|
HC IVPW INIT VES PRESSUREWIRE SEN
|
Facility
|
IP
|
$12,125.00
|
|
|
Service Code
|
CPT 93571
|
| Hospital Charge Code |
906812133
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,425.00 |
| Max. Negotiated Rate |
$10,306.25 |
| Rate for Payer: Adventist Health Commercial |
$2,425.00
|
| Rate for Payer: Cash Price |
$5,456.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,850.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,850.00
|
| Rate for Payer: Galaxy Health WC |
$10,306.25
|
| Rate for Payer: Global Benefits Group Commercial |
$7,275.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,087.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,619.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,505.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,910.00
|
| Rate for Payer: Multiplan Commercial |
$9,700.00
|
| Rate for Payer: Networks By Design Commercial |
$7,881.25
|
| Rate for Payer: Prime Health Services Commercial |
$10,306.25
|
|
|
HC IVPW INIT VES PRESSUREWIRE SEN
|
Facility
|
OP
|
$12,125.00
|
|
|
Service Code
|
CPT 93571
|
| Hospital Charge Code |
906812133
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$407.92 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$2,425.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,306.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,668.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,093.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,445.96
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$5,456.25
|
| Rate for Payer: Cash Price |
$5,456.25
|
| Rate for Payer: Cash Price |
$5,456.25
|
| Rate for Payer: Cigna of CA HMO |
$7,881.25
|
| Rate for Payer: Cigna of CA PPO |
$8,972.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,306.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,306.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,306.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,850.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,850.00
|
| Rate for Payer: Galaxy Health WC |
$10,306.25
|
| Rate for Payer: Global Benefits Group Commercial |
$7,275.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$407.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,087.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$461.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,505.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,910.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,487.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,487.50
|
| Rate for Payer: Multiplan Commercial |
$9,700.00
|
| Rate for Payer: Networks By Design Commercial |
$7,881.25
|
| Rate for Payer: Prime Health Services Commercial |
$10,306.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,275.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,275.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,306.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,306.25
|
| Rate for Payer: Vantage Medical Group Senior |
$10,306.25
|
|
|
HC IVPW INIT VES PRESSUREWIRE SEN
|
Facility
|
IP
|
$12,360.00
|
|
|
Service Code
|
CPT 93571
|
| Hospital Charge Code |
906820079
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,472.00 |
| Max. Negotiated Rate |
$10,506.00 |
| Rate for Payer: Adventist Health Commercial |
$2,472.00
|
| Rate for Payer: Cash Price |
$5,562.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,944.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,944.00
|
| Rate for Payer: Galaxy Health WC |
$10,506.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,416.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,244.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,709.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,650.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,966.40
|
| Rate for Payer: Multiplan Commercial |
$9,888.00
|
| Rate for Payer: Networks By Design Commercial |
$8,034.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,506.00
|
|
|
HC IV START KIT
|
Facility
|
OP
|
$64.37
|
|
| Hospital Charge Code |
901698271
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.87 |
| Max. Negotiated Rate |
$54.71 |
| Rate for Payer: Adventist Health Commercial |
$12.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$42.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$54.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$35.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$48.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.53
|
| Rate for Payer: Cash Price |
$28.97
|
| Rate for Payer: Cigna of CA HMO |
$41.20
|
| Rate for Payer: Cigna of CA PPO |
$47.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$54.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$54.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$54.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.75
|
| Rate for Payer: EPIC Health Plan Senior |
$25.75
|
| Rate for Payer: Galaxy Health WC |
$54.71
|
| Rate for Payer: Global Benefits Group Commercial |
$38.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$39.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$45.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$45.06
|
| Rate for Payer: Multiplan Commercial |
$51.50
|
| Rate for Payer: Networks By Design Commercial |
$41.84
|
| Rate for Payer: Prime Health Services Commercial |
$54.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$38.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$38.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.19
|
| Rate for Payer: United Healthcare All Other HMO |
$32.19
|
| Rate for Payer: United Healthcare HMO Rider |
$32.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$54.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$54.71
|
| Rate for Payer: Vantage Medical Group Senior |
$54.71
|
|
|
HC IV START KIT
|
Facility
|
IP
|
$4.92
|
|
| Hospital Charge Code |
901698283
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$4.18 |
| Rate for Payer: Adventist Health Commercial |
$0.98
|
| Rate for Payer: Cash Price |
$2.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.97
|
| Rate for Payer: EPIC Health Plan Senior |
$1.97
|
| Rate for Payer: Galaxy Health WC |
$4.18
|
| Rate for Payer: Global Benefits Group Commercial |
$2.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.18
|
| Rate for Payer: Multiplan Commercial |
$3.94
|
| Rate for Payer: Networks By Design Commercial |
$3.20
|
| Rate for Payer: Prime Health Services Commercial |
$4.18
|
|
|
HC IV START KIT
|
Facility
|
OP
|
$4.92
|
|
| Hospital Charge Code |
901698283
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$4.18 |
| Rate for Payer: Adventist Health Commercial |
$0.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.02
|
| Rate for Payer: Cash Price |
$2.21
|
| Rate for Payer: Cigna of CA HMO |
$3.15
|
| Rate for Payer: Cigna of CA PPO |
$3.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.97
|
| Rate for Payer: EPIC Health Plan Senior |
$1.97
|
| Rate for Payer: Galaxy Health WC |
$4.18
|
| Rate for Payer: Global Benefits Group Commercial |
$2.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.44
|
| Rate for Payer: Multiplan Commercial |
$3.94
|
| Rate for Payer: Networks By Design Commercial |
$3.20
|
| Rate for Payer: Prime Health Services Commercial |
$4.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.46
|
| Rate for Payer: United Healthcare All Other HMO |
$2.46
|
| Rate for Payer: United Healthcare HMO Rider |
$2.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.18
|
| Rate for Payer: Vantage Medical Group Senior |
$4.18
|
|
|
HC IV START KIT
|
Facility
|
IP
|
$64.37
|
|
| Hospital Charge Code |
901698271
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.87 |
| Max. Negotiated Rate |
$54.71 |
| Rate for Payer: Adventist Health Commercial |
$12.87
|
| Rate for Payer: Cash Price |
$28.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.75
|
| Rate for Payer: EPIC Health Plan Senior |
$25.75
|
| Rate for Payer: Galaxy Health WC |
$54.71
|
| Rate for Payer: Global Benefits Group Commercial |
$38.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$39.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.45
|
| Rate for Payer: Multiplan Commercial |
$51.50
|
| Rate for Payer: Networks By Design Commercial |
$41.84
|
| Rate for Payer: Prime Health Services Commercial |
$54.71
|
|
|
HC IV START KIT W/SM BORE EXT SET
|
Facility
|
IP
|
$22.06
|
|
| Hospital Charge Code |
901698434
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.41 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Adventist Health Commercial |
$4.41
|
| Rate for Payer: Cash Price |
$9.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.82
|
| Rate for Payer: EPIC Health Plan Senior |
$8.82
|
| Rate for Payer: Galaxy Health WC |
$18.75
|
| Rate for Payer: Global Benefits Group Commercial |
$13.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.29
|
| Rate for Payer: Multiplan Commercial |
$17.65
|
| Rate for Payer: Networks By Design Commercial |
$14.34
|
| Rate for Payer: Prime Health Services Commercial |
$18.75
|
|
|
HC IV START KIT W/SM BORE EXT SET
|
Facility
|
OP
|
$22.06
|
|
| Hospital Charge Code |
901698434
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.41 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Adventist Health Commercial |
$4.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.55
|
| Rate for Payer: Cash Price |
$9.93
|
| Rate for Payer: Cigna of CA HMO |
$14.12
|
| Rate for Payer: Cigna of CA PPO |
$16.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.82
|
| Rate for Payer: EPIC Health Plan Senior |
$8.82
|
| Rate for Payer: Galaxy Health WC |
$18.75
|
| Rate for Payer: Global Benefits Group Commercial |
$13.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.44
|
| Rate for Payer: Multiplan Commercial |
$17.65
|
| Rate for Payer: Networks By Design Commercial |
$14.34
|
| Rate for Payer: Prime Health Services Commercial |
$18.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.03
|
| Rate for Payer: United Healthcare All Other HMO |
$11.03
|
| Rate for Payer: United Healthcare HMO Rider |
$11.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.75
|
| Rate for Payer: Vantage Medical Group Senior |
$18.75
|
|
|
HC IVU EXCRETORY
|
Facility
|
IP
|
$1,375.00
|
|
|
Service Code
|
CPT 74400
|
| Hospital Charge Code |
909001910
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$275.00 |
| Max. Negotiated Rate |
$1,168.75 |
| Rate for Payer: Adventist Health Commercial |
$275.00
|
| Rate for Payer: Cash Price |
$618.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$550.00
|
| Rate for Payer: EPIC Health Plan Senior |
$550.00
|
| Rate for Payer: Galaxy Health WC |
$1,168.75
|
| Rate for Payer: Global Benefits Group Commercial |
$825.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$917.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$523.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$851.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$330.00
|
| Rate for Payer: Multiplan Commercial |
$1,100.00
|
| Rate for Payer: Networks By Design Commercial |
$893.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,168.75
|
|
|
HC IVU EXCRETORY
|
Facility
|
OP
|
$1,375.00
|
|
|
Service Code
|
CPT 74400
|
| Hospital Charge Code |
909001910
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$110.44 |
| Max. Negotiated Rate |
$1,168.75 |
| Rate for Payer: Adventist Health Commercial |
$275.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$901.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$475.39
|
| Rate for Payer: Blue Shield of California Commercial |
$841.50
|
| Rate for Payer: Blue Shield of California EPN |
$555.50
|
| Rate for Payer: Cash Price |
$618.75
|
| Rate for Payer: Cash Price |
$618.75
|
| Rate for Payer: Cigna of CA HMO |
$880.00
|
| Rate for Payer: Cigna of CA PPO |
$1,017.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.36
|
| Rate for Payer: EPIC Health Plan Senior |
$226.19
|
| Rate for Payer: Galaxy Health WC |
$1,168.75
|
| Rate for Payer: Global Benefits Group Commercial |
$825.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$110.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$917.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$124.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$330.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$303.09
|
| Rate for Payer: Multiplan Commercial |
$1,100.00
|
| Rate for Payer: Networks By Design Commercial |
$893.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,168.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$825.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$825.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$470.69
|
| Rate for Payer: United Healthcare All Other HMO |
$470.69
|
| Rate for Payer: United Healthcare HMO Rider |
$470.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$470.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$226.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
|
HC IVU HYPERTENSIVE
|
Facility
|
IP
|
$878.00
|
|
|
Service Code
|
CPT 74415
|
| Hospital Charge Code |
909001911
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$175.60 |
| Max. Negotiated Rate |
$746.30 |
| Rate for Payer: Adventist Health Commercial |
$175.60
|
| Rate for Payer: Cash Price |
$395.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$351.20
|
| Rate for Payer: EPIC Health Plan Senior |
$351.20
|
| Rate for Payer: Galaxy Health WC |
$746.30
|
| Rate for Payer: Global Benefits Group Commercial |
$526.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$585.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$334.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$543.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.72
|
| Rate for Payer: Multiplan Commercial |
$702.40
|
| Rate for Payer: Networks By Design Commercial |
$570.70
|
| Rate for Payer: Prime Health Services Commercial |
$746.30
|
|
|
HC IVU HYPERTENSIVE
|
Facility
|
OP
|
$878.00
|
|
|
Service Code
|
CPT 74415
|
| Hospital Charge Code |
909001911
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$166.86 |
| Max. Negotiated Rate |
$746.30 |
| Rate for Payer: Adventist Health Commercial |
$175.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$575.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$595.48
|
| Rate for Payer: Blue Shield of California Commercial |
$537.34
|
| Rate for Payer: Blue Shield of California EPN |
$354.71
|
| Rate for Payer: Cash Price |
$395.10
|
| Rate for Payer: Cash Price |
$395.10
|
| Rate for Payer: Cigna of CA HMO |
$561.92
|
| Rate for Payer: Cigna of CA PPO |
$649.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.36
|
| Rate for Payer: EPIC Health Plan Senior |
$226.19
|
| Rate for Payer: Galaxy Health WC |
$746.30
|
| Rate for Payer: Global Benefits Group Commercial |
$526.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$166.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$585.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$188.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$303.09
|
| Rate for Payer: Multiplan Commercial |
$702.40
|
| Rate for Payer: Networks By Design Commercial |
$570.70
|
| Rate for Payer: Prime Health Services Commercial |
$746.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$526.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$526.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$470.69
|
| Rate for Payer: United Healthcare All Other HMO |
$470.69
|
| Rate for Payer: United Healthcare HMO Rider |
$470.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$470.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$226.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
|
HC IVUS ADD'L VESSEL
|
Facility
|
OP
|
$7,928.00
|
|
|
Service Code
|
CPT 92979
|
| Hospital Charge Code |
906820035
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$231.49 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,585.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,738.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,360.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,946.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$3,567.60
|
| Rate for Payer: Cash Price |
$3,567.60
|
| Rate for Payer: Cash Price |
$3,567.60
|
| Rate for Payer: Cigna of CA HMO |
$5,153.20
|
| Rate for Payer: Cigna of CA PPO |
$5,866.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,738.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,738.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,738.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,171.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,171.20
|
| Rate for Payer: Galaxy Health WC |
$6,738.80
|
| Rate for Payer: Global Benefits Group Commercial |
$4,756.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$231.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,287.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$261.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,907.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,902.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,549.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,549.60
|
| Rate for Payer: Multiplan Commercial |
$6,342.40
|
| Rate for Payer: Networks By Design Commercial |
$5,153.20
|
| Rate for Payer: Prime Health Services Commercial |
$6,738.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,756.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,756.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,738.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,738.80
|
| Rate for Payer: Vantage Medical Group Senior |
$6,738.80
|
|
|
HC IVUS ADD'L VESSEL
|
Facility
|
OP
|
$4,767.00
|
|
|
Service Code
|
CPT 92979
|
| Hospital Charge Code |
906811210
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$231.49 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$953.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,051.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,621.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,575.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$2,145.15
|
| Rate for Payer: Cash Price |
$2,145.15
|
| Rate for Payer: Cash Price |
$2,145.15
|
| Rate for Payer: Cigna of CA HMO |
$3,098.55
|
| Rate for Payer: Cigna of CA PPO |
$3,527.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,051.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,051.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,051.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,906.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,906.80
|
| Rate for Payer: Galaxy Health WC |
$4,051.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,860.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$231.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,179.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$261.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,950.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,144.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,336.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,336.90
|
| Rate for Payer: Multiplan Commercial |
$3,813.60
|
| Rate for Payer: Networks By Design Commercial |
$3,098.55
|
| Rate for Payer: Prime Health Services Commercial |
$4,051.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,860.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,860.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,051.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,051.95
|
| Rate for Payer: Vantage Medical Group Senior |
$4,051.95
|
|
|
HC IVUS ADD'L VESSEL
|
Facility
|
IP
|
$4,767.00
|
|
|
Service Code
|
CPT 92979
|
| Hospital Charge Code |
906811210
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$953.40 |
| Max. Negotiated Rate |
$4,051.95 |
| Rate for Payer: Adventist Health Commercial |
$953.40
|
| Rate for Payer: Cash Price |
$2,145.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,906.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,906.80
|
| Rate for Payer: Galaxy Health WC |
$4,051.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,860.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,179.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,816.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,950.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,144.08
|
| Rate for Payer: Multiplan Commercial |
$3,813.60
|
| Rate for Payer: Networks By Design Commercial |
$3,098.55
|
| Rate for Payer: Prime Health Services Commercial |
$4,051.95
|
|
|
HC IVUS ADD'L VESSEL
|
Facility
|
IP
|
$7,928.00
|
|
|
Service Code
|
CPT 92979
|
| Hospital Charge Code |
906820035
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,585.60 |
| Max. Negotiated Rate |
$6,738.80 |
| Rate for Payer: Adventist Health Commercial |
$1,585.60
|
| Rate for Payer: Cash Price |
$3,567.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,171.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,171.20
|
| Rate for Payer: Galaxy Health WC |
$6,738.80
|
| Rate for Payer: Global Benefits Group Commercial |
$4,756.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,287.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,020.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,907.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,902.72
|
| Rate for Payer: Multiplan Commercial |
$6,342.40
|
| Rate for Payer: Networks By Design Commercial |
$5,153.20
|
| Rate for Payer: Prime Health Services Commercial |
$6,738.80
|
|
|
HC IVUS INITIAL VESSEL
|
Facility
|
OP
|
$11,144.00
|
|
|
Service Code
|
CPT 92978
|
| Hospital Charge Code |
906820034
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$378.32 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$2,228.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,472.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,129.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,358.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$5,014.80
|
| Rate for Payer: Cash Price |
$5,014.80
|
| Rate for Payer: Cash Price |
$5,014.80
|
| Rate for Payer: Cigna of CA HMO |
$7,243.60
|
| Rate for Payer: Cigna of CA PPO |
$8,246.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,472.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,472.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,472.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,457.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,457.60
|
| Rate for Payer: Galaxy Health WC |
$9,472.40
|
| Rate for Payer: Global Benefits Group Commercial |
$6,686.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$378.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,433.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$427.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,898.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,674.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,800.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,800.80
|
| Rate for Payer: Multiplan Commercial |
$8,915.20
|
| Rate for Payer: Networks By Design Commercial |
$7,243.60
|
| Rate for Payer: Prime Health Services Commercial |
$9,472.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,686.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,686.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,472.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,472.40
|
| Rate for Payer: Vantage Medical Group Senior |
$9,472.40
|
|
|
HC IVUS INITIAL VESSEL
|
Facility
|
IP
|
$11,144.00
|
|
|
Service Code
|
CPT 92978
|
| Hospital Charge Code |
906820034
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,228.80 |
| Max. Negotiated Rate |
$9,472.40 |
| Rate for Payer: Adventist Health Commercial |
$2,228.80
|
| Rate for Payer: Cash Price |
$5,014.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,457.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,457.60
|
| Rate for Payer: Galaxy Health WC |
$9,472.40
|
| Rate for Payer: Global Benefits Group Commercial |
$6,686.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,433.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,245.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,898.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,674.56
|
| Rate for Payer: Multiplan Commercial |
$8,915.20
|
| Rate for Payer: Networks By Design Commercial |
$7,243.60
|
| Rate for Payer: Prime Health Services Commercial |
$9,472.40
|
|
|
HC IVUS INITIAL VESSEL
|
Facility
|
OP
|
$10,932.00
|
|
|
Service Code
|
CPT 92978
|
| Hospital Charge Code |
906811200
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$378.32 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$2,186.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,292.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,012.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,199.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$4,919.40
|
| Rate for Payer: Cash Price |
$4,919.40
|
| Rate for Payer: Cash Price |
$4,919.40
|
| Rate for Payer: Cigna of CA HMO |
$7,105.80
|
| Rate for Payer: Cigna of CA PPO |
$8,089.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,292.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,292.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,292.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,372.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,372.80
|
| Rate for Payer: Galaxy Health WC |
$9,292.20
|
| Rate for Payer: Global Benefits Group Commercial |
$6,559.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$378.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,291.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$427.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,766.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,623.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,652.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,652.40
|
| Rate for Payer: Multiplan Commercial |
$8,745.60
|
| Rate for Payer: Networks By Design Commercial |
$7,105.80
|
| Rate for Payer: Prime Health Services Commercial |
$9,292.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,559.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,559.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,292.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,292.20
|
| Rate for Payer: Vantage Medical Group Senior |
$9,292.20
|
|
|
HC IVUS INITIAL VESSEL
|
Facility
|
IP
|
$10,932.00
|
|
|
Service Code
|
CPT 92978
|
| Hospital Charge Code |
906811200
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,186.40 |
| Max. Negotiated Rate |
$9,292.20 |
| Rate for Payer: Adventist Health Commercial |
$2,186.40
|
| Rate for Payer: Cash Price |
$4,919.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,372.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,372.80
|
| Rate for Payer: Galaxy Health WC |
$9,292.20
|
| Rate for Payer: Global Benefits Group Commercial |
$6,559.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,291.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,165.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,766.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,623.68
|
| Rate for Payer: Multiplan Commercial |
$8,745.60
|
| Rate for Payer: Networks By Design Commercial |
$7,105.80
|
| Rate for Payer: Prime Health Services Commercial |
$9,292.20
|
|
|
HC JEJUNOSTOMY PERC
|
Facility
|
IP
|
$1,174.00
|
|
|
Service Code
|
CPT 74355
|
| Hospital Charge Code |
909001868
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$234.80 |
| Max. Negotiated Rate |
$997.90 |
| Rate for Payer: Adventist Health Commercial |
$234.80
|
| Rate for Payer: Cash Price |
$528.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$469.60
|
| Rate for Payer: EPIC Health Plan Senior |
$469.60
|
| Rate for Payer: Galaxy Health WC |
$997.90
|
| Rate for Payer: Global Benefits Group Commercial |
$704.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$783.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$447.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$726.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$281.76
|
| Rate for Payer: Multiplan Commercial |
$939.20
|
| Rate for Payer: Networks By Design Commercial |
$763.10
|
| Rate for Payer: Prime Health Services Commercial |
$997.90
|
|
|
HC JEJUNOSTOMY PERC
|
Facility
|
OP
|
$1,174.00
|
|
|
Service Code
|
CPT 74355
|
| Hospital Charge Code |
909001868
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$173.14 |
| Max. Negotiated Rate |
$997.90 |
| Rate for Payer: Adventist Health Commercial |
$234.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$770.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$997.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$645.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$880.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$740.64
|
| Rate for Payer: Blue Shield of California Commercial |
$718.49
|
| Rate for Payer: Blue Shield of California EPN |
$474.30
|
| Rate for Payer: Cash Price |
$528.30
|
| Rate for Payer: Cash Price |
$528.30
|
| Rate for Payer: Cigna of CA HMO |
$751.36
|
| Rate for Payer: Cigna of CA PPO |
$868.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$997.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$997.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$997.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$469.60
|
| Rate for Payer: EPIC Health Plan Senior |
$469.60
|
| Rate for Payer: Galaxy Health WC |
$997.90
|
| Rate for Payer: Global Benefits Group Commercial |
$704.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$173.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$783.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$195.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$726.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$281.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$821.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$821.80
|
| Rate for Payer: Multiplan Commercial |
$939.20
|
| Rate for Payer: Networks By Design Commercial |
$763.10
|
| Rate for Payer: Prime Health Services Commercial |
$997.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$704.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$704.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$587.00
|
| Rate for Payer: United Healthcare All Other HMO |
$587.00
|
| Rate for Payer: United Healthcare HMO Rider |
$587.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$587.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$997.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$997.90
|
| Rate for Payer: Vantage Medical Group Senior |
$997.90
|
|
|
HC JEJUNOSTOMY TUBE PLACEMENT
|
Facility
|
IP
|
$507.00
|
|
|
Service Code
|
CPT 44015
|
| Hospital Charge Code |
906744015
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$101.40 |
| Max. Negotiated Rate |
$430.95 |
| Rate for Payer: Adventist Health Commercial |
$101.40
|
| Rate for Payer: Cash Price |
$228.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.80
|
| Rate for Payer: EPIC Health Plan Senior |
$202.80
|
| Rate for Payer: Galaxy Health WC |
$430.95
|
| Rate for Payer: Global Benefits Group Commercial |
$304.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$338.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$193.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$313.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.68
|
| Rate for Payer: Multiplan Commercial |
$405.60
|
| Rate for Payer: Networks By Design Commercial |
$329.55
|
| Rate for Payer: Prime Health Services Commercial |
$430.95
|
|
|
HC JEJUNOSTOMY TUBE PLACEMENT
|
Facility
|
OP
|
$668.00
|
|
|
Service Code
|
CPT 44015
|
| Hospital Charge Code |
906744015
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$133.60 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$133.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$567.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$367.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$501.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$300.60
|
| Rate for Payer: Cash Price |
$300.60
|
| Rate for Payer: Cigna of CA HMO |
$427.52
|
| Rate for Payer: Cigna of CA PPO |
$494.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$567.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$567.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$567.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$267.20
|
| Rate for Payer: EPIC Health Plan Senior |
$267.20
|
| Rate for Payer: Galaxy Health WC |
$567.80
|
| Rate for Payer: Global Benefits Group Commercial |
$400.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$445.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$413.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$160.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$467.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$467.60
|
| Rate for Payer: Multiplan Commercial |
$534.40
|
| Rate for Payer: Networks By Design Commercial |
$434.20
|
| Rate for Payer: Prime Health Services Commercial |
$567.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$400.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$400.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| 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 |
$567.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$567.80
|
| Rate for Payer: Vantage Medical Group Senior |
$567.80
|
|
