|
HC INDR TERUMO BOKARHI KIT
|
Facility
|
OP
|
$572.75
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812421
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$114.55 |
| Max. Negotiated Rate |
$486.84 |
| Rate for Payer: Adventist Health Commercial |
$114.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$375.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$486.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$315.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$429.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$351.73
|
| Rate for Payer: Cash Price |
$315.01
|
| Rate for Payer: Cigna of CA HMO |
$366.56
|
| Rate for Payer: Cigna of CA PPO |
$423.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$486.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$486.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$486.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$229.10
|
| Rate for Payer: EPIC Health Plan Senior |
$229.10
|
| Rate for Payer: Galaxy Health WC |
$486.84
|
| Rate for Payer: Global Benefits Group Commercial |
$343.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$382.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$218.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$354.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$137.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$400.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$400.93
|
| Rate for Payer: Multiplan Commercial |
$458.20
|
| Rate for Payer: Networks By Design Commercial |
$372.29
|
| Rate for Payer: Prime Health Services Commercial |
$486.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$343.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$343.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$286.38
|
| Rate for Payer: United Healthcare All Other HMO |
$286.38
|
| Rate for Payer: United Healthcare HMO Rider |
$286.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$286.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$486.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$486.84
|
| Rate for Payer: Vantage Medical Group Senior |
$486.84
|
|
|
HC INDR TERUMO GLIDESHEATH
|
Facility
|
IP
|
$273.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812392
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.60 |
| Max. Negotiated Rate |
$232.05 |
| Rate for Payer: Adventist Health Commercial |
$54.60
|
| Rate for Payer: Cash Price |
$150.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.20
|
| Rate for Payer: EPIC Health Plan Senior |
$109.20
|
| Rate for Payer: Galaxy Health WC |
$232.05
|
| Rate for Payer: Global Benefits Group Commercial |
$163.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$182.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$168.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.52
|
| Rate for Payer: Multiplan Commercial |
$218.40
|
| Rate for Payer: Networks By Design Commercial |
$177.45
|
| Rate for Payer: Prime Health Services Commercial |
$232.05
|
|
|
HC INDR TERUMO GLIDESHEATH
|
Facility
|
OP
|
$273.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812392
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.60 |
| Max. Negotiated Rate |
$232.05 |
| Rate for Payer: Adventist Health Commercial |
$54.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$179.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$232.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$150.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$204.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$167.65
|
| Rate for Payer: Cash Price |
$150.15
|
| Rate for Payer: Cigna of CA HMO |
$174.72
|
| Rate for Payer: Cigna of CA PPO |
$202.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$232.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$232.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$232.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.20
|
| Rate for Payer: EPIC Health Plan Senior |
$109.20
|
| Rate for Payer: Galaxy Health WC |
$232.05
|
| Rate for Payer: Global Benefits Group Commercial |
$163.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$182.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$168.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$191.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$191.10
|
| Rate for Payer: Multiplan Commercial |
$218.40
|
| Rate for Payer: Networks By Design Commercial |
$177.45
|
| Rate for Payer: Prime Health Services Commercial |
$232.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$163.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$163.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$136.50
|
| Rate for Payer: United Healthcare All Other HMO |
$136.50
|
| Rate for Payer: United Healthcare HMO Rider |
$136.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$136.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$232.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$232.05
|
| Rate for Payer: Vantage Medical Group Senior |
$232.05
|
|
|
HC INDR TERUMO PINNACLE
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812394
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$59.50 |
| Rate for Payer: Adventist Health Commercial |
$14.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$45.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$59.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$52.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.99
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: Cigna of CA HMO |
$44.80
|
| Rate for Payer: Cigna of CA PPO |
$51.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$59.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$59.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.00
|
| Rate for Payer: EPIC Health Plan Senior |
$28.00
|
| Rate for Payer: Galaxy Health WC |
$59.50
|
| Rate for Payer: Global Benefits Group Commercial |
$42.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$49.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.00
|
| Rate for Payer: Multiplan Commercial |
$56.00
|
| Rate for Payer: Networks By Design Commercial |
$45.50
|
| Rate for Payer: Prime Health Services Commercial |
$59.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.00
|
| Rate for Payer: United Healthcare All Other HMO |
$35.00
|
| Rate for Payer: United Healthcare HMO Rider |
$35.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$59.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$59.50
|
| Rate for Payer: Vantage Medical Group Senior |
$59.50
|
|
|
HC INDR TERUMO PINNACLE
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812394
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$59.50 |
| Rate for Payer: Adventist Health Commercial |
$14.00
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.00
|
| Rate for Payer: EPIC Health Plan Senior |
$28.00
|
| Rate for Payer: Galaxy Health WC |
$59.50
|
| Rate for Payer: Global Benefits Group Commercial |
$42.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.80
|
| Rate for Payer: Multiplan Commercial |
$56.00
|
| Rate for Payer: Networks By Design Commercial |
$45.50
|
| Rate for Payer: Prime Health Services Commercial |
$59.50
|
|
|
HC INDR TERUMO PINNACLE DSTN
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812528
|
|
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: Cash Price |
$319.00
|
| 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 Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| 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 INDR TERUMO PINNACLE DSTN
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812528
|
|
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 |
$356.18
|
| Rate for Payer: Cash Price |
$319.00
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| 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
|
|
|
HC INDR TERUMO SLENDER
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812551
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$148.75 |
| Rate for Payer: Adventist Health Commercial |
$35.00
|
| Rate for Payer: Cash Price |
$96.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.00
|
| Rate for Payer: EPIC Health Plan Senior |
$70.00
|
| Rate for Payer: Galaxy Health WC |
$148.75
|
| Rate for Payer: Global Benefits Group Commercial |
$105.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$116.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$108.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: Multiplan Commercial |
$140.00
|
| Rate for Payer: Networks By Design Commercial |
$113.75
|
| Rate for Payer: Prime Health Services Commercial |
$148.75
|
|
|
HC INDR TERUMO SLENDER
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812551
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$148.75 |
| Rate for Payer: Adventist Health Commercial |
$35.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$114.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$148.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$96.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$131.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$107.47
|
| Rate for Payer: Cash Price |
$96.25
|
| Rate for Payer: Cigna of CA HMO |
$112.00
|
| Rate for Payer: Cigna of CA PPO |
$129.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$148.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$148.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.00
|
| Rate for Payer: EPIC Health Plan Senior |
$70.00
|
| Rate for Payer: Galaxy Health WC |
$148.75
|
| Rate for Payer: Global Benefits Group Commercial |
$105.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$116.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$108.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$122.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$122.50
|
| Rate for Payer: Multiplan Commercial |
$140.00
|
| Rate for Payer: Networks By Design Commercial |
$113.75
|
| Rate for Payer: Prime Health Services Commercial |
$148.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$105.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$105.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$87.50
|
| Rate for Payer: United Healthcare All Other HMO |
$87.50
|
| Rate for Payer: United Healthcare HMO Rider |
$87.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$87.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$148.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.75
|
| Rate for Payer: Vantage Medical Group Senior |
$148.75
|
|
|
HC IND STJ UNIVERSAL DIRECT SL II
|
Facility
|
IP
|
$2,984.00
|
|
|
Service Code
|
CPT C1893
|
| Hospital Charge Code |
906812539
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$596.80 |
| Max. Negotiated Rate |
$2,536.40 |
| Rate for Payer: Adventist Health Commercial |
$596.80
|
| Rate for Payer: Cash Price |
$1,641.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,193.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,193.60
|
| Rate for Payer: Galaxy Health WC |
$2,536.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,790.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,990.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,136.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,847.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$716.16
|
| Rate for Payer: Multiplan Commercial |
$2,387.20
|
| Rate for Payer: Networks By Design Commercial |
$1,939.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,536.40
|
|
|
HC IND STJ UNIVERSAL DIRECT SL II
|
Facility
|
OP
|
$2,984.00
|
|
|
Service Code
|
CPT C1893
|
| Hospital Charge Code |
906812539
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$596.80 |
| Max. Negotiated Rate |
$2,536.40 |
| Rate for Payer: Adventist Health Commercial |
$596.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,957.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,536.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,641.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,238.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,832.47
|
| Rate for Payer: Cash Price |
$1,641.20
|
| Rate for Payer: Cigna of CA HMO |
$1,909.76
|
| Rate for Payer: Cigna of CA PPO |
$2,208.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,536.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,536.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,536.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,193.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,193.60
|
| Rate for Payer: Galaxy Health WC |
$2,536.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,790.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,990.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,136.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,847.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$716.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,088.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,088.80
|
| Rate for Payer: Multiplan Commercial |
$2,387.20
|
| Rate for Payer: Networks By Design Commercial |
$1,939.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,536.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,790.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,790.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,492.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,492.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,492.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,492.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,536.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,536.40
|
| Rate for Payer: Vantage Medical Group Senior |
$2,536.40
|
|
|
HC INFANT LOWER EXT 2 VIEW
|
Facility
|
OP
|
$462.00
|
|
|
Service Code
|
CPT 73592
|
| Hospital Charge Code |
909001630
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$34.91 |
| Max. Negotiated Rate |
$392.70 |
| Rate for Payer: Adventist Health Commercial |
$92.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$303.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$139.38
|
| Rate for Payer: Blue Shield of California Commercial |
$282.74
|
| Rate for Payer: Blue Shield of California EPN |
$186.65
|
| Rate for Payer: Cash Price |
$254.10
|
| Rate for Payer: Cash Price |
$254.10
|
| Rate for Payer: Cigna of CA HMO |
$295.68
|
| Rate for Payer: Cigna of CA PPO |
$341.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$392.70
|
| Rate for Payer: Global Benefits Group Commercial |
$277.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$34.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$308.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$369.60
|
| Rate for Payer: Networks By Design Commercial |
$300.30
|
| Rate for Payer: Prime Health Services Commercial |
$392.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$277.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$277.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC INFANT LOWER EXT 2 VIEW
|
Facility
|
IP
|
$462.00
|
|
|
Service Code
|
CPT 73592
|
| Hospital Charge Code |
909001630
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$92.40 |
| Max. Negotiated Rate |
$392.70 |
| Rate for Payer: Adventist Health Commercial |
$92.40
|
| Rate for Payer: Cash Price |
$254.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.80
|
| Rate for Payer: EPIC Health Plan Senior |
$184.80
|
| Rate for Payer: Galaxy Health WC |
$392.70
|
| Rate for Payer: Global Benefits Group Commercial |
$277.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$308.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$176.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$285.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.88
|
| Rate for Payer: Multiplan Commercial |
$369.60
|
| Rate for Payer: Networks By Design Commercial |
$300.30
|
| Rate for Payer: Prime Health Services Commercial |
$392.70
|
|
|
HC INFANT PIV KIT
|
Facility
|
IP
|
$54.12
|
|
| Hospital Charge Code |
901698468
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$46.00 |
| Rate for Payer: Adventist Health Commercial |
$10.82
|
| Rate for Payer: Cash Price |
$29.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.65
|
| Rate for Payer: EPIC Health Plan Senior |
$21.65
|
| Rate for Payer: Galaxy Health WC |
$46.00
|
| Rate for Payer: Global Benefits Group Commercial |
$32.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.99
|
| Rate for Payer: Multiplan Commercial |
$43.30
|
| Rate for Payer: Networks By Design Commercial |
$35.18
|
| Rate for Payer: Prime Health Services Commercial |
$46.00
|
|
|
HC INFANT PIV KIT
|
Facility
|
OP
|
$54.12
|
|
| Hospital Charge Code |
901698468
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$46.00 |
| Rate for Payer: Dignity Health Medi-Cal |
$46.00
|
| Rate for Payer: Adventist Health Commercial |
$10.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$35.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.24
|
| Rate for Payer: Cash Price |
$29.77
|
| Rate for Payer: Cigna of CA HMO |
$34.64
|
| Rate for Payer: Cigna of CA PPO |
$40.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$46.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.65
|
| Rate for Payer: EPIC Health Plan Senior |
$21.65
|
| Rate for Payer: Galaxy Health WC |
$46.00
|
| Rate for Payer: Global Benefits Group Commercial |
$32.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37.88
|
| Rate for Payer: Multiplan Commercial |
$43.30
|
| Rate for Payer: Networks By Design Commercial |
$35.18
|
| Rate for Payer: Prime Health Services Commercial |
$46.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.06
|
| Rate for Payer: United Healthcare All Other HMO |
$27.06
|
| Rate for Payer: United Healthcare HMO Rider |
$27.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$46.00
|
| Rate for Payer: Vantage Medical Group Senior |
$46.00
|
|
|
HC INFANT UPPER EXT 2 VIEW
|
Facility
|
IP
|
$470.00
|
|
|
Service Code
|
CPT 73092
|
| Hospital Charge Code |
909001555
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$399.50 |
| Rate for Payer: Adventist Health Commercial |
$94.00
|
| Rate for Payer: Cash Price |
$258.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$188.00
|
| Rate for Payer: EPIC Health Plan Senior |
$188.00
|
| Rate for Payer: Galaxy Health WC |
$399.50
|
| Rate for Payer: Global Benefits Group Commercial |
$282.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$313.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$179.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$290.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.80
|
| Rate for Payer: Multiplan Commercial |
$376.00
|
| Rate for Payer: Networks By Design Commercial |
$305.50
|
| Rate for Payer: Prime Health Services Commercial |
$399.50
|
|
|
HC INFANT UPPER EXT 2 VIEW
|
Facility
|
OP
|
$470.00
|
|
|
Service Code
|
CPT 73092
|
| Hospital Charge Code |
909001555
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$34.91 |
| Max. Negotiated Rate |
$399.50 |
| Rate for Payer: Adventist Health Commercial |
$94.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$308.27
|
| 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 |
$139.38
|
| Rate for Payer: Blue Shield of California Commercial |
$287.64
|
| Rate for Payer: Blue Shield of California EPN |
$189.88
|
| Rate for Payer: Cash Price |
$258.50
|
| Rate for Payer: Cash Price |
$258.50
|
| Rate for Payer: Cigna of CA HMO |
$300.80
|
| Rate for Payer: Cigna of CA PPO |
$347.80
|
| 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 |
$399.50
|
| Rate for Payer: Global Benefits Group Commercial |
$282.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$34.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$313.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.80
|
| 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 |
$376.00
|
| Rate for Payer: Networks By Design Commercial |
$305.50
|
| Rate for Payer: Prime Health Services Commercial |
$399.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$282.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$282.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| 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 INFANT URINE PVC CATH KIT 5FR
|
Facility
|
OP
|
$15.25
|
|
| Hospital Charge Code |
901698585
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.05 |
| Max. Negotiated Rate |
$12.96 |
| Rate for Payer: Adventist Health Commercial |
$3.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.37
|
| Rate for Payer: Cash Price |
$8.39
|
| Rate for Payer: Cigna of CA HMO |
$9.76
|
| Rate for Payer: Cigna of CA PPO |
$11.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.10
|
| Rate for Payer: EPIC Health Plan Senior |
$6.10
|
| Rate for Payer: Galaxy Health WC |
$12.96
|
| Rate for Payer: Global Benefits Group Commercial |
$9.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.68
|
| Rate for Payer: Multiplan Commercial |
$12.20
|
| Rate for Payer: Networks By Design Commercial |
$9.91
|
| Rate for Payer: Prime Health Services Commercial |
$12.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.62
|
| Rate for Payer: United Healthcare All Other HMO |
$7.62
|
| Rate for Payer: United Healthcare HMO Rider |
$7.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.96
|
| Rate for Payer: Vantage Medical Group Senior |
$12.96
|
|
|
HC INFANT URINE PVC CATH KIT 5FR
|
Facility
|
IP
|
$15.25
|
|
| Hospital Charge Code |
901698585
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.05 |
| Max. Negotiated Rate |
$12.96 |
| Rate for Payer: Adventist Health Commercial |
$3.05
|
| Rate for Payer: Cash Price |
$8.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.10
|
| Rate for Payer: EPIC Health Plan Senior |
$6.10
|
| Rate for Payer: Galaxy Health WC |
$12.96
|
| Rate for Payer: Global Benefits Group Commercial |
$9.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.66
|
| Rate for Payer: Multiplan Commercial |
$12.20
|
| Rate for Payer: Networks By Design Commercial |
$9.91
|
| Rate for Payer: Prime Health Services Commercial |
$12.96
|
|
|
HC INFLUENZA A ANTIGEN
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT 87400
|
| Hospital Charge Code |
900911778
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Senior |
$80.00
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$133.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$123.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Multiplan Commercial |
$160.00
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
|
|
HC INFLUENZA A ANTIGEN
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
CPT 87400
|
| Hospital Charge Code |
900911778
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.73 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$131.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.88
|
| Rate for Payer: Blue Shield of California Commercial |
$133.80
|
| Rate for Payer: Blue Shield of California EPN |
$88.40
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna of CA HMO |
$128.00
|
| Rate for Payer: Cigna of CA PPO |
$148.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.08
|
| Rate for Payer: EPIC Health Plan Senior |
$14.13
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$133.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.93
|
| Rate for Payer: Multiplan Commercial |
$160.00
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$120.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$120.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.45
|
| Rate for Payer: United Healthcare All Other HMO |
$11.45
|
| Rate for Payer: United Healthcare HMO Rider |
$11.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.45
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.54
|
| Rate for Payer: Vantage Medical Group Senior |
$14.13
|
|
|
HC INF/PEDS CUTDOWN TRAY TOP
|
Facility
|
OP
|
$144.08
|
|
| Hospital Charge Code |
901698282
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.82 |
| Max. Negotiated Rate |
$122.47 |
| Rate for Payer: Adventist Health Commercial |
$28.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$122.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$79.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$108.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$88.48
|
| Rate for Payer: Cash Price |
$79.24
|
| Rate for Payer: Cigna of CA HMO |
$92.21
|
| Rate for Payer: Cigna of CA PPO |
$106.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$122.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$122.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$122.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.63
|
| Rate for Payer: EPIC Health Plan Senior |
$57.63
|
| Rate for Payer: Galaxy Health WC |
$122.47
|
| Rate for Payer: Global Benefits Group Commercial |
$86.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$96.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$89.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$100.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$100.86
|
| Rate for Payer: Multiplan Commercial |
$115.26
|
| Rate for Payer: Networks By Design Commercial |
$93.65
|
| Rate for Payer: Prime Health Services Commercial |
$122.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$86.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$86.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$72.04
|
| Rate for Payer: United Healthcare All Other HMO |
$72.04
|
| Rate for Payer: United Healthcare HMO Rider |
$72.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$72.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$122.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$122.47
|
| Rate for Payer: Vantage Medical Group Senior |
$122.47
|
|
|
HC INF/PEDS CUTDOWN TRAY TOP
|
Facility
|
IP
|
$144.08
|
|
| Hospital Charge Code |
901698282
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.82 |
| Max. Negotiated Rate |
$122.47 |
| Rate for Payer: Adventist Health Commercial |
$28.82
|
| Rate for Payer: Cash Price |
$79.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.63
|
| Rate for Payer: EPIC Health Plan Senior |
$57.63
|
| Rate for Payer: Galaxy Health WC |
$122.47
|
| Rate for Payer: Global Benefits Group Commercial |
$86.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$96.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$89.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.58
|
| Rate for Payer: Multiplan Commercial |
$115.26
|
| Rate for Payer: Networks By Design Commercial |
$93.65
|
| Rate for Payer: Prime Health Services Commercial |
$122.47
|
|
|
HC INFRARED MCAL
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT 97026
|
| Hospital Charge Code |
901300047
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$144.50 |
| Rate for Payer: Adventist Health Commercial |
$34.00
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.00
|
| Rate for Payer: EPIC Health Plan Senior |
$68.00
|
| Rate for Payer: Galaxy Health WC |
$144.50
|
| Rate for Payer: Global Benefits Group Commercial |
$102.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$113.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$105.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.80
|
| Rate for Payer: Multiplan Commercial |
$136.00
|
| Rate for Payer: Networks By Design Commercial |
$110.50
|
| Rate for Payer: Prime Health Services Commercial |
$144.50
|
|
|
HC INFRARED MCAL
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
CPT 97026
|
| Hospital Charge Code |
901300047
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$16.53 |
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$69.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$111.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$144.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$93.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$127.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Cigna of CA HMO |
$108.80
|
| Rate for Payer: Cigna of CA PPO |
$125.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$144.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$144.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$144.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.00
|
| Rate for Payer: EPIC Health Plan Senior |
$68.00
|
| Rate for Payer: Galaxy Health WC |
$144.50
|
| Rate for Payer: Global Benefits Group Commercial |
$102.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$113.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$105.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$119.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$119.00
|
| Rate for Payer: Multiplan Commercial |
$136.00
|
| Rate for Payer: Networks By Design Commercial |
$110.50
|
| Rate for Payer: Prime Health Services Commercial |
$144.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$102.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$102.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$144.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$144.50
|
| Rate for Payer: Vantage Medical Group Senior |
$144.50
|
|
