|
HC DUPLX LO EXT ARTERY BILAT
|
Facility
|
OP
|
$2,833.00
|
|
|
Service Code
|
CPT 93925
|
| Hospital Charge Code |
908100106
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$162.74 |
| Max. Negotiated Rate |
$2,408.05 |
| Rate for Payer: Adventist Health Commercial |
$566.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,858.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,739.75
|
| Rate for Payer: Blue Shield of California Commercial |
$1,733.80
|
| Rate for Payer: Blue Shield of California EPN |
$1,144.53
|
| Rate for Payer: Cash Price |
$1,558.15
|
| Rate for Payer: Cash Price |
$1,558.15
|
| Rate for Payer: Cash Price |
$1,558.15
|
| Rate for Payer: Cigna of CA HMO |
$1,813.12
|
| Rate for Payer: Cigna of CA PPO |
$2,096.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.63
|
| Rate for Payer: EPIC Health Plan Senior |
$307.13
|
| Rate for Payer: Galaxy Health WC |
$2,408.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,699.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$162.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,889.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$184.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$679.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.55
|
| Rate for Payer: Multiplan Commercial |
$2,266.40
|
| Rate for Payer: Networks By Design Commercial |
$1,841.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,408.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,699.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,699.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,588.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,289.00
|
| Rate for Payer: United Healthcare HMO Rider |
$978.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$895.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$307.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC DUPLX LO EXT ARTERY UNI
|
Facility
|
OP
|
$2,034.00
|
|
|
Service Code
|
CPT 93926
|
| Hospital Charge Code |
908100123
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$135.12 |
| Max. Negotiated Rate |
$1,728.90 |
| Rate for Payer: Adventist Health Commercial |
$406.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,334.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,249.08
|
| Rate for Payer: Blue Shield of California Commercial |
$1,244.81
|
| Rate for Payer: Blue Shield of California EPN |
$821.74
|
| Rate for Payer: Cash Price |
$1,118.70
|
| Rate for Payer: Cash Price |
$1,118.70
|
| Rate for Payer: Cash Price |
$1,118.70
|
| Rate for Payer: Cigna of CA HMO |
$1,301.76
|
| Rate for Payer: Cigna of CA PPO |
$1,505.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$1,728.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,220.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$142.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,356.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$161.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$488.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$1,627.20
|
| Rate for Payer: Networks By Design Commercial |
$1,322.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,728.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,220.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,220.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,588.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,289.00
|
| Rate for Payer: United Healthcare HMO Rider |
$978.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$895.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC DUPLX LO EXT ARTERY UNI
|
Facility
|
IP
|
$2,034.00
|
|
|
Service Code
|
CPT 93926
|
| Hospital Charge Code |
908100123
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$406.80 |
| Max. Negotiated Rate |
$1,728.90 |
| Rate for Payer: Adventist Health Commercial |
$406.80
|
| Rate for Payer: Cash Price |
$1,118.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$813.60
|
| Rate for Payer: EPIC Health Plan Senior |
$813.60
|
| Rate for Payer: Galaxy Health WC |
$1,728.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,220.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,356.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$774.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,259.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$488.16
|
| Rate for Payer: Multiplan Commercial |
$1,627.20
|
| Rate for Payer: Networks By Design Commercial |
$1,322.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,728.90
|
|
|
HC DUPLX UP EXT ARTERY BILAT
|
Facility
|
IP
|
$2,690.00
|
|
|
Service Code
|
CPT 93930
|
| Hospital Charge Code |
908100105
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$538.00 |
| Max. Negotiated Rate |
$2,286.50 |
| Rate for Payer: Adventist Health Commercial |
$538.00
|
| Rate for Payer: Cash Price |
$1,479.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,076.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,076.00
|
| Rate for Payer: Galaxy Health WC |
$2,286.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,614.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,794.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,024.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,665.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$645.60
|
| Rate for Payer: Multiplan Commercial |
$2,152.00
|
| Rate for Payer: Networks By Design Commercial |
$1,748.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,286.50
|
|
|
HC DUPLX UP EXT ARTERY BILAT
|
Facility
|
OP
|
$2,690.00
|
|
|
Service Code
|
CPT 93930
|
| Hospital Charge Code |
908100105
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$156.26 |
| Max. Negotiated Rate |
$2,286.50 |
| Rate for Payer: Adventist Health Commercial |
$538.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,764.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,651.93
|
| Rate for Payer: Blue Shield of California Commercial |
$1,646.28
|
| Rate for Payer: Blue Shield of California EPN |
$1,086.76
|
| Rate for Payer: Cash Price |
$1,479.50
|
| Rate for Payer: Cash Price |
$1,479.50
|
| Rate for Payer: Cash Price |
$1,479.50
|
| Rate for Payer: Cigna of CA HMO |
$1,721.60
|
| Rate for Payer: Cigna of CA PPO |
$1,990.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.63
|
| Rate for Payer: EPIC Health Plan Senior |
$307.13
|
| Rate for Payer: Galaxy Health WC |
$2,286.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,614.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$156.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,794.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$176.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$645.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.55
|
| Rate for Payer: Multiplan Commercial |
$2,152.00
|
| Rate for Payer: Networks By Design Commercial |
$1,748.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,286.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,614.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,614.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,588.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,289.00
|
| Rate for Payer: United Healthcare HMO Rider |
$978.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$895.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$307.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC DUPLX UP EXT ARTERY UNI
|
Facility
|
OP
|
$2,257.00
|
|
|
Service Code
|
CPT 93931
|
| Hospital Charge Code |
908100120
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$135.12 |
| Max. Negotiated Rate |
$1,918.45 |
| Rate for Payer: Adventist Health Commercial |
$451.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,480.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,386.02
|
| Rate for Payer: Blue Shield of California Commercial |
$1,381.28
|
| Rate for Payer: Blue Shield of California EPN |
$911.83
|
| Rate for Payer: Cash Price |
$1,241.35
|
| Rate for Payer: Cash Price |
$1,241.35
|
| Rate for Payer: Cash Price |
$1,241.35
|
| Rate for Payer: Cigna of CA HMO |
$1,444.48
|
| Rate for Payer: Cigna of CA PPO |
$1,670.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$1,918.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,354.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$139.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,505.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$157.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$541.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$1,805.60
|
| Rate for Payer: Networks By Design Commercial |
$1,467.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,918.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,354.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,354.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,588.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,289.00
|
| Rate for Payer: United Healthcare HMO Rider |
$978.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$895.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC DUPLX UP EXT ARTERY UNI
|
Facility
|
IP
|
$2,257.00
|
|
|
Service Code
|
CPT 93931
|
| Hospital Charge Code |
908100120
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$451.40 |
| Max. Negotiated Rate |
$1,918.45 |
| Rate for Payer: Adventist Health Commercial |
$451.40
|
| Rate for Payer: Cash Price |
$1,241.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$902.80
|
| Rate for Payer: EPIC Health Plan Senior |
$902.80
|
| Rate for Payer: Galaxy Health WC |
$1,918.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,354.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,505.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$859.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,397.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$541.68
|
| Rate for Payer: Multiplan Commercial |
$1,805.60
|
| Rate for Payer: Networks By Design Commercial |
$1,467.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,918.45
|
|
|
HC DUP SCAN EXTRACRANIAL ART COMPLEX
|
Facility
|
IP
|
$2,266.00
|
|
|
Service Code
|
CPT 93880
|
| Hospital Charge Code |
908100102
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$453.20 |
| Max. Negotiated Rate |
$1,926.10 |
| Rate for Payer: Adventist Health Commercial |
$453.20
|
| Rate for Payer: Cash Price |
$1,246.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$906.40
|
| Rate for Payer: EPIC Health Plan Senior |
$906.40
|
| Rate for Payer: Galaxy Health WC |
$1,926.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,359.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,511.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$863.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,402.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$543.84
|
| Rate for Payer: Multiplan Commercial |
$1,812.80
|
| Rate for Payer: Networks By Design Commercial |
$1,472.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,926.10
|
|
|
HC DUP SCAN EXTRACRANIAL ART COMPLEX
|
Facility
|
OP
|
$2,266.00
|
|
|
Service Code
|
CPT 93880
|
| Hospital Charge Code |
908100102
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$263.16 |
| Max. Negotiated Rate |
$1,926.10 |
| Rate for Payer: Adventist Health Commercial |
$453.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,486.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,391.55
|
| Rate for Payer: Blue Shield of California Commercial |
$1,386.79
|
| Rate for Payer: Blue Shield of California EPN |
$915.46
|
| Rate for Payer: Cash Price |
$1,246.30
|
| Rate for Payer: Cash Price |
$1,246.30
|
| Rate for Payer: Cash Price |
$1,246.30
|
| Rate for Payer: Cigna of CA HMO |
$1,450.24
|
| Rate for Payer: Cigna of CA PPO |
$1,676.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.63
|
| Rate for Payer: EPIC Health Plan Senior |
$307.13
|
| Rate for Payer: Galaxy Health WC |
$1,926.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,359.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$263.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,511.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$543.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.55
|
| Rate for Payer: Multiplan Commercial |
$1,812.80
|
| Rate for Payer: Networks By Design Commercial |
$1,472.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,926.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,359.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,359.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,588.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,289.00
|
| Rate for Payer: United Healthcare HMO Rider |
$978.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$895.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$307.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC DUP SCAN EXTRACRANIAL ART LIMITED
|
Facility
|
IP
|
$1,102.00
|
|
|
Service Code
|
CPT 93882
|
| Hospital Charge Code |
908100116
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$220.40 |
| Max. Negotiated Rate |
$936.70 |
| Rate for Payer: Adventist Health Commercial |
$220.40
|
| Rate for Payer: Cash Price |
$606.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$440.80
|
| Rate for Payer: EPIC Health Plan Senior |
$440.80
|
| Rate for Payer: Galaxy Health WC |
$936.70
|
| Rate for Payer: Global Benefits Group Commercial |
$661.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$735.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$419.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$682.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.48
|
| Rate for Payer: Multiplan Commercial |
$881.60
|
| Rate for Payer: Networks By Design Commercial |
$716.30
|
| Rate for Payer: Prime Health Services Commercial |
$936.70
|
|
|
HC DUP SCAN EXTRACRANIAL ART LIMITED
|
Facility
|
OP
|
$1,102.00
|
|
|
Service Code
|
CPT 93882
|
| Hospital Charge Code |
908100116
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$128.08 |
| Max. Negotiated Rate |
$1,588.00 |
| Rate for Payer: Adventist Health Commercial |
$220.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$722.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$676.74
|
| Rate for Payer: Blue Shield of California Commercial |
$674.42
|
| Rate for Payer: Blue Shield of California EPN |
$445.21
|
| Rate for Payer: Cash Price |
$606.10
|
| Rate for Payer: Cash Price |
$606.10
|
| Rate for Payer: Cash Price |
$606.10
|
| Rate for Payer: Cigna of CA HMO |
$705.28
|
| Rate for Payer: Cigna of CA PPO |
$815.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$936.70
|
| Rate for Payer: Global Benefits Group Commercial |
$661.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$128.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$735.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$881.60
|
| Rate for Payer: Networks By Design Commercial |
$716.30
|
| Rate for Payer: Prime Health Services Commercial |
$936.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$661.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$661.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,588.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,289.00
|
| Rate for Payer: United Healthcare HMO Rider |
$978.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$895.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC DVC BERLIN HEART DRIVING UNIT
|
Facility
|
IP
|
$18,596.00
|
|
| Hospital Charge Code |
901692008
|
|
Hospital Revenue Code
|
291
|
| Min. Negotiated Rate |
$3,719.20 |
| Max. Negotiated Rate |
$15,806.60 |
| Rate for Payer: Adventist Health Commercial |
$3,719.20
|
| Rate for Payer: Cash Price |
$10,227.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,438.40
|
| Rate for Payer: EPIC Health Plan Senior |
$7,438.40
|
| Rate for Payer: Galaxy Health WC |
$15,806.60
|
| Rate for Payer: Global Benefits Group Commercial |
$11,157.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,403.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,085.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,510.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,463.04
|
| Rate for Payer: Multiplan Commercial |
$14,876.80
|
| Rate for Payer: Networks By Design Commercial |
$12,087.40
|
| Rate for Payer: Prime Health Services Commercial |
$15,806.60
|
|
|
HC DVC BERLIN HEART DRIVING UNIT
|
Facility
|
OP
|
$18,596.00
|
|
| Hospital Charge Code |
901692008
|
|
Hospital Revenue Code
|
291
|
| Min. Negotiated Rate |
$3,719.20 |
| Max. Negotiated Rate |
$15,806.60 |
| Rate for Payer: Adventist Health Commercial |
$3,719.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,197.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,806.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,227.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,947.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,419.80
|
| Rate for Payer: Cash Price |
$10,227.80
|
| Rate for Payer: Cigna of CA HMO |
$11,901.44
|
| Rate for Payer: Cigna of CA PPO |
$13,761.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,806.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,806.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15,806.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,438.40
|
| Rate for Payer: EPIC Health Plan Senior |
$7,438.40
|
| Rate for Payer: Galaxy Health WC |
$15,806.60
|
| Rate for Payer: Global Benefits Group Commercial |
$11,157.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,403.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,085.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,510.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,463.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,017.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13,017.20
|
| Rate for Payer: Multiplan Commercial |
$14,876.80
|
| Rate for Payer: Networks By Design Commercial |
$12,087.40
|
| Rate for Payer: Prime Health Services Commercial |
$15,806.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,157.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11,157.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,298.00
|
| Rate for Payer: United Healthcare All Other HMO |
$9,298.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,298.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,806.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,806.60
|
| Rate for Payer: Vantage Medical Group Senior |
$15,806.60
|
|
|
HC DVC FEEDING TUBE 5-18FR
|
Facility
|
OP
|
$15.91
|
|
|
Service Code
|
CPT B9998
|
| Hospital Charge Code |
901698340
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.18 |
| Max. Negotiated Rate |
$13.52 |
| Rate for Payer: Adventist Health Commercial |
$3.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.77
|
| Rate for Payer: Cash Price |
$8.75
|
| Rate for Payer: Cigna of CA HMO |
$10.18
|
| Rate for Payer: Cigna of CA PPO |
$11.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.36
|
| Rate for Payer: EPIC Health Plan Senior |
$6.36
|
| Rate for Payer: Galaxy Health WC |
$13.52
|
| Rate for Payer: Global Benefits Group Commercial |
$9.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.14
|
| Rate for Payer: Multiplan Commercial |
$12.73
|
| Rate for Payer: Networks By Design Commercial |
$10.34
|
| Rate for Payer: Prime Health Services Commercial |
$13.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.96
|
| Rate for Payer: United Healthcare All Other HMO |
$7.96
|
| Rate for Payer: United Healthcare HMO Rider |
$7.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.52
|
| Rate for Payer: Vantage Medical Group Senior |
$13.52
|
|
|
HC DVC FEEDING TUBE 5-18FR
|
Facility
|
IP
|
$15.91
|
|
|
Service Code
|
CPT B9998
|
| Hospital Charge Code |
901698340
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.18 |
| Max. Negotiated Rate |
$13.52 |
| Rate for Payer: Adventist Health Commercial |
$3.18
|
| Rate for Payer: Cash Price |
$8.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.36
|
| Rate for Payer: EPIC Health Plan Senior |
$6.36
|
| Rate for Payer: Galaxy Health WC |
$13.52
|
| Rate for Payer: Global Benefits Group Commercial |
$9.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.82
|
| Rate for Payer: Multiplan Commercial |
$12.73
|
| Rate for Payer: Networks By Design Commercial |
$10.34
|
| Rate for Payer: Prime Health Services Commercial |
$13.52
|
|
|
HC DVC NASAL SUCTION
|
Facility
|
IP
|
$20.66
|
|
| Hospital Charge Code |
901604906
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.13 |
| Max. Negotiated Rate |
$17.56 |
| Rate for Payer: Adventist Health Commercial |
$4.13
|
| Rate for Payer: Cash Price |
$11.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.26
|
| Rate for Payer: EPIC Health Plan Senior |
$8.26
|
| Rate for Payer: Galaxy Health WC |
$17.56
|
| Rate for Payer: Global Benefits Group Commercial |
$12.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.96
|
| Rate for Payer: Multiplan Commercial |
$16.53
|
| Rate for Payer: Networks By Design Commercial |
$13.43
|
| Rate for Payer: Prime Health Services Commercial |
$17.56
|
|
|
HC DVC NASAL SUCTION
|
Facility
|
OP
|
$20.66
|
|
| Hospital Charge Code |
901604906
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.13 |
| Max. Negotiated Rate |
$17.56 |
| Rate for Payer: Adventist Health Commercial |
$4.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.69
|
| Rate for Payer: Cash Price |
$11.36
|
| Rate for Payer: Cigna of CA HMO |
$13.22
|
| Rate for Payer: Cigna of CA PPO |
$15.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.26
|
| Rate for Payer: EPIC Health Plan Senior |
$8.26
|
| Rate for Payer: Galaxy Health WC |
$17.56
|
| Rate for Payer: Global Benefits Group Commercial |
$12.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.46
|
| Rate for Payer: Multiplan Commercial |
$16.53
|
| Rate for Payer: Networks By Design Commercial |
$13.43
|
| Rate for Payer: Prime Health Services Commercial |
$17.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.33
|
| Rate for Payer: United Healthcare All Other HMO |
$10.33
|
| Rate for Payer: United Healthcare HMO Rider |
$10.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.56
|
| Rate for Payer: Vantage Medical Group Senior |
$17.56
|
|
|
HC DVC NASAL SUCTION PREEMIE
|
Facility
|
IP
|
$19.02
|
|
| Hospital Charge Code |
901605138
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$16.17 |
| Rate for Payer: Adventist Health Commercial |
$3.80
|
| Rate for Payer: Cash Price |
$10.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.61
|
| Rate for Payer: EPIC Health Plan Senior |
$7.61
|
| Rate for Payer: Galaxy Health WC |
$16.17
|
| Rate for Payer: Global Benefits Group Commercial |
$11.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.56
|
| Rate for Payer: Multiplan Commercial |
$15.22
|
| Rate for Payer: Networks By Design Commercial |
$12.36
|
| Rate for Payer: Prime Health Services Commercial |
$16.17
|
|
|
HC DVC NASAL SUCTION PREEMIE
|
Facility
|
OP
|
$19.02
|
|
| Hospital Charge Code |
901605138
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$16.17 |
| Rate for Payer: Adventist Health Commercial |
$3.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.68
|
| Rate for Payer: Cash Price |
$10.46
|
| Rate for Payer: Cigna of CA HMO |
$12.17
|
| Rate for Payer: Cigna of CA PPO |
$14.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.61
|
| Rate for Payer: EPIC Health Plan Senior |
$7.61
|
| Rate for Payer: Galaxy Health WC |
$16.17
|
| Rate for Payer: Global Benefits Group Commercial |
$11.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.31
|
| Rate for Payer: Multiplan Commercial |
$15.22
|
| Rate for Payer: Networks By Design Commercial |
$12.36
|
| Rate for Payer: Prime Health Services Commercial |
$16.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.51
|
| Rate for Payer: United Healthcare All Other HMO |
$9.51
|
| Rate for Payer: United Healthcare HMO Rider |
$9.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.17
|
| Rate for Payer: Vantage Medical Group Senior |
$16.17
|
|
|
HC DVC NASAL SUCTION STD W/COVER
|
Facility
|
IP
|
$25.42
|
|
| Hospital Charge Code |
901698481
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.08 |
| Max. Negotiated Rate |
$21.61 |
| Rate for Payer: Adventist Health Commercial |
$5.08
|
| Rate for Payer: Cash Price |
$13.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.17
|
| Rate for Payer: EPIC Health Plan Senior |
$10.17
|
| Rate for Payer: Galaxy Health WC |
$21.61
|
| Rate for Payer: Global Benefits Group Commercial |
$15.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.10
|
| Rate for Payer: Multiplan Commercial |
$20.34
|
| Rate for Payer: Networks By Design Commercial |
$16.52
|
| Rate for Payer: Prime Health Services Commercial |
$21.61
|
|
|
HC DVC NASAL SUCTION STD W/COVER
|
Facility
|
OP
|
$25.42
|
|
| Hospital Charge Code |
901698481
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.08 |
| Max. Negotiated Rate |
$21.61 |
| Rate for Payer: Adventist Health Commercial |
$5.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.61
|
| Rate for Payer: Cash Price |
$13.98
|
| Rate for Payer: Cigna of CA HMO |
$16.27
|
| Rate for Payer: Cigna of CA PPO |
$18.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.17
|
| Rate for Payer: EPIC Health Plan Senior |
$10.17
|
| Rate for Payer: Galaxy Health WC |
$21.61
|
| Rate for Payer: Global Benefits Group Commercial |
$15.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.79
|
| Rate for Payer: Multiplan Commercial |
$20.34
|
| Rate for Payer: Networks By Design Commercial |
$16.52
|
| Rate for Payer: Prime Health Services Commercial |
$21.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.71
|
| Rate for Payer: United Healthcare All Other HMO |
$12.71
|
| Rate for Payer: United Healthcare HMO Rider |
$12.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.61
|
| Rate for Payer: Vantage Medical Group Senior |
$21.61
|
|
|
HC DVC NASAL SUCTION STNDR
|
Facility
|
OP
|
$19.84
|
|
| Hospital Charge Code |
901605137
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.97 |
| Max. Negotiated Rate |
$16.86 |
| Rate for Payer: Adventist Health Commercial |
$3.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.18
|
| Rate for Payer: Cash Price |
$10.91
|
| Rate for Payer: Cigna of CA HMO |
$12.70
|
| Rate for Payer: Cigna of CA PPO |
$14.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.94
|
| Rate for Payer: EPIC Health Plan Senior |
$7.94
|
| Rate for Payer: Galaxy Health WC |
$16.86
|
| Rate for Payer: Global Benefits Group Commercial |
$11.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.89
|
| Rate for Payer: Multiplan Commercial |
$15.87
|
| Rate for Payer: Networks By Design Commercial |
$12.90
|
| Rate for Payer: Prime Health Services Commercial |
$16.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.92
|
| Rate for Payer: United Healthcare All Other HMO |
$9.92
|
| Rate for Payer: United Healthcare HMO Rider |
$9.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.86
|
| Rate for Payer: Vantage Medical Group Senior |
$16.86
|
|
|
HC DVC NASAL SUCTION STNDR
|
Facility
|
IP
|
$19.84
|
|
| Hospital Charge Code |
901605137
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.97 |
| Max. Negotiated Rate |
$16.86 |
| Rate for Payer: Adventist Health Commercial |
$3.97
|
| Rate for Payer: Cash Price |
$10.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.94
|
| Rate for Payer: EPIC Health Plan Senior |
$7.94
|
| Rate for Payer: Galaxy Health WC |
$16.86
|
| Rate for Payer: Global Benefits Group Commercial |
$11.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.76
|
| Rate for Payer: Multiplan Commercial |
$15.87
|
| Rate for Payer: Networks By Design Commercial |
$12.90
|
| Rate for Payer: Prime Health Services Commercial |
$16.86
|
|
|
HC DVC NASAL SUCTN PREEMIE W/CVR
|
Facility
|
OP
|
$25.42
|
|
| Hospital Charge Code |
901698482
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.08 |
| Max. Negotiated Rate |
$21.61 |
| Rate for Payer: Adventist Health Commercial |
$5.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.61
|
| Rate for Payer: Cash Price |
$13.98
|
| Rate for Payer: Cigna of CA HMO |
$16.27
|
| Rate for Payer: Cigna of CA PPO |
$18.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.17
|
| Rate for Payer: EPIC Health Plan Senior |
$10.17
|
| Rate for Payer: Galaxy Health WC |
$21.61
|
| Rate for Payer: Global Benefits Group Commercial |
$15.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.79
|
| Rate for Payer: Multiplan Commercial |
$20.34
|
| Rate for Payer: Networks By Design Commercial |
$16.52
|
| Rate for Payer: Prime Health Services Commercial |
$21.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.71
|
| Rate for Payer: United Healthcare All Other HMO |
$12.71
|
| Rate for Payer: United Healthcare HMO Rider |
$12.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.61
|
| Rate for Payer: Vantage Medical Group Senior |
$21.61
|
|
|
HC DVC NASAL SUCTN PREEMIE W/CVR
|
Facility
|
IP
|
$25.42
|
|
| Hospital Charge Code |
901698482
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.08 |
| Max. Negotiated Rate |
$21.61 |
| Rate for Payer: Adventist Health Commercial |
$5.08
|
| Rate for Payer: Cash Price |
$13.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.17
|
| Rate for Payer: EPIC Health Plan Senior |
$10.17
|
| Rate for Payer: Galaxy Health WC |
$21.61
|
| Rate for Payer: Global Benefits Group Commercial |
$15.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.10
|
| Rate for Payer: Multiplan Commercial |
$20.34
|
| Rate for Payer: Networks By Design Commercial |
$16.52
|
| Rate for Payer: Prime Health Services Commercial |
$21.61
|
|
