPT 45333
|
| Hospital Charge Code |
906745333
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$182.51 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$679.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,158.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,274.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,158.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,528.20
|
| Rate for Payer: Cash Price |
$1,528.20
|
| Rate for Payer: Cash Price |
$1,528.20
|
| Rate for Payer: Central Health Plan Commercial |
$2,716.80
|
| Rate for Payer: Cigna of CA HMO |
$2,173.44
|
| Rate for Payer: Cigna of CA PPO |
$2,513.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,274.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,158.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,563.87
|
| Rate for Payer: EPIC Health Plan Senior |
$1,158.42
|
| Rate for Payer: Galaxy Health WC |
$2,886.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,037.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,056.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,899.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$182.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,158.42
|
| Rate for Payer: InnovAge PACE Commercial |
$1,737.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,265.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$201.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,158.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$679.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,552.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,552.28
|
| Rate for Payer: Multiplan Commercial |
$2,547.00
|
| Rate for Payer: Networks By Design Commercial |
$2,207.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,158.42
|
| Rate for Payer: Prime Health Services Commercial |
$2,886.60
|
| Rate for Payer: Prime Health Services Medicare |
$1,227.93
|
| Rate for Payer: Riverside University Health System MISP |
$1,274.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,037.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,390.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,158.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,274.26
|
| Rate for Payer: Vantage Medical Group Senior |
$1,158.42
|
|
|
HC SIGMDSCPY FLEX W POLYPECTOMY
|
Facility
|
IP
|
$5,348.00
|
|
|
Service Code
|
CPT 45333
|
| Hospital Charge Code |
906745333
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,069.60 |
| Max. Negotiated Rate |
$4,813.20 |
| Rate for Payer: Adventist Health Commercial |
$1,069.60
|
| Rate for Payer: Cash Price |
$2,406.60
|
| Rate for Payer: Central Health Plan Commercial |
$4,278.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,139.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,139.20
|
| Rate for Payer: Galaxy Health WC |
$4,545.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,208.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,813.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,567.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,037.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,310.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,069.60
|
| Rate for Payer: Multiplan Commercial |
$4,011.00
|
| Rate for Payer: Networks By Design Commercial |
$3,476.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,545.80
|
|
|
HC SIGMDSCPY W BLLN DILATION
|
Facility
|
OP
|
$2,116.00
|
|
|
Service Code
|
CPT 45340
|
| Hospital Charge Code |
906745340
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$423.20 |
| Max. Negotiated Rate |
$7,378.00 |
| Rate for Payer: Adventist Health Commercial |
$423.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,498.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,498.14
|
| 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 |
$952.20
|
| Rate for Payer: Cash Price |
$952.20
|
| Rate for Payer: Cash Price |
$952.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,692.80
|
| Rate for Payer: Cigna of CA HMO |
$1,354.24
|
| Rate for Payer: Cigna of CA PPO |
$1,565.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,647.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,498.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,022.49
|
| Rate for Payer: EPIC Health Plan Senior |
$1,498.14
|
| Rate for Payer: Galaxy Health WC |
$1,798.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,269.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,904.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,456.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$611.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,498.14
|
| Rate for Payer: InnovAge PACE Commercial |
$2,247.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,411.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$675.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,498.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$423.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,007.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,007.51
|
| Rate for Payer: Multiplan Commercial |
$1,587.00
|
| Rate for Payer: Networks By Design Commercial |
$1,375.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,498.14
|
| Rate for Payer: Prime Health Services Commercial |
$1,798.60
|
| Rate for Payer: Prime Health Services Medicare |
$1,588.03
|
| Rate for Payer: Riverside University Health System MISP |
$1,647.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,269.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,797.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,498.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Vantage Medical Group Senior |
$1,498.14
|
|
|
HC SIGMDSCPY W BLLN DILATION
|
Facility
|
IP
|
$3,334.00
|
|
|
Service Code
|
CPT 45340
|
| Hospital Charge Code |
906745340
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$666.80 |
| Max. Negotiated Rate |
$3,000.60 |
| Rate for Payer: Adventist Health Commercial |
$666.80
|
| Rate for Payer: Cash Price |
$1,500.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,667.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,333.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,333.60
|
| Rate for Payer: Galaxy Health WC |
$2,833.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,000.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,000.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,223.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,270.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,063.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$666.80
|
| Rate for Payer: Multiplan Commercial |
$2,500.50
|
| Rate for Payer: Networks By Design Commercial |
$2,167.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,833.90
|
|
|
HC SIGMDSCPY W BX SNGL OR MULTI
|
Facility
|
OP
|
$3,661.00
|
|
|
Service Code
|
CPT 45331
|
| Hospital Charge Code |
906745331
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$124.24 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$732.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,158.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,274.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,158.42
|
| 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 |
$2,236.87
|
| Rate for Payer: Blue Shield of California EPN |
$1,460.74
|
| Rate for Payer: Cash Price |
$1,647.45
|
| Rate for Payer: Cash Price |
$1,647.45
|
| Rate for Payer: Cash Price |
$1,647.45
|
| Rate for Payer: Central Health Plan Commercial |
$2,928.80
|
| Rate for Payer: Cigna of CA HMO |
$2,343.04
|
| Rate for Payer: Cigna of CA PPO |
$2,709.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,274.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,158.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,563.87
|
| Rate for Payer: EPIC Health Plan Senior |
$1,158.42
|
| Rate for Payer: Galaxy Health WC |
$3,111.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,196.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,294.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,899.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$124.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,158.42
|
| Rate for Payer: InnovAge PACE Commercial |
$1,737.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,441.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$137.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,158.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$732.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,552.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,552.28
|
| Rate for Payer: Multiplan Commercial |
$2,745.75
|
| Rate for Payer: Networks By Design Commercial |
$2,379.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,158.42
|
| Rate for Payer: Prime Health Services Commercial |
$3,111.85
|
| Rate for Payer: Prime Health Services Medicare |
$1,227.93
|
| Rate for Payer: Riverside University Health System MISP |
$1,274.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,196.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,196.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,830.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,830.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,830.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,830.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,158.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,274.26
|
| Rate for Payer: Vantage Medical Group Senior |
$1,158.42
|
|
|
HC SIGMDSCPY W BX SNGL OR MULTI
|
Facility
|
IP
|
$5,767.00
|
|
|
Service Code
|
CPT 45331
|
| Hospital Charge Code |
906745331
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,153.40 |
| Max. Negotiated Rate |
$5,190.30 |
| Rate for Payer: Adventist Health Commercial |
$1,153.40
|
| Rate for Payer: Cash Price |
$2,595.15
|
| Rate for Payer: Central Health Plan Commercial |
$4,613.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,306.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,306.80
|
| Rate for Payer: Galaxy Health WC |
$4,901.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,460.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,190.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,846.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,197.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,569.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,153.40
|
| Rate for Payer: Multiplan Commercial |
$4,325.25
|
| Rate for Payer: Networks By Design Commercial |
$3,748.55
|
| Rate for Payer: Prime Health Services Commercial |
$4,901.95
|
|
|
HC SIGMDSCPY W BX SNGL OR MULTI
|
Facility
|
OP
|
$3,661.00
|
|
|
Service Code
|
CPT 45331
|
| Hospital Charge Code |
906745331
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$124.24 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$732.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,158.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,274.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,158.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,647.45
|
| Rate for Payer: Cash Price |
$1,647.45
|
| Rate for Payer: Cash Price |
$1,647.45
|
| Rate for Payer: Central Health Plan Commercial |
$2,928.80
|
| Rate for Payer: Cigna of CA HMO |
$2,343.04
|
| Rate for Payer: Cigna of CA PPO |
$2,709.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,274.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,158.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,563.87
|
| Rate for Payer: EPIC Health Plan Senior |
$1,158.42
|
| Rate for Payer: Galaxy Health WC |
$3,111.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,196.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,294.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,899.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$124.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,158.42
|
| Rate for Payer: InnovAge PACE Commercial |
$1,737.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,441.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$137.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,158.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$732.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,552.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,552.28
|
| Rate for Payer: Multiplan Commercial |
$2,745.75
|
| Rate for Payer: Networks By Design Commercial |
$2,379.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,158.42
|
| Rate for Payer: Prime Health Services Commercial |
$3,111.85
|
| Rate for Payer: Prime Health Services Medicare |
$1,227.93
|
| Rate for Payer: Riverside University Health System MISP |
$1,274.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,196.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,390.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,158.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,274.26
|
| Rate for Payer: Vantage Medical Group Senior |
$1,158.42
|
|
|
HC SIGMDSCPY W BX SNGL OR MULTI
|
Facility
|
IP
|
$5,767.00
|
|
|
Service Code
|
CPT 45331
|
| Hospital Charge Code |
906745331
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,153.40 |
| Max. Negotiated Rate |
$5,190.30 |
| Rate for Payer: Adventist Health Commercial |
$1,153.40
|
| Rate for Payer: Cash Price |
$2,595.15
|
| Rate for Payer: Central Health Plan Commercial |
$4,613.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,306.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,306.80
|
| Rate for Payer: Galaxy Health WC |
$4,901.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,460.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,190.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,846.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,197.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,569.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,153.40
|
| Rate for Payer: Multiplan Commercial |
$4,325.25
|
| Rate for Payer: Networks By Design Commercial |
$3,748.55
|
| Rate for Payer: Prime Health Services Commercial |
$4,901.95
|
|
|
HC SIGMDSCPY W CNTRL BLEEDING
|
Facility
|
IP
|
$4,868.00
|
|
|
Service Code
|
CPT 45334
|
| Hospital Charge Code |
906745334
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$973.60 |
| Max. Negotiated Rate |
$4,381.20 |
| Rate for Payer: Adventist Health Commercial |
$973.60
|
| Rate for Payer: Cash Price |
$2,190.60
|
| Rate for Payer: Central Health Plan Commercial |
$3,894.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,947.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,947.20
|
| Rate for Payer: Galaxy Health WC |
$4,137.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,920.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,381.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,246.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,854.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,013.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$973.60
|
| Rate for Payer: Multiplan Commercial |
$3,651.00
|
| Rate for Payer: Networks By Design Commercial |
$3,164.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,137.80
|
|
|
HC SIGMDSCPY W CNTRL BLEEDING
|
Facility
|
OP
|
$3,091.00
|
|
|
Service Code
|
CPT 45334
|
| Hospital Charge Code |
906745334
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$211.96 |
| Max. Negotiated Rate |
$7,378.00 |
| Rate for Payer: Adventist Health Commercial |
$618.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,498.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,498.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,390.95
|
| Rate for Payer: Cash Price |
$1,390.95
|
| Rate for Payer: Cash Price |
$1,390.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,472.80
|
| Rate for Payer: Cigna of CA HMO |
$1,978.24
|
| Rate for Payer: Cigna of CA PPO |
$2,287.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,647.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,498.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,022.49
|
| Rate for Payer: EPIC Health Plan Senior |
$1,498.14
|
| Rate for Payer: Galaxy Health WC |
$2,627.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,854.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,781.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,456.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$211.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,498.14
|
| Rate for Payer: InnovAge PACE Commercial |
$2,247.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,061.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$234.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,498.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$618.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,007.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,007.51
|
| Rate for Payer: Multiplan Commercial |
$2,318.25
|
| Rate for Payer: Networks By Design Commercial |
$2,009.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,498.14
|
| Rate for Payer: Prime Health Services Commercial |
$2,627.35
|
| Rate for Payer: Prime Health Services Medicare |
$1,588.03
|
| Rate for Payer: Riverside University Health System MISP |
$1,647.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,854.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,797.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,498.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Vantage Medical Group Senior |
$1,498.14
|
|
