|
HC SNGL AXIS ANKLE/FLEXIBLE KEEL
|
Facility
|
OP
|
$654.00
|
|
|
Service Code
|
CPT L5975
|
| Hospital Charge Code |
905355975
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$214.19 |
| Max. Negotiated Rate |
$588.60 |
| Rate for Payer: Adventist Health Commercial |
$268.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$555.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$359.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$490.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$384.09
|
| Rate for Payer: Blue Shield of California Commercial |
$505.54
|
| Rate for Payer: Blue Shield of California EPN |
$329.62
|
| Rate for Payer: Cash Price |
$359.70
|
| Rate for Payer: Cash Price |
$359.70
|
| Rate for Payer: Central Health Plan Commercial |
$523.20
|
| Rate for Payer: Cigna of CA HMO |
$457.80
|
| Rate for Payer: Cigna of CA PPO |
$457.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$555.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$555.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$555.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$261.60
|
| Rate for Payer: EPIC Health Plan Senior |
$261.60
|
| Rate for Payer: Galaxy Health WC |
$555.90
|
| Rate for Payer: Global Benefits Group Commercial |
$392.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$588.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$356.32
|
| Rate for Payer: InnovAge PACE Commercial |
$327.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$436.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$393.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$404.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$268.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$457.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$457.80
|
| Rate for Payer: Multiplan Commercial |
$490.50
|
| Rate for Payer: Networks By Design Commercial |
$327.00
|
| Rate for Payer: Prime Health Services Commercial |
$555.90
|
| Rate for Payer: Riverside University Health System MISP |
$261.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$392.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$392.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$245.45
|
| Rate for Payer: United Healthcare All Other HMO |
$238.91
|
| Rate for Payer: United Healthcare HMO Rider |
$233.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$214.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$555.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$555.90
|
| Rate for Payer: Vantage Medical Group Senior |
$555.90
|
|
|
HC SNGL AXIS ANKLE/FLEXIBLE KEEL
|
Facility
|
IP
|
$654.00
|
|
|
Service Code
|
CPT L5975
|
| Hospital Charge Code |
905355975
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$130.80 |
| Max. Negotiated Rate |
$588.60 |
| Rate for Payer: Adventist Health Commercial |
$130.80
|
| Rate for Payer: Blue Shield of California Commercial |
$505.54
|
| Rate for Payer: Blue Shield of California EPN |
$329.62
|
| Rate for Payer: Cash Price |
$359.70
|
| Rate for Payer: Central Health Plan Commercial |
$523.20
|
| Rate for Payer: Cigna of CA HMO |
$457.80
|
| Rate for Payer: Cigna of CA PPO |
$457.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$261.60
|
| Rate for Payer: EPIC Health Plan Senior |
$261.60
|
| Rate for Payer: Galaxy Health WC |
$555.90
|
| Rate for Payer: Global Benefits Group Commercial |
$392.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$588.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$436.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$249.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$404.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.80
|
| Rate for Payer: Multiplan Commercial |
$490.50
|
| Rate for Payer: Networks By Design Commercial |
$425.10
|
| Rate for Payer: Prime Health Services Commercial |
$555.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$245.45
|
| Rate for Payer: United Healthcare All Other HMO |
$238.91
|
| Rate for Payer: United Healthcare HMO Rider |
$233.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$214.19
|
|
|
HC SNRE ENDOS 1.8MMX180CM 2.5CM PED
|
Facility
|
OP
|
$127.30
|
|
| Hospital Charge Code |
900100348
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.46 |
| Max. Negotiated Rate |
$114.57 |
| Rate for Payer: Adventist Health Commercial |
$25.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$77.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$108.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$70.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$95.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$61.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$74.76
|
| Rate for Payer: Blue Shield of California Commercial |
$77.78
|
| Rate for Payer: Blue Shield of California EPN |
$50.79
|
| Rate for Payer: Cash Price |
$70.02
|
| Rate for Payer: Central Health Plan Commercial |
$101.84
|
| Rate for Payer: Cigna of CA HMO |
$81.47
|
| Rate for Payer: Cigna of CA PPO |
$94.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$108.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$108.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$108.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.92
|
| Rate for Payer: EPIC Health Plan Senior |
$50.92
|
| Rate for Payer: Galaxy Health WC |
$108.20
|
| Rate for Payer: Global Benefits Group Commercial |
$76.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$114.57
|
| Rate for Payer: InnovAge PACE Commercial |
$63.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$84.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$78.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$89.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$89.11
|
| Rate for Payer: Multiplan Commercial |
$95.47
|
| Rate for Payer: Networks By Design Commercial |
$82.75
|
| Rate for Payer: Prime Health Services Commercial |
$108.20
|
| Rate for Payer: Riverside University Health System MISP |
$50.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$76.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$76.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$63.65
|
| Rate for Payer: United Healthcare All Other HMO |
$63.65
|
| Rate for Payer: United Healthcare HMO Rider |
$63.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$63.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$108.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$108.20
|
| Rate for Payer: Vantage Medical Group Senior |
$108.20
|
|
|
HC SNRE ENDOS 1.8MMX180CM 2.5CM PED
|
Facility
|
IP
|
$127.30
|
|
| Hospital Charge Code |
900100348
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.46 |
| Max. Negotiated Rate |
$114.57 |
| Rate for Payer: Adventist Health Commercial |
$25.46
|
| Rate for Payer: Cash Price |
$70.02
|
| Rate for Payer: Central Health Plan Commercial |
$101.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.92
|
| Rate for Payer: EPIC Health Plan Senior |
$50.92
|
| Rate for Payer: Galaxy Health WC |
$108.20
|
| Rate for Payer: Global Benefits Group Commercial |
$76.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$114.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$84.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$78.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.46
|
| Rate for Payer: Multiplan Commercial |
$95.47
|
| Rate for Payer: Networks By Design Commercial |
$82.75
|
| Rate for Payer: Prime Health Services Commercial |
$108.20
|
|
|
HC SNRE ENDOS 2.3MMX240CM
|
Facility
|
OP
|
$163.88
|
|
| Hospital Charge Code |
900100349
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.78 |
| Max. Negotiated Rate |
$147.49 |
| Rate for Payer: Adventist Health Commercial |
$32.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$99.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$139.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$90.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$122.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$79.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$96.25
|
| Rate for Payer: Blue Shield of California Commercial |
$100.13
|
| Rate for Payer: Blue Shield of California EPN |
$65.39
|
| Rate for Payer: Cash Price |
$90.13
|
| Rate for Payer: Central Health Plan Commercial |
$131.10
|
| Rate for Payer: Cigna of CA HMO |
$104.88
|
| Rate for Payer: Cigna of CA PPO |
$121.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$139.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$139.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$139.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.55
|
| Rate for Payer: EPIC Health Plan Senior |
$65.55
|
| Rate for Payer: Galaxy Health WC |
$139.30
|
| Rate for Payer: Global Benefits Group Commercial |
$98.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$147.49
|
| Rate for Payer: InnovAge PACE Commercial |
$81.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$109.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$101.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$114.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$114.72
|
| Rate for Payer: Multiplan Commercial |
$122.91
|
| Rate for Payer: Networks By Design Commercial |
$106.52
|
| Rate for Payer: Prime Health Services Commercial |
$139.30
|
| Rate for Payer: Riverside University Health System MISP |
$65.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$98.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$98.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$81.94
|
| Rate for Payer: United Healthcare All Other HMO |
$81.94
|
| Rate for Payer: United Healthcare HMO Rider |
$81.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$139.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$139.30
|
| Rate for Payer: Vantage Medical Group Senior |
$139.30
|
|
|
HC SNRE ENDOS 2.3MMX240CM
|
Facility
|
IP
|
$163.88
|
|
| Hospital Charge Code |
900100349
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.78 |
| Max. Negotiated Rate |
$147.49 |
| Rate for Payer: Adventist Health Commercial |
$32.78
|
| Rate for Payer: Cash Price |
$90.13
|
| Rate for Payer: Central Health Plan Commercial |
$131.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.55
|
| Rate for Payer: EPIC Health Plan Senior |
$65.55
|
| Rate for Payer: Galaxy Health WC |
$139.30
|
| Rate for Payer: Global Benefits Group Commercial |
$98.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$147.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$109.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$101.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.78
|
| Rate for Payer: Multiplan Commercial |
$122.91
|
| Rate for Payer: Networks By Design Commercial |
$106.52
|
| Rate for Payer: Prime Health Services Commercial |
$139.30
|
|
|
HC SNRE ENDOS 2.5X5.5CM 7FRX240CM
|
Facility
|
OP
|
$76.00
|
|
| Hospital Charge Code |
900100350
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.20 |
| Max. Negotiated Rate |
$68.40 |
| Rate for Payer: Adventist Health Commercial |
$15.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$46.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$57.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$36.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.63
|
| Rate for Payer: Blue Shield of California Commercial |
$46.44
|
| Rate for Payer: Blue Shield of California EPN |
$30.32
|
| Rate for Payer: Cash Price |
$41.80
|
| Rate for Payer: Central Health Plan Commercial |
$60.80
|
| Rate for Payer: Cigna of CA HMO |
$48.64
|
| Rate for Payer: Cigna of CA PPO |
$56.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$64.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$64.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.40
|
| Rate for Payer: EPIC Health Plan Senior |
$30.40
|
| Rate for Payer: Galaxy Health WC |
$64.60
|
| Rate for Payer: Global Benefits Group Commercial |
$45.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$68.40
|
| Rate for Payer: InnovAge PACE Commercial |
$38.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$53.20
|
| Rate for Payer: Multiplan Commercial |
$57.00
|
| Rate for Payer: Networks By Design Commercial |
$49.40
|
| Rate for Payer: Prime Health Services Commercial |
$64.60
|
| Rate for Payer: Riverside University Health System MISP |
$30.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$38.00
|
| Rate for Payer: United Healthcare All Other HMO |
$38.00
|
| Rate for Payer: United Healthcare HMO Rider |
$38.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$38.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.60
|
| Rate for Payer: Vantage Medical Group Senior |
$64.60
|
|
|
HC SNRE ENDOS 2.5X5.5CM 7FRX240CM
|
Facility
|
IP
|
$76.00
|
|
| Hospital Charge Code |
900100350
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.20 |
| Max. Negotiated Rate |
$68.40 |
| Rate for Payer: Adventist Health Commercial |
$15.20
|
| Rate for Payer: Cash Price |
$41.80
|
| Rate for Payer: Central Health Plan Commercial |
$60.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.40
|
| Rate for Payer: EPIC Health Plan Senior |
$30.40
|
| Rate for Payer: Galaxy Health WC |
$64.60
|
| Rate for Payer: Global Benefits Group Commercial |
$45.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$68.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.20
|
| Rate for Payer: Multiplan Commercial |
$57.00
|
| Rate for Payer: Networks By Design Commercial |
$49.40
|
| Rate for Payer: Prime Health Services Commercial |
$64.60
|
|
|
HC SNRE ENDOS 7FRX240CM
|
Facility
|
IP
|
$79.80
|
|
| Hospital Charge Code |
900100351
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.96 |
| Max. Negotiated Rate |
$71.82 |
| Rate for Payer: Adventist Health Commercial |
$15.96
|
| Rate for Payer: Cash Price |
$43.89
|
| Rate for Payer: Central Health Plan Commercial |
$63.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.92
|
| Rate for Payer: EPIC Health Plan Senior |
$31.92
|
| Rate for Payer: Galaxy Health WC |
$67.83
|
| Rate for Payer: Global Benefits Group Commercial |
$47.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$71.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.96
|
| Rate for Payer: Multiplan Commercial |
$59.85
|
| Rate for Payer: Networks By Design Commercial |
$51.87
|
| Rate for Payer: Prime Health Services Commercial |
$67.83
|
|
|
HC SNRE ENDOS 7FRX240CM
|
Facility
|
OP
|
$79.80
|
|
| Hospital Charge Code |
900100351
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.96 |
| Max. Negotiated Rate |
$71.82 |
| Rate for Payer: Adventist Health Commercial |
$15.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$48.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$67.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$43.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$59.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$38.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.87
|
| Rate for Payer: Blue Shield of California Commercial |
$48.76
|
| Rate for Payer: Blue Shield of California EPN |
$31.84
|
| Rate for Payer: Cash Price |
$43.89
|
| Rate for Payer: Central Health Plan Commercial |
$63.84
|
| Rate for Payer: Cigna of CA HMO |
$51.07
|
| Rate for Payer: Cigna of CA PPO |
$59.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$67.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$67.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.92
|
| Rate for Payer: EPIC Health Plan Senior |
$31.92
|
| Rate for Payer: Galaxy Health WC |
$67.83
|
| Rate for Payer: Global Benefits Group Commercial |
$47.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$71.82
|
| Rate for Payer: InnovAge PACE Commercial |
$39.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$55.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$55.86
|
| Rate for Payer: Multiplan Commercial |
$59.85
|
| Rate for Payer: Networks By Design Commercial |
$51.87
|
| Rate for Payer: Prime Health Services Commercial |
$67.83
|
| Rate for Payer: Riverside University Health System MISP |
$31.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$47.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$47.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$39.90
|
| Rate for Payer: United Healthcare All Other HMO |
$39.90
|
| Rate for Payer: United Healthcare HMO Rider |
$39.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$67.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$67.83
|
| Rate for Payer: Vantage Medical Group Senior |
$67.83
|
|
|
HC SNRE POLYPECTOMY 2.5CM 7FR
|
Facility
|
OP
|
$144.40
|
|
| Hospital Charge Code |
900100352
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.88 |
| Max. Negotiated Rate |
$129.96 |
| Rate for Payer: Adventist Health Commercial |
$28.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$87.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$122.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$79.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$108.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$69.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$84.81
|
| Rate for Payer: Blue Shield of California Commercial |
$88.23
|
| Rate for Payer: Blue Shield of California EPN |
$57.62
|
| Rate for Payer: Cash Price |
$79.42
|
| Rate for Payer: Central Health Plan Commercial |
$115.52
|
| Rate for Payer: Cigna of CA HMO |
$92.42
|
| Rate for Payer: Cigna of CA PPO |
$106.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$122.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$122.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$122.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.76
|
| Rate for Payer: EPIC Health Plan Senior |
$57.76
|
| Rate for Payer: Galaxy Health WC |
$122.74
|
| Rate for Payer: Global Benefits Group Commercial |
$86.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$129.96
|
| Rate for Payer: InnovAge PACE Commercial |
$72.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$96.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$89.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$101.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.08
|
| Rate for Payer: Multiplan Commercial |
$108.30
|
| Rate for Payer: Networks By Design Commercial |
$93.86
|
| Rate for Payer: Prime Health Services Commercial |
$122.74
|
| Rate for Payer: Riverside University Health System MISP |
$57.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$86.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$86.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$72.20
|
| Rate for Payer: United Healthcare All Other HMO |
$72.20
|
| Rate for Payer: United Healthcare HMO Rider |
$72.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$72.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$122.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$122.74
|
| Rate for Payer: Vantage Medical Group Senior |
$122.74
|
|
|
HC SNRE POLYPECTOMY 2.5CM 7FR
|
Facility
|
IP
|
$144.40
|
|
| Hospital Charge Code |
900100352
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.88 |
| Max. Negotiated Rate |
$129.96 |
| Rate for Payer: Adventist Health Commercial |
$28.88
|
| Rate for Payer: Cash Price |
$79.42
|
| Rate for Payer: Central Health Plan Commercial |
$115.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.76
|
| Rate for Payer: EPIC Health Plan Senior |
$57.76
|
| Rate for Payer: Galaxy Health WC |
$122.74
|
| Rate for Payer: Global Benefits Group Commercial |
$86.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$129.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$96.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$89.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.88
|
| Rate for Payer: Multiplan Commercial |
$108.30
|
| Rate for Payer: Networks By Design Commercial |
$93.86
|
| Rate for Payer: Prime Health Services Commercial |
$122.74
|
|
|
HC SNRE POLYPECTOMY 3X4.5CM
|
Facility
|
IP
|
$522.01
|
|
| Hospital Charge Code |
900100353
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$104.40 |
| Max. Negotiated Rate |
$469.81 |
| Rate for Payer: Adventist Health Commercial |
$104.40
|
| Rate for Payer: Cash Price |
$287.11
|
| Rate for Payer: Central Health Plan Commercial |
$417.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.80
|
| Rate for Payer: EPIC Health Plan Senior |
$208.80
|
| Rate for Payer: Galaxy Health WC |
$443.71
|
| Rate for Payer: Global Benefits Group Commercial |
$313.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$469.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$348.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$323.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.40
|
| Rate for Payer: Multiplan Commercial |
$391.51
|
| Rate for Payer: Networks By Design Commercial |
$339.31
|
| Rate for Payer: Prime Health Services Commercial |
$443.71
|
|
|
HC SNRE POLYPECTOMY 3X4.5CM
|
Facility
|
OP
|
$522.01
|
|
| Hospital Charge Code |
900100353
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$104.40 |
| Max. Negotiated Rate |
$469.81 |
| Rate for Payer: Adventist Health Commercial |
$104.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$317.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$443.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$287.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$391.51
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$252.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.58
|
| Rate for Payer: Blue Shield of California Commercial |
$318.95
|
| Rate for Payer: Blue Shield of California EPN |
$208.28
|
| Rate for Payer: Cash Price |
$287.11
|
| Rate for Payer: Central Health Plan Commercial |
$417.61
|
| Rate for Payer: Cigna of CA HMO |
$334.09
|
| Rate for Payer: Cigna of CA PPO |
$386.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$443.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$443.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$443.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.80
|
| Rate for Payer: EPIC Health Plan Senior |
$208.80
|
| Rate for Payer: Galaxy Health WC |
$443.71
|
| Rate for Payer: Global Benefits Group Commercial |
$313.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$469.81
|
| Rate for Payer: InnovAge PACE Commercial |
$261.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$348.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$323.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$365.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$365.41
|
| Rate for Payer: Multiplan Commercial |
$391.51
|
| Rate for Payer: Networks By Design Commercial |
$339.31
|
| Rate for Payer: Prime Health Services Commercial |
$443.71
|
| Rate for Payer: Riverside University Health System MISP |
$208.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$313.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$313.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$261.00
|
| Rate for Payer: United Healthcare HMO Rider |
$261.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$261.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$443.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$443.71
|
| Rate for Payer: Vantage Medical Group Senior |
$443.71
|
|
|
HC SOA 55284 CYSTICER AB IGG
|
Facility
|
IP
|
$59.10
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
900914796
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.82 |
| Max. Negotiated Rate |
$53.19 |
| Rate for Payer: Adventist Health Commercial |
$11.82
|
| Rate for Payer: Cash Price |
$32.51
|
| Rate for Payer: Central Health Plan Commercial |
$47.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.64
|
| Rate for Payer: EPIC Health Plan Senior |
$23.64
|
| Rate for Payer: Galaxy Health WC |
$50.23
|
| Rate for Payer: Global Benefits Group Commercial |
$35.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.82
|
| Rate for Payer: Multiplan Commercial |
$44.33
|
| Rate for Payer: Networks By Design Commercial |
$38.41
|
| Rate for Payer: Prime Health Services Commercial |
$50.23
|
|
|
HC SOA 55284 CYSTICER AB IGG
|
Facility
|
OP
|
$59.10
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
900914796
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.54 |
| Max. Negotiated Rate |
$95.51 |
| Rate for Payer: Adventist Health Commercial |
$11.82
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$35.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$95.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.38
|
| Rate for Payer: Blue Shield of California Commercial |
$35.87
|
| Rate for Payer: Blue Shield of California EPN |
$23.46
|
| Rate for Payer: Cash Price |
$32.51
|
| Rate for Payer: Cash Price |
$32.51
|
| Rate for Payer: Central Health Plan Commercial |
$47.28
|
| Rate for Payer: Cigna of CA HMO |
$37.82
|
| Rate for Payer: Cigna of CA PPO |
$43.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.56
|
| Rate for Payer: EPIC Health Plan Senior |
$13.01
|
| Rate for Payer: Galaxy Health WC |
$50.23
|
| Rate for Payer: Global Benefits Group Commercial |
$35.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.19
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.01
|
| Rate for Payer: InnovAge PACE Commercial |
$19.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.43
|
| Rate for Payer: Multiplan Commercial |
$44.33
|
| Rate for Payer: Networks By Design Commercial |
$38.41
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.01
|
| Rate for Payer: Prime Health Services Commercial |
$50.23
|
| Rate for Payer: Prime Health Services Medicare |
$13.79
|
| Rate for Payer: Riverside University Health System MISP |
$14.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.54
|
| Rate for Payer: United Healthcare All Other HMO |
$10.54
|
| Rate for Payer: United Healthcare HMO Rider |
$10.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.31
|
| Rate for Payer: Vantage Medical Group Senior |
$13.01
|
|
|
HC SOA 837 CEL MODY8 MUT
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
CPT 81403
|
| Hospital Charge Code |
900914773
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$675.00 |
| Rate for Payer: Adventist Health Commercial |
$150.00
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Central Health Plan Commercial |
$600.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$300.00
|
| Rate for Payer: EPIC Health Plan Senior |
$300.00
|
| Rate for Payer: Galaxy Health WC |
$637.50
|
| Rate for Payer: Global Benefits Group Commercial |
$450.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$675.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$500.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$285.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$464.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$150.00
|
| Rate for Payer: Multiplan Commercial |
$562.50
|
| Rate for Payer: Networks By Design Commercial |
$487.50
|
| Rate for Payer: Prime Health Services Commercial |
$637.50
|
|
|
HC SOA 837 CEL MODY8 MUT
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
CPT 81403
|
| Hospital Charge Code |
900914773
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$1,088.71 |
| Rate for Payer: Adventist Health Commercial |
$150.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$185.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$455.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$277.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$203.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$185.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,088.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$220.96
|
| Rate for Payer: Blue Shield of California Commercial |
$455.25
|
| Rate for Payer: Blue Shield of California EPN |
$297.75
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Central Health Plan Commercial |
$600.00
|
| Rate for Payer: Cigna of CA HMO |
$480.00
|
| Rate for Payer: Cigna of CA PPO |
$555.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$277.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$203.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$185.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$250.02
|
| Rate for Payer: EPIC Health Plan Senior |
$185.20
|
| Rate for Payer: Galaxy Health WC |
$637.50
|
| Rate for Payer: Global Benefits Group Commercial |
$450.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$675.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$303.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$318.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$185.20
|
| Rate for Payer: InnovAge PACE Commercial |
$277.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$500.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$351.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$185.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$150.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$248.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$248.17
|
| Rate for Payer: Multiplan Commercial |
$562.50
|
| Rate for Payer: Networks By Design Commercial |
$487.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$185.20
|
| Rate for Payer: Prime Health Services Commercial |
$637.50
|
| Rate for Payer: Prime Health Services Medicare |
$196.31
|
| Rate for Payer: Riverside University Health System MISP |
$203.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$450.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$450.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$150.01
|
| Rate for Payer: United Healthcare All Other HMO |
$150.01
|
| Rate for Payer: United Healthcare HMO Rider |
$150.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$150.01
|
| Rate for Payer: Upland Medical Group Pediatric |
$185.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$277.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$203.72
|
| Rate for Payer: Vantage Medical Group Senior |
$185.20
|
|
|
HC SOA 885 MONOGEN EVL 81405
|
Facility
|
IP
|
$1,053.75
|
|
|
Service Code
|
CPT 81405
|
| Hospital Charge Code |
900914774
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$210.75 |
| Max. Negotiated Rate |
$948.38 |
| Rate for Payer: Adventist Health Commercial |
$210.75
|
| Rate for Payer: Cash Price |
$579.56
|
| Rate for Payer: Central Health Plan Commercial |
$843.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$421.50
|
| Rate for Payer: EPIC Health Plan Senior |
$421.50
|
| Rate for Payer: Galaxy Health WC |
$895.69
|
| Rate for Payer: Global Benefits Group Commercial |
$632.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$948.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$702.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$401.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$652.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.75
|
| Rate for Payer: Multiplan Commercial |
$790.31
|
| Rate for Payer: Networks By Design Commercial |
$684.94
|
| Rate for Payer: Prime Health Services Commercial |
$895.69
|
|
|
HC SOA 885 MONOGEN EVL 81405
|
Facility
|
OP
|
$1,053.75
|
|
|
Service Code
|
CPT 81405
|
| Hospital Charge Code |
900914774
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$210.75 |
| Max. Negotiated Rate |
$1,714.49 |
| Rate for Payer: Adventist Health Commercial |
$210.75
|
| Rate for Payer: Adventist Health Medi-Cal |
$301.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$639.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$452.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$331.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$301.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,714.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.96
|
| Rate for Payer: Blue Shield of California Commercial |
$639.63
|
| Rate for Payer: Blue Shield of California EPN |
$418.34
|
| Rate for Payer: Cash Price |
$579.56
|
| Rate for Payer: Cash Price |
$579.56
|
| Rate for Payer: Central Health Plan Commercial |
$843.00
|
| Rate for Payer: Cigna of CA HMO |
$674.40
|
| Rate for Payer: Cigna of CA PPO |
$779.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$452.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$331.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$301.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$406.82
|
| Rate for Payer: EPIC Health Plan Senior |
$301.35
|
| Rate for Payer: Galaxy Health WC |
$895.69
|
| Rate for Payer: Global Benefits Group Commercial |
$632.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$948.38
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$494.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$518.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$301.35
|
| Rate for Payer: InnovAge PACE Commercial |
$452.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$702.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$572.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$301.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$403.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$403.81
|
| Rate for Payer: Multiplan Commercial |
$790.31
|
| Rate for Payer: Networks By Design Commercial |
$684.94
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$301.35
|
| Rate for Payer: Prime Health Services Commercial |
$895.69
|
| Rate for Payer: Prime Health Services Medicare |
$319.43
|
| Rate for Payer: Riverside University Health System MISP |
$331.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$632.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$632.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$244.10
|
| Rate for Payer: United Healthcare All Other HMO |
$244.10
|
| Rate for Payer: United Healthcare HMO Rider |
$244.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$244.10
|
| Rate for Payer: Upland Medical Group Pediatric |
$301.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$452.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$331.49
|
| Rate for Payer: Vantage Medical Group Senior |
$301.35
|
|
|
HC SOA 885 MONOGEN EVL 81406
|
Facility
|
IP
|
$1,053.75
|
|
|
Service Code
|
CPT 81406
|
| Hospital Charge Code |
900914775
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$210.75 |
| Max. Negotiated Rate |
$948.38 |
| Rate for Payer: Adventist Health Commercial |
$210.75
|
| Rate for Payer: Cash Price |
$579.56
|
| Rate for Payer: Central Health Plan Commercial |
$843.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$421.50
|
| Rate for Payer: EPIC Health Plan Senior |
$421.50
|
| Rate for Payer: Galaxy Health WC |
$895.69
|
| Rate for Payer: Global Benefits Group Commercial |
$632.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$948.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$702.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$401.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$652.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.75
|
| Rate for Payer: Multiplan Commercial |
$790.31
|
| Rate for Payer: Networks By Design Commercial |
$684.94
|
| Rate for Payer: Prime Health Services Commercial |
$895.69
|
|
|
HC SOA 885 MONOGEN EVL 81406
|
Facility
|
OP
|
$1,053.75
|
|
|
Service Code
|
CPT 81406
|
| Hospital Charge Code |
900914775
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$210.75 |
| Max. Negotiated Rate |
$1,748.87 |
| Rate for Payer: Adventist Health Commercial |
$210.75
|
| Rate for Payer: Adventist Health Medi-Cal |
$282.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$639.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$424.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$311.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$282.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,748.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$354.94
|
| Rate for Payer: Blue Shield of California Commercial |
$639.63
|
| Rate for Payer: Blue Shield of California EPN |
$418.34
|
| Rate for Payer: Cash Price |
$579.56
|
| Rate for Payer: Cash Price |
$579.56
|
| Rate for Payer: Central Health Plan Commercial |
$843.00
|
| Rate for Payer: Cigna of CA HMO |
$674.40
|
| Rate for Payer: Cigna of CA PPO |
$779.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$424.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$311.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$282.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$381.89
|
| Rate for Payer: EPIC Health Plan Senior |
$282.88
|
| Rate for Payer: Galaxy Health WC |
$895.69
|
| Rate for Payer: Global Benefits Group Commercial |
$632.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$948.38
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$463.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$486.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$282.88
|
| Rate for Payer: InnovAge PACE Commercial |
$424.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$702.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$537.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$282.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$379.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$379.06
|
| Rate for Payer: Multiplan Commercial |
$790.31
|
| Rate for Payer: Networks By Design Commercial |
$684.94
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$282.88
|
| Rate for Payer: Prime Health Services Commercial |
$895.69
|
| Rate for Payer: Prime Health Services Medicare |
$299.85
|
| Rate for Payer: Riverside University Health System MISP |
$311.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$632.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$632.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$229.13
|
| Rate for Payer: United Healthcare All Other HMO |
$229.13
|
| Rate for Payer: United Healthcare HMO Rider |
$229.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$229.13
|
| Rate for Payer: Upland Medical Group Pediatric |
$282.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$424.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$311.17
|
| Rate for Payer: Vantage Medical Group Senior |
$282.88
|
|
|
HC SOA 885 MONOGEN EVL 81479
|
Facility
|
OP
|
$1,053.75
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914776
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$210.75 |
| Max. Negotiated Rate |
$948.38 |
| Rate for Payer: Adventist Health Commercial |
$210.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$639.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$895.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$579.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$790.31
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$510.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$618.87
|
| Rate for Payer: Blue Shield of California Commercial |
$639.63
|
| Rate for Payer: Blue Shield of California EPN |
$418.34
|
| Rate for Payer: Cash Price |
$579.56
|
| Rate for Payer: Central Health Plan Commercial |
$843.00
|
| Rate for Payer: Cigna of CA HMO |
$674.40
|
| Rate for Payer: Cigna of CA PPO |
$779.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$895.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$895.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$895.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$421.50
|
| Rate for Payer: EPIC Health Plan Senior |
$421.50
|
| Rate for Payer: Galaxy Health WC |
$895.69
|
| Rate for Payer: Global Benefits Group Commercial |
$632.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$948.38
|
| Rate for Payer: InnovAge PACE Commercial |
$526.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$702.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$652.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$737.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$737.62
|
| Rate for Payer: Multiplan Commercial |
$790.31
|
| Rate for Payer: Networks By Design Commercial |
$684.94
|
| Rate for Payer: Prime Health Services Commercial |
$895.69
|
| Rate for Payer: Riverside University Health System MISP |
$421.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$632.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$632.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$526.88
|
| Rate for Payer: United Healthcare All Other HMO |
$526.88
|
| Rate for Payer: United Healthcare HMO Rider |
$526.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$526.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$895.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$895.69
|
| Rate for Payer: Vantage Medical Group Senior |
$895.69
|
|
|
HC SOA 885 MONOGEN EVL 81479
|
Facility
|
IP
|
$1,053.75
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914776
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$210.75 |
| Max. Negotiated Rate |
$948.38 |
| Rate for Payer: Adventist Health Commercial |
$210.75
|
| Rate for Payer: Cash Price |
$579.56
|
| Rate for Payer: Central Health Plan Commercial |
$843.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$421.50
|
| Rate for Payer: EPIC Health Plan Senior |
$421.50
|
| Rate for Payer: Galaxy Health WC |
$895.69
|
| Rate for Payer: Global Benefits Group Commercial |
$632.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$948.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$702.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$401.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$652.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.75
|
| Rate for Payer: Multiplan Commercial |
$790.31
|
| Rate for Payer: Networks By Design Commercial |
$684.94
|
| Rate for Payer: Prime Health Services Commercial |
$895.69
|
|
|
HC SO ABD RESTRAIN CANVAS & WEB
|
Facility
|
IP
|
$212.00
|
|
|
Service Code
|
CPT L3660
|
| Hospital Charge Code |
905353660
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$42.40 |
| Max. Negotiated Rate |
$190.80 |
| Rate for Payer: Adventist Health Commercial |
$42.40
|
| Rate for Payer: Blue Shield of California Commercial |
$163.88
|
| Rate for Payer: Blue Shield of California EPN |
$106.85
|
| Rate for Payer: Cash Price |
$212.00
|
| Rate for Payer: Central Health Plan Commercial |
$169.60
|
| Rate for Payer: Cigna of CA HMO |
$148.40
|
| Rate for Payer: Cigna of CA PPO |
$148.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.80
|
| Rate for Payer: EPIC Health Plan Senior |
$84.80
|
| Rate for Payer: Galaxy Health WC |
$180.20
|
| Rate for Payer: Global Benefits Group Commercial |
$127.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$190.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$141.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$131.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.40
|
| Rate for Payer: Multiplan Commercial |
$159.00
|
| Rate for Payer: Networks By Design Commercial |
$137.80
|
| Rate for Payer: Prime Health Services Commercial |
$180.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$79.56
|
| Rate for Payer: United Healthcare All Other HMO |
$77.44
|
| Rate for Payer: United Healthcare HMO Rider |
$75.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$69.43
|
|
