|
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 |
$1,129.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,726.17
|
| Rate for Payer: Blue Shield of California Commercial |
$1,132.49
|
| Rate for Payer: Blue Shield of California Commercial |
$1,716.22
|
| Rate for Payer: Cash Price |
$1,210.50
|
| Rate for Payer: Cash Price |
$1,210.50
|
| Rate for Payer: Cash Price |
$1,210.50
|
| 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 |
$460.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,883.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.35
|
| Rate for Payer: EPIC Health Plan Senior |
$337.57
|
| 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/Senior |
$503.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$156.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,708.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$176.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$645.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.22
|
| 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 |
$306.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
|
|
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 |
$1,210.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,883.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,708.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,587.10
|
| 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 UNI
|
Facility
|
OP
|
$2,257.00
|
|
|
Service Code
|
CPT 93931
|
| Hospital Charge Code |
908100120
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$1,918.45 |
| Rate for Payer: Adventist Health Commercial |
$451.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$711.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,448.32
|
| Rate for Payer: Blue Shield of California Commercial |
$1,439.97
|
| Rate for Payer: Blue Shield of California Commercial |
$950.20
|
| Rate for Payer: Cash Price |
$1,015.65
|
| Rate for Payer: Cash Price |
$1,015.65
|
| Rate for Payer: Cash Price |
$1,015.65
|
| 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 |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,579.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| 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/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$139.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,433.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$157.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$541.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$169.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$180.18
|
| 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 |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
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 |
$1,015.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,579.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,433.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,331.63
|
| 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
|
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 |
$1,129.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,454.09
|
| Rate for Payer: Blue Shield of California Commercial |
$1,445.71
|
| Rate for Payer: Blue Shield of California Commercial |
$953.99
|
| Rate for Payer: Cash Price |
$1,019.70
|
| Rate for Payer: Cash Price |
$1,019.70
|
| Rate for Payer: Cash Price |
$1,019.70
|
| 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 |
$460.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,586.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.35
|
| Rate for Payer: EPIC Health Plan Senior |
$337.57
|
| 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/Senior |
$503.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$263.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,438.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$297.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$543.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.22
|
| 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 |
$306.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
|
|
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 |
$1,019.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,586.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,438.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,336.94
|
| 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 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 |
$495.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$771.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$699.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$650.18
|
| 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 |
$1,127.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$707.15
|
| Rate for Payer: Blue Shield of California Commercial |
$463.94
|
| Rate for Payer: Blue Shield of California Commercial |
$703.08
|
| Rate for Payer: Cash Price |
$495.90
|
| Rate for Payer: Cash Price |
$495.90
|
| Rate for Payer: Cash Price |
$495.90
|
| 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 |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$771.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$936.70
|
| Rate for Payer: Global Benefits Group Commercial |
$661.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$128.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$699.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$144.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$169.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$180.18
|
| 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 |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
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 |
$8,368.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13,017.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$11,808.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,971.64
|
| 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 |
$11,933.05
|
| Rate for Payer: Cash Price |
$8,368.20
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$13,017.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$11,808.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6,750.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,971.64
|
| 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: 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
|
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 |
$7.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.14
|
| 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 Foundation Hospitals Commercial/Self Funded |
$10.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.39
|
| 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 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 |
$10.21
|
| Rate for Payer: Cash Price |
$7.16
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.14
|
| 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 Foundation Hospitals Commercial/Self Funded |
$10.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.39
|
| 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 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 |
$9.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.46
|
| 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 Foundation Hospitals Commercial/Self Funded |
$13.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.19
|
| 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 |
$13.26
|
| Rate for Payer: Cash Price |
$9.30
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.46
|
| 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 Foundation Hospitals Commercial/Self Funded |
$13.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.19
|
| 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
|
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 |
$12.21
|
| Rate for Payer: Cash Price |
$8.56
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.31
|
| 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 Foundation Hospitals Commercial/Self Funded |
$12.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.22
|
| 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 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 |
$8.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.31
|
| 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 Foundation Hospitals Commercial/Self Funded |
$12.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.22
|
| 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 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: Cash Price |
$11.44
|
| Rate for Payer: Cigna of CA HMO |
$16.27
|
| Rate for Payer: Cigna of CA PPO |
$18.81
|
| 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 |
$16.31
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.79
|
| 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 Foundation Hospitals Commercial/Self Funded |
$16.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.00
|
| 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 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 |
$11.44
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.79
|
| 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 Foundation Hospitals Commercial/Self Funded |
$16.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.00
|
| 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 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 |
$8.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.89
|
| 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 Foundation Hospitals Commercial/Self Funded |
$12.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.71
|
| 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 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 |
$12.73
|
| Rate for Payer: Cash Price |
$8.93
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.89
|
| 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 Foundation Hospitals Commercial/Self Funded |
$12.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.71
|
| 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 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 |
$16.31
|
| Rate for Payer: Cash Price |
$11.44
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.79
|
| 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 Foundation Hospitals Commercial/Self Funded |
$16.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.00
|
| 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 |
$11.44
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.79
|
| 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 Foundation Hospitals Commercial/Self Funded |
$16.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.00
|
| 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 PELVIC ORTHOTIC TPOD
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT E0944 NU
|
| Hospital Charge Code |
901605152
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$493.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$406.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$368.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$342.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.20
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
|
|
HC DVC PELVIC ORTHOTIC TPOD
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT E0944 NU
|
| Hospital Charge Code |
901605152
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$52.42 |
| Max. Negotiated Rate |
$493.00 |
| Rate for Payer: Cigna of CA PPO |
$429.20
|
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$136.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$372.19
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cigna of CA HMO |
$371.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$493.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$406.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$52.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$368.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$59.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$342.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$406.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC DVC RESQPOD RESUSCITATOR
|
Facility
|
OP
|
$580.00
|
|
| Hospital Charge Code |
901605270
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$493.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$380.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$372.19
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cigna of CA HMO |
$371.20
|
| Rate for Payer: Cigna of CA PPO |
$429.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$493.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$406.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$368.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$210.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$342.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$406.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$290.00
|
| Rate for Payer: United Healthcare All Other HMO |
$290.00
|
| Rate for Payer: United Healthcare HMO Rider |
$290.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
