|
HC INCSNAL BX SKIN EA SEP/ADD LSN
|
Facility
|
IP
|
$569.00
|
|
|
Service Code
|
CPT 11107
|
| Hospital Charge Code |
900511107
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$113.80 |
| Max. Negotiated Rate |
$483.65 |
| Rate for Payer: Adventist Health Commercial |
$113.80
|
| Rate for Payer: Cash Price |
$256.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$398.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$227.60
|
| Rate for Payer: EPIC Health Plan Senior |
$227.60
|
| Rate for Payer: Galaxy Health WC |
$483.65
|
| Rate for Payer: Global Benefits Group Commercial |
$341.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$361.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$335.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.56
|
| Rate for Payer: Multiplan Commercial |
$455.20
|
| Rate for Payer: Networks By Design Commercial |
$369.85
|
| Rate for Payer: Prime Health Services Commercial |
$483.65
|
|
|
HC IND ABTN GT 1 IA INJ INCL HA
|
Facility
|
OP
|
$6,220.00
|
|
|
Service Code
|
CPT 59850
|
| Hospital Charge Code |
909009850
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$551.14 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,244.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,287.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,421.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,665.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,454.70
|
| Rate for Payer: Blue Shield of California Commercial |
$2,942.61
|
| Rate for Payer: Cash Price |
$2,799.00
|
| Rate for Payer: Cash Price |
$2,799.00
|
| Rate for Payer: Cash Price |
$2,799.00
|
| Rate for Payer: Cigna of CA HMO |
$3,980.80
|
| Rate for Payer: Cigna of CA PPO |
$4,602.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,287.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,287.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,287.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,354.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,488.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,488.00
|
| Rate for Payer: Galaxy Health WC |
$5,287.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,732.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$551.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,949.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$623.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,669.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,492.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,354.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,354.00
|
| Rate for Payer: Multiplan Commercial |
$4,976.00
|
| Rate for Payer: Networks By Design Commercial |
$4,043.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,287.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,732.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,110.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,287.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,287.00
|
| Rate for Payer: Vantage Medical Group Senior |
$5,287.00
|
|
|
HC IND ABTN GT 1 IA INJ INCL HA
|
Facility
|
IP
|
$6,220.00
|
|
|
Service Code
|
CPT 59850
|
| Hospital Charge Code |
909009850
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,244.00 |
| Max. Negotiated Rate |
$5,287.00 |
| Rate for Payer: Adventist Health Commercial |
$1,244.00
|
| Rate for Payer: Cash Price |
$2,799.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,354.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,488.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,488.00
|
| Rate for Payer: Galaxy Health WC |
$5,287.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,732.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,949.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,669.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,492.80
|
| Rate for Payer: Multiplan Commercial |
$4,976.00
|
| Rate for Payer: Networks By Design Commercial |
$4,043.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,287.00
|
|
|
HC INDIV BRIEF THERAPY
|
Facility
|
IP
|
$228.00
|
|
|
Service Code
|
CPT 90832
|
| Hospital Charge Code |
907804005
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$45.60 |
| Max. Negotiated Rate |
$193.80 |
| Rate for Payer: Adventist Health Commercial |
$45.60
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$159.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.20
|
| Rate for Payer: EPIC Health Plan Senior |
$91.20
|
| Rate for Payer: Galaxy Health WC |
$193.80
|
| Rate for Payer: Global Benefits Group Commercial |
$136.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$144.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$134.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.72
|
| Rate for Payer: Multiplan Commercial |
$182.40
|
| Rate for Payer: Networks By Design Commercial |
$148.20
|
| Rate for Payer: Prime Health Services Commercial |
$193.80
|
|
|
HC INDIV BRIEF THERAPY
|
Facility
|
OP
|
$228.00
|
|
|
Service Code
|
CPT 90832
|
| Hospital Charge Code |
907804005
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$45.60 |
| Max. Negotiated Rate |
$3,171.00 |
| Rate for Payer: Adventist Health Commercial |
$45.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$342.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$251.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$228.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,601.00
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cigna of CA HMO |
$145.92
|
| Rate for Payer: Cigna of CA PPO |
$168.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$342.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$251.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$228.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$159.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$376.68
|
| Rate for Payer: EPIC Health Plan Senior |
$251.12
|
| Rate for Payer: Galaxy Health WC |
$193.80
|
| Rate for Payer: Global Benefits Group Commercial |
$136.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$374.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$228.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$144.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$100.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$245.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$287.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$305.91
|
| Rate for Payer: Multiplan Commercial |
$182.40
|
| Rate for Payer: Multiplan WC |
$325.28
|
| Rate for Payer: Networks By Design Commercial |
$148.20
|
| Rate for Payer: Prime Health Services Commercial |
$193.80
|
| Rate for Payer: Prime Health Services WC |
$321.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$136.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.00
|
| Rate for Payer: United Healthcare All Other HMO |
$114.00
|
| Rate for Payer: United Healthcare HMO Rider |
$114.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$228.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$342.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$251.12
|
| Rate for Payer: Vantage Medical Group Senior |
$228.29
|
|
|
HC INDR ARROW FLEX 24 CM
|
Facility
|
OP
|
$71.42
|
|
|
Service Code
|
CPT C1893
|
| Hospital Charge Code |
906812001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$413.38 |
| Rate for Payer: Adventist Health Commercial |
$14.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$413.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$60.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$53.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.83
|
| Rate for Payer: Cash Price |
$32.14
|
| Rate for Payer: Cash Price |
$32.14
|
| Rate for Payer: Cigna of CA HMO |
$45.71
|
| Rate for Payer: Cigna of CA PPO |
$52.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$60.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$60.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$60.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.57
|
| Rate for Payer: EPIC Health Plan Senior |
$28.57
|
| Rate for Payer: Galaxy Health WC |
$60.71
|
| Rate for Payer: Global Benefits Group Commercial |
$42.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$45.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$42.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$49.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.99
|
| Rate for Payer: Multiplan Commercial |
$57.14
|
| Rate for Payer: Networks By Design Commercial |
$46.42
|
| Rate for Payer: Prime Health Services Commercial |
$60.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.71
|
| Rate for Payer: United Healthcare All Other HMO |
$35.71
|
| Rate for Payer: United Healthcare HMO Rider |
$35.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$60.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$60.71
|
| Rate for Payer: Vantage Medical Group Senior |
$60.71
|
|
|
HC INDR ARROW FLEX 24 CM
|
Facility
|
IP
|
$71.42
|
|
|
Service Code
|
CPT C1893
|
| Hospital Charge Code |
906812001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$60.71 |
| Rate for Payer: Adventist Health Commercial |
$14.28
|
| Rate for Payer: Cash Price |
$32.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.57
|
| Rate for Payer: EPIC Health Plan Senior |
$28.57
|
| Rate for Payer: Galaxy Health WC |
$60.71
|
| Rate for Payer: Global Benefits Group Commercial |
$42.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$45.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$42.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.14
|
| Rate for Payer: Multiplan Commercial |
$57.14
|
| Rate for Payer: Networks By Design Commercial |
$46.42
|
| Rate for Payer: Prime Health Services Commercial |
$60.71
|
|
|
HC INDR BIO/WEB PREFACE
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
CPT C1893
|
| Hospital Charge Code |
906812264
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$105.80 |
| Max. Negotiated Rate |
$449.65 |
| Rate for Payer: Adventist Health Commercial |
$105.80
|
| Rate for Payer: Cash Price |
$238.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$370.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$211.60
|
| Rate for Payer: EPIC Health Plan Senior |
$211.60
|
| Rate for Payer: Galaxy Health WC |
$449.65
|
| Rate for Payer: Global Benefits Group Commercial |
$317.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$335.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$312.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.96
|
| Rate for Payer: Multiplan Commercial |
$423.20
|
| Rate for Payer: Networks By Design Commercial |
$343.85
|
| Rate for Payer: Prime Health Services Commercial |
$449.65
|
|
|
HC INDR BIO/WEB PREFACE
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
CPT C1893
|
| Hospital Charge Code |
906812264
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$105.80 |
| Max. Negotiated Rate |
$449.65 |
| Rate for Payer: Adventist Health Commercial |
$105.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$413.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$449.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$290.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$396.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$339.46
|
| Rate for Payer: Cash Price |
$238.05
|
| Rate for Payer: Cash Price |
$238.05
|
| Rate for Payer: Cigna of CA HMO |
$338.56
|
| Rate for Payer: Cigna of CA PPO |
$391.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$449.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$449.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$449.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$370.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$211.60
|
| Rate for Payer: EPIC Health Plan Senior |
$211.60
|
| Rate for Payer: Galaxy Health WC |
$449.65
|
| Rate for Payer: Global Benefits Group Commercial |
$317.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$335.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$192.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$312.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$370.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$370.30
|
| Rate for Payer: Multiplan Commercial |
$423.20
|
| Rate for Payer: Networks By Design Commercial |
$343.85
|
| Rate for Payer: Prime Health Services Commercial |
$449.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$317.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$317.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$264.50
|
| Rate for Payer: United Healthcare All Other HMO |
$264.50
|
| Rate for Payer: United Healthcare HMO Rider |
$264.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$264.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$449.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$449.65
|
| Rate for Payer: Vantage Medical Group Senior |
$449.65
|
|
|
HC INDR COOK MULLINS 48CM
|
Facility
|
OP
|
$369.75
|
|
|
Service Code
|
CPT C1893
|
| Hospital Charge Code |
906811765
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$73.95 |
| Max. Negotiated Rate |
$413.38 |
| Rate for Payer: Adventist Health Commercial |
$73.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$413.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$314.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$203.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$277.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$237.27
|
| Rate for Payer: Cash Price |
$166.39
|
| Rate for Payer: Cash Price |
$166.39
|
| Rate for Payer: Cigna of CA HMO |
$236.64
|
| Rate for Payer: Cigna of CA PPO |
$273.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$314.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$314.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$314.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$258.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$147.90
|
| Rate for Payer: EPIC Health Plan Senior |
$147.90
|
| Rate for Payer: Galaxy Health WC |
$314.29
|
| Rate for Payer: Global Benefits Group Commercial |
$221.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$234.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$134.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$218.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$258.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$258.82
|
| Rate for Payer: Multiplan Commercial |
$295.80
|
| Rate for Payer: Networks By Design Commercial |
$240.34
|
| Rate for Payer: Prime Health Services Commercial |
$314.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$221.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$221.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$184.88
|
| Rate for Payer: United Healthcare All Other HMO |
$184.88
|
| Rate for Payer: United Healthcare HMO Rider |
$184.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$184.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$314.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$314.29
|
| Rate for Payer: Vantage Medical Group Senior |
$314.29
|
|
|
HC INDR COOK MULLINS 48CM
|
Facility
|
IP
|
$369.75
|
|
|
Service Code
|
CPT C1893
|
| Hospital Charge Code |
906811765
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$73.95 |
| Max. Negotiated Rate |
$314.29 |
| Rate for Payer: Adventist Health Commercial |
$73.95
|
| Rate for Payer: Cash Price |
$166.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$258.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$147.90
|
| Rate for Payer: EPIC Health Plan Senior |
$147.90
|
| Rate for Payer: Galaxy Health WC |
$314.29
|
| Rate for Payer: Global Benefits Group Commercial |
$221.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$234.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$218.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.74
|
| Rate for Payer: Multiplan Commercial |
$295.80
|
| Rate for Payer: Networks By Design Commercial |
$240.34
|
| Rate for Payer: Prime Health Services Commercial |
$314.29
|
|
|
HC INDR CORDIS AVANTI 035/038
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906811762
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$69.70 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$57.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$52.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$48.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.68
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
|
|
HC INDR CORDIS AVANTI 035/038
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906811762
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$266.83 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$266.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52.62
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$69.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$57.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$52.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$48.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.40
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.00
|
| Rate for Payer: United Healthcare All Other HMO |
$41.00
|
| Rate for Payer: United Healthcare HMO Rider |
$41.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.70
|
| Rate for Payer: Vantage Medical Group Senior |
$69.70
|
|
|
HC INDR MICROPUNCTURE NEEDLE
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
909081252
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$84.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Senior |
$48.00
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$76.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$70.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.80
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Networks By Design Commercial |
$78.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
|
|
HC INDR MICROPUNCTURE NEEDLE
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
909081252
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$266.83 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$266.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$102.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$77.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna of CA HMO |
$76.80
|
| Rate for Payer: Cigna of CA PPO |
$88.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$102.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$102.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$84.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Senior |
$48.00
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$76.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$43.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$70.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Networks By Design Commercial |
$78.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.00
|
| Rate for Payer: United Healthcare All Other HMO |
$60.00
|
| Rate for Payer: United Healthcare HMO Rider |
$60.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$60.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$102.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$102.00
|
| Rate for Payer: Vantage Medical Group Senior |
$102.00
|
|
|
HC INDR SHTH STJ FASTCATH EP
|
Facility
|
OP
|
$648.00
|
|
|
Service Code
|
CPT C1893
|
| Hospital Charge Code |
906812277
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$129.60 |
| Max. Negotiated Rate |
$550.80 |
| Rate for Payer: Adventist Health Commercial |
$129.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$413.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$550.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$356.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$486.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$415.82
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Cigna of CA HMO |
$414.72
|
| Rate for Payer: Cigna of CA PPO |
$479.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$550.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$550.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$550.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$453.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$259.20
|
| Rate for Payer: EPIC Health Plan Senior |
$259.20
|
| Rate for Payer: Galaxy Health WC |
$550.80
|
| Rate for Payer: Global Benefits Group Commercial |
$388.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$411.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$235.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$382.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$453.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$453.60
|
| Rate for Payer: Multiplan Commercial |
$518.40
|
| Rate for Payer: Networks By Design Commercial |
$421.20
|
| Rate for Payer: Prime Health Services Commercial |
$550.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$388.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$388.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$324.00
|
| Rate for Payer: United Healthcare All Other HMO |
$324.00
|
| Rate for Payer: United Healthcare HMO Rider |
$324.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$324.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$550.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$550.80
|
| Rate for Payer: Vantage Medical Group Senior |
$550.80
|
|
|
HC INDR SHTH STJ FASTCATH EP
|
Facility
|
IP
|
$648.00
|
|
|
Service Code
|
CPT C1893
|
| Hospital Charge Code |
906812277
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$129.60 |
| Max. Negotiated Rate |
$550.80 |
| Rate for Payer: Adventist Health Commercial |
$129.60
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$453.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$259.20
|
| Rate for Payer: EPIC Health Plan Senior |
$259.20
|
| Rate for Payer: Galaxy Health WC |
$550.80
|
| Rate for Payer: Global Benefits Group Commercial |
$388.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$411.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$382.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.52
|
| Rate for Payer: Multiplan Commercial |
$518.40
|
| Rate for Payer: Networks By Design Commercial |
$421.20
|
| Rate for Payer: Prime Health Services Commercial |
$550.80
|
|
|
HC INDR STJ APEEL CS
|
Facility
|
IP
|
$1,530.00
|
|
|
Service Code
|
CPT C1892
|
| Hospital Charge Code |
906813541
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$306.00 |
| Max. Negotiated Rate |
$1,300.50 |
| Rate for Payer: Adventist Health Commercial |
$306.00
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,071.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.00
|
| Rate for Payer: EPIC Health Plan Senior |
$612.00
|
| Rate for Payer: Galaxy Health WC |
$1,300.50
|
| Rate for Payer: Global Benefits Group Commercial |
$918.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$971.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$902.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$367.20
|
| Rate for Payer: Multiplan Commercial |
$1,224.00
|
| Rate for Payer: Networks By Design Commercial |
$994.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,300.50
|
|
|
HC INDR STJ APEEL CS
|
Facility
|
OP
|
$1,530.00
|
|
|
Service Code
|
CPT C1892
|
| Hospital Charge Code |
906813541
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$306.00 |
| Max. Negotiated Rate |
$1,300.50 |
| Rate for Payer: Adventist Health Commercial |
$306.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,294.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,300.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$841.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,147.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$981.80
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: Cigna of CA HMO |
$979.20
|
| Rate for Payer: Cigna of CA PPO |
$1,132.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,300.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,300.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,300.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,071.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.00
|
| Rate for Payer: EPIC Health Plan Senior |
$612.00
|
| Rate for Payer: Galaxy Health WC |
$1,300.50
|
| Rate for Payer: Global Benefits Group Commercial |
$918.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$971.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$555.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$902.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$367.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,071.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,071.00
|
| Rate for Payer: Multiplan Commercial |
$1,224.00
|
| Rate for Payer: Networks By Design Commercial |
$994.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,300.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$918.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$918.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$765.00
|
| Rate for Payer: United Healthcare All Other HMO |
$765.00
|
| Rate for Payer: United Healthcare HMO Rider |
$765.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$765.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,300.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,300.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,300.50
|
|
|
HC INDR STJ FASTCATH 60 CM
|
Facility
|
OP
|
$478.21
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$95.64 |
| Max. Negotiated Rate |
$406.48 |
| Rate for Payer: Adventist Health Commercial |
$95.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$266.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$406.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$263.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$358.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.87
|
| Rate for Payer: Cash Price |
$215.19
|
| Rate for Payer: Cash Price |
$215.19
|
| Rate for Payer: Cigna of CA HMO |
$306.05
|
| Rate for Payer: Cigna of CA PPO |
$353.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$406.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$406.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$406.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$334.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$191.28
|
| Rate for Payer: EPIC Health Plan Senior |
$191.28
|
| Rate for Payer: Galaxy Health WC |
$406.48
|
| Rate for Payer: Global Benefits Group Commercial |
$286.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$303.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$173.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$282.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$334.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$334.75
|
| Rate for Payer: Multiplan Commercial |
$382.57
|
| Rate for Payer: Networks By Design Commercial |
$310.84
|
| Rate for Payer: Prime Health Services Commercial |
$406.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$286.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$286.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$239.10
|
| Rate for Payer: United Healthcare All Other HMO |
$239.10
|
| Rate for Payer: United Healthcare HMO Rider |
$239.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$239.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$406.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$406.48
|
| Rate for Payer: Vantage Medical Group Senior |
$406.48
|
|
|
HC INDR STJ FASTCATH 60 CM
|
Facility
|
IP
|
$478.21
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$95.64 |
| Max. Negotiated Rate |
$406.48 |
| Rate for Payer: Adventist Health Commercial |
$95.64
|
| Rate for Payer: Cash Price |
$215.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$334.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$191.28
|
| Rate for Payer: EPIC Health Plan Senior |
$191.28
|
| Rate for Payer: Galaxy Health WC |
$406.48
|
| Rate for Payer: Global Benefits Group Commercial |
$286.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$303.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$282.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.77
|
| Rate for Payer: Multiplan Commercial |
$382.57
|
| Rate for Payer: Networks By Design Commercial |
$310.84
|
| Rate for Payer: Prime Health Services Commercial |
$406.48
|
|
|
HC INDR STJ FASTCATH 63CM 10FR
|
Facility
|
OP
|
$504.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812322
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.80 |
| Max. Negotiated Rate |
$428.40 |
| Rate for Payer: Adventist Health Commercial |
$100.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$266.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$428.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$378.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$323.42
|
| Rate for Payer: Cash Price |
$226.80
|
| Rate for Payer: Cash Price |
$226.80
|
| Rate for Payer: Cigna of CA HMO |
$322.56
|
| Rate for Payer: Cigna of CA PPO |
$372.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$428.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$428.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$428.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$352.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.60
|
| Rate for Payer: EPIC Health Plan Senior |
$201.60
|
| Rate for Payer: Galaxy Health WC |
$428.40
|
| Rate for Payer: Global Benefits Group Commercial |
$302.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$320.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$182.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$297.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$352.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$352.80
|
| Rate for Payer: Multiplan Commercial |
$403.20
|
| Rate for Payer: Networks By Design Commercial |
$327.60
|
| Rate for Payer: Prime Health Services Commercial |
$428.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$302.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$302.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$252.00
|
| Rate for Payer: United Healthcare All Other HMO |
$252.00
|
| Rate for Payer: United Healthcare HMO Rider |
$252.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$252.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$428.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$428.40
|
| Rate for Payer: Vantage Medical Group Senior |
$428.40
|
|
|
HC INDR STJ FASTCATH 63CM 10FR
|
Facility
|
IP
|
$504.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812322
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.80 |
| Max. Negotiated Rate |
$428.40 |
| Rate for Payer: Adventist Health Commercial |
$100.80
|
| Rate for Payer: Cash Price |
$226.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$352.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.60
|
| Rate for Payer: EPIC Health Plan Senior |
$201.60
|
| Rate for Payer: Galaxy Health WC |
$428.40
|
| Rate for Payer: Global Benefits Group Commercial |
$302.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$320.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$297.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.96
|
| Rate for Payer: Multiplan Commercial |
$403.20
|
| Rate for Payer: Networks By Design Commercial |
$327.60
|
| Rate for Payer: Prime Health Services Commercial |
$428.40
|
|
|
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 |
$165.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$145.65
|
| Rate for Payer: Blue Shield of California Commercial |
$194.50
|
| Rate for Payer: Blue Shield of California Commercial |
$294.76
|
| Rate for Payer: Cash Price |
$207.90
|
| Rate for Payer: Cash Price |
$207.90
|
| 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 |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$323.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| Rate for Payer: Galaxy Health WC |
$392.70
|
| Rate for Payer: Global Benefits Group Commercial |
$277.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$34.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$293.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$141.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.99
|
| 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 |
$111.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
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 |
$207.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$323.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$293.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$272.58
|
| 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
|
|
