|
HC OT RE-EVALUATION
|
Facility
|
IP
|
$665.00
|
|
|
Service Code
|
CPT 97168
|
| Hospital Charge Code |
908603273
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$133.00 |
| Max. Negotiated Rate |
$565.25 |
| Rate for Payer: Adventist Health Commercial |
$133.00
|
| Rate for Payer: Cash Price |
$365.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$266.00
|
| Rate for Payer: EPIC Health Plan Senior |
$266.00
|
| Rate for Payer: Galaxy Health WC |
$565.25
|
| Rate for Payer: Global Benefits Group Commercial |
$399.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$443.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$253.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$411.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.60
|
| Rate for Payer: Multiplan Commercial |
$532.00
|
| Rate for Payer: Networks By Design Commercial |
$432.25
|
| Rate for Payer: Prime Health Services Commercial |
$565.25
|
|
|
HC OTSM POUCH DRAIN BR 1.5"-38MM
|
Facility
|
OP
|
$11.40
|
|
|
Service Code
|
CPT A5057
|
| Hospital Charge Code |
901698480
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$9.69 |
| Rate for Payer: Adventist Health Commercial |
$2.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.00
|
| Rate for Payer: Cash Price |
$6.27
|
| Rate for Payer: Cigna of CA HMO |
$7.30
|
| Rate for Payer: Cigna of CA PPO |
$8.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.56
|
| Rate for Payer: EPIC Health Plan Senior |
$4.56
|
| Rate for Payer: Galaxy Health WC |
$9.69
|
| Rate for Payer: Global Benefits Group Commercial |
$6.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.98
|
| Rate for Payer: Multiplan Commercial |
$9.12
|
| Rate for Payer: Networks By Design Commercial |
$7.41
|
| Rate for Payer: Prime Health Services Commercial |
$9.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.70
|
| Rate for Payer: United Healthcare All Other HMO |
$5.70
|
| Rate for Payer: United Healthcare HMO Rider |
$5.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.69
|
| Rate for Payer: Vantage Medical Group Senior |
$9.69
|
|
|
HC OTSM POUCH DRAIN BR 1.5"-38MM
|
Facility
|
IP
|
$11.40
|
|
|
Service Code
|
CPT A5057
|
| Hospital Charge Code |
901698480
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$9.69 |
| Rate for Payer: Adventist Health Commercial |
$2.28
|
| Rate for Payer: Cash Price |
$6.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.56
|
| Rate for Payer: EPIC Health Plan Senior |
$4.56
|
| Rate for Payer: Galaxy Health WC |
$9.69
|
| Rate for Payer: Global Benefits Group Commercial |
$6.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.74
|
| Rate for Payer: Multiplan Commercial |
$9.12
|
| Rate for Payer: Networks By Design Commercial |
$7.41
|
| Rate for Payer: Prime Health Services Commercial |
$9.69
|
|
|
HC OTSM POUCH DRN BR 2.125"-55MM
|
Facility
|
OP
|
$11.40
|
|
|
Service Code
|
CPT A5057
|
| Hospital Charge Code |
901698479
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$9.69 |
| Rate for Payer: Adventist Health Commercial |
$2.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.00
|
| Rate for Payer: Cash Price |
$6.27
|
| Rate for Payer: Cigna of CA HMO |
$7.30
|
| Rate for Payer: Cigna of CA PPO |
$8.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.56
|
| Rate for Payer: EPIC Health Plan Senior |
$4.56
|
| Rate for Payer: Galaxy Health WC |
$9.69
|
| Rate for Payer: Global Benefits Group Commercial |
$6.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.98
|
| Rate for Payer: Multiplan Commercial |
$9.12
|
| Rate for Payer: Networks By Design Commercial |
$7.41
|
| Rate for Payer: Prime Health Services Commercial |
$9.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.70
|
| Rate for Payer: United Healthcare All Other HMO |
$5.70
|
| Rate for Payer: United Healthcare HMO Rider |
$5.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.69
|
| Rate for Payer: Vantage Medical Group Senior |
$9.69
|
|
|
HC OTSM POUCH DRN BR 2.125"-55MM
|
Facility
|
IP
|
$11.40
|
|
|
Service Code
|
CPT A5057
|
| Hospital Charge Code |
901698479
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$9.69 |
| Rate for Payer: Adventist Health Commercial |
$2.28
|
| Rate for Payer: Cash Price |
$6.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.56
|
| Rate for Payer: EPIC Health Plan Senior |
$4.56
|
| Rate for Payer: Galaxy Health WC |
$9.69
|
| Rate for Payer: Global Benefits Group Commercial |
$6.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.74
|
| Rate for Payer: Multiplan Commercial |
$9.12
|
| Rate for Payer: Networks By Design Commercial |
$7.41
|
| Rate for Payer: Prime Health Services Commercial |
$9.69
|
|
|
HC OUTBACK CATHETER
|
Facility
|
OP
|
$5,075.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909020023
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,015.00 |
| Max. Negotiated Rate |
$4,313.75 |
| Rate for Payer: Adventist Health Commercial |
$1,015.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,313.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,791.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,806.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,939.44
|
| Rate for Payer: Blue Shield of California Commercial |
$3,745.35
|
| Rate for Payer: Blue Shield of California EPN |
$2,466.45
|
| Rate for Payer: Cash Price |
$2,791.25
|
| Rate for Payer: Cigna of CA HMO |
$3,552.50
|
| Rate for Payer: Cigna of CA PPO |
$3,552.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,313.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,313.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,313.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,030.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,030.00
|
| Rate for Payer: Galaxy Health WC |
$4,313.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,045.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,385.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,933.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,141.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,218.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,552.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,552.50
|
| Rate for Payer: Multiplan Commercial |
$4,060.00
|
| Rate for Payer: Networks By Design Commercial |
$2,537.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,313.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,045.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,045.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,904.65
|
| Rate for Payer: United Healthcare All Other HMO |
$1,853.90
|
| Rate for Payer: United Healthcare HMO Rider |
$1,813.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,662.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,313.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,313.75
|
| Rate for Payer: Vantage Medical Group Senior |
$4,313.75
|
|
|
HC OUTBACK CATHETER
|
Facility
|
IP
|
$5,075.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909020023
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,015.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,015.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,791.25
|
| Rate for Payer: Cash Price |
$2,791.25
|
| Rate for Payer: Cigna of CA HMO |
$3,552.50
|
| Rate for Payer: Cigna of CA PPO |
$3,552.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,030.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,030.00
|
| Rate for Payer: Galaxy Health WC |
$4,313.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,045.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,385.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,933.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,141.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,218.00
|
| Rate for Payer: Multiplan Commercial |
$4,060.00
|
| Rate for Payer: Networks By Design Commercial |
$2,537.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,313.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,904.65
|
| Rate for Payer: United Healthcare All Other HMO |
$1,853.90
|
| Rate for Payer: United Healthcare HMO Rider |
$1,813.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,662.06
|
|
|
HC OUTBACK ELITE RE-ENTRY CATH
|
Facility
|
OP
|
$4,075.00
|
|
| Hospital Charge Code |
906812724
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$815.00 |
| Max. Negotiated Rate |
$3,463.75 |
| Rate for Payer: Adventist Health Commercial |
$815.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,672.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,463.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,241.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,056.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,502.46
|
| Rate for Payer: Cash Price |
$2,241.25
|
| Rate for Payer: Cigna of CA HMO |
$2,608.00
|
| Rate for Payer: Cigna of CA PPO |
$3,015.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,463.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,463.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,463.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,630.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,630.00
|
| Rate for Payer: Galaxy Health WC |
$3,463.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,445.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,718.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,552.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,522.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$978.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,852.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,852.50
|
| Rate for Payer: Multiplan Commercial |
$3,260.00
|
| Rate for Payer: Networks By Design Commercial |
$2,648.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,463.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,445.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,445.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,037.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,037.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,037.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,037.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,463.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,463.75
|
| Rate for Payer: Vantage Medical Group Senior |
$3,463.75
|
|
|
HC OUTBACK ELITE RE-ENTRY CATH
|
Facility
|
IP
|
$4,075.00
|
|
| Hospital Charge Code |
906812724
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$815.00 |
| Max. Negotiated Rate |
$3,463.75 |
| Rate for Payer: Adventist Health Commercial |
$815.00
|
| Rate for Payer: Cash Price |
$2,241.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,630.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,630.00
|
| Rate for Payer: Galaxy Health WC |
$3,463.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,445.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,718.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,552.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,522.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$978.00
|
| Rate for Payer: Multiplan Commercial |
$3,260.00
|
| Rate for Payer: Networks By Design Commercial |
$2,648.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,463.75
|
|
|
HC OUTFLARE WEDGE
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT L3390
|
| Hospital Charge Code |
905353390
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cigna of CA HMO |
$70.00
|
| Rate for Payer: Cigna of CA PPO |
$70.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Senior |
$40.00
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$61.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$80.00
|
| Rate for Payer: Networks By Design Commercial |
$50.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.53
|
| Rate for Payer: United Healthcare All Other HMO |
$36.53
|
| Rate for Payer: United Healthcare HMO Rider |
$35.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.75
|
|
|
HC OUTFLARE WEDGE
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT L3390
|
| Hospital Charge Code |
915353390
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cigna of CA HMO |
$70.00
|
| Rate for Payer: Cigna of CA PPO |
$70.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Senior |
$40.00
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$61.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$80.00
|
| Rate for Payer: Networks By Design Commercial |
$50.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.53
|
| Rate for Payer: United Healthcare All Other HMO |
$36.53
|
| Rate for Payer: United Healthcare HMO Rider |
$35.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.75
|
|
|
HC OUTFLARE WEDGE
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT L3390
|
| Hospital Charge Code |
915353390
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: Adventist Health Commercial |
$41.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$85.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.92
|
| Rate for Payer: Blue Shield of California Commercial |
$73.80
|
| Rate for Payer: Blue Shield of California EPN |
$48.60
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cigna of CA HMO |
$70.00
|
| Rate for Payer: Cigna of CA PPO |
$70.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$85.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$85.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$85.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Senior |
$40.00
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$31.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$61.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$70.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$80.00
|
| Rate for Payer: Networks By Design Commercial |
$50.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.53
|
| Rate for Payer: United Healthcare All Other HMO |
$36.53
|
| Rate for Payer: United Healthcare HMO Rider |
$35.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$85.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$85.00
|
| Rate for Payer: Vantage Medical Group Senior |
$85.00
|
|
|
HC OUTFLARE WEDGE
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT L3390
|
| Hospital Charge Code |
905353390
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: Adventist Health Commercial |
$41.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$85.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.92
|
| Rate for Payer: Blue Shield of California Commercial |
$73.80
|
| Rate for Payer: Blue Shield of California EPN |
$48.60
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cigna of CA HMO |
$70.00
|
| Rate for Payer: Cigna of CA PPO |
$70.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$85.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$85.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$85.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Senior |
$40.00
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$31.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$61.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$70.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$80.00
|
| Rate for Payer: Networks By Design Commercial |
$50.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.53
|
| Rate for Payer: United Healthcare All Other HMO |
$36.53
|
| Rate for Payer: United Healthcare HMO Rider |
$35.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$85.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$85.00
|
| Rate for Payer: Vantage Medical Group Senior |
$85.00
|
|
|
HC OVA & PARASITES, PRESERVED
|
Facility
|
OP
|
$142.00
|
|
|
Service Code
|
CPT 87177
|
| Hospital Charge Code |
900911726
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.21 |
| Max. Negotiated Rate |
$120.70 |
| Rate for Payer: Adventist Health Commercial |
$28.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$93.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$87.44
|
| Rate for Payer: Blue Shield of California Commercial |
$95.00
|
| Rate for Payer: Blue Shield of California EPN |
$62.76
|
| Rate for Payer: Cash Price |
$78.10
|
| Rate for Payer: Cash Price |
$78.10
|
| Rate for Payer: Cigna of CA HMO |
$90.88
|
| Rate for Payer: Cigna of CA PPO |
$105.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.79
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.02
|
| Rate for Payer: EPIC Health Plan Senior |
$8.90
|
| Rate for Payer: Galaxy Health WC |
$120.70
|
| Rate for Payer: Global Benefits Group Commercial |
$85.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$94.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.93
|
| Rate for Payer: Multiplan Commercial |
$113.60
|
| Rate for Payer: Networks By Design Commercial |
$92.30
|
| Rate for Payer: Prime Health Services Commercial |
$120.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$85.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$85.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.21
|
| Rate for Payer: United Healthcare All Other HMO |
$7.21
|
| Rate for Payer: United Healthcare HMO Rider |
$7.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.21
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.79
|
| Rate for Payer: Vantage Medical Group Senior |
$8.90
|
|
|
HC OVA & PARASITES, PRESERVED
|
Facility
|
IP
|
$142.00
|
|
|
Service Code
|
CPT 87177
|
| Hospital Charge Code |
900911726
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$28.40 |
| Max. Negotiated Rate |
$120.70 |
| Rate for Payer: Adventist Health Commercial |
$28.40
|
| Rate for Payer: Cash Price |
$78.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.80
|
| Rate for Payer: EPIC Health Plan Senior |
$56.80
|
| Rate for Payer: Galaxy Health WC |
$120.70
|
| Rate for Payer: Global Benefits Group Commercial |
$85.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$94.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$87.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.08
|
| Rate for Payer: Multiplan Commercial |
$113.60
|
| Rate for Payer: Networks By Design Commercial |
$92.30
|
| Rate for Payer: Prime Health Services Commercial |
$120.70
|
|
|
HC OXYGEN PER HOUR
|
Facility
|
IP
|
$29.00
|
|
| Hospital Charge Code |
900802001
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.80 |
| Max. Negotiated Rate |
$24.65 |
| Rate for Payer: Adventist Health Commercial |
$5.80
|
| Rate for Payer: Cash Price |
$15.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.60
|
| Rate for Payer: EPIC Health Plan Senior |
$11.60
|
| Rate for Payer: Galaxy Health WC |
$24.65
|
| Rate for Payer: Global Benefits Group Commercial |
$17.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.96
|
| Rate for Payer: Multiplan Commercial |
$23.20
|
| Rate for Payer: Networks By Design Commercial |
$18.85
|
| Rate for Payer: Prime Health Services Commercial |
$24.65
|
|
|
HC OXYGEN PER HOUR
|
Facility
|
IP
|
$30.00
|
|
| Hospital Charge Code |
900800650
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
|
|
HC OXYGEN PER HOUR
|
Facility
|
OP
|
$29.00
|
|
| Hospital Charge Code |
900802001
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.80 |
| Max. Negotiated Rate |
$24.65 |
| Rate for Payer: Adventist Health Commercial |
$5.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.81
|
| Rate for Payer: Cash Price |
$15.95
|
| Rate for Payer: Cigna of CA HMO |
$18.56
|
| Rate for Payer: Cigna of CA PPO |
$21.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.60
|
| Rate for Payer: EPIC Health Plan Senior |
$11.60
|
| Rate for Payer: Galaxy Health WC |
$24.65
|
| Rate for Payer: Global Benefits Group Commercial |
$17.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.30
|
| Rate for Payer: Multiplan Commercial |
$23.20
|
| Rate for Payer: Networks By Design Commercial |
$18.85
|
| Rate for Payer: Prime Health Services Commercial |
$24.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.50
|
| Rate for Payer: United Healthcare All Other HMO |
$14.50
|
| Rate for Payer: United Healthcare HMO Rider |
$14.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.65
|
| Rate for Payer: Vantage Medical Group Senior |
$24.65
|
|
|
HC OXYGEN PER HOUR
|
Facility
|
OP
|
$30.00
|
|
| Hospital Charge Code |
900800650
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.42
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cigna of CA HMO |
$19.20
|
| Rate for Payer: Cigna of CA PPO |
$22.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.00
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15.00
|
| Rate for Payer: United Healthcare HMO Rider |
$15.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.50
|
| Rate for Payer: Vantage Medical Group Senior |
$25.50
|
|
|
HC OXYGEN PER HOUR PACU
|
Facility
|
IP
|
$29.00
|
|
| Hospital Charge Code |
900100043
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.80 |
| Max. Negotiated Rate |
$24.65 |
| Rate for Payer: Adventist Health Commercial |
$5.80
|
| Rate for Payer: Cash Price |
$15.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.60
|
| Rate for Payer: EPIC Health Plan Senior |
$11.60
|
| Rate for Payer: Galaxy Health WC |
$24.65
|
| Rate for Payer: Global Benefits Group Commercial |
$17.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.96
|
| Rate for Payer: Multiplan Commercial |
$23.20
|
| Rate for Payer: Networks By Design Commercial |
$18.85
|
| Rate for Payer: Prime Health Services Commercial |
$24.65
|
|
|
HC OXYGEN PER HOUR PACU
|
Facility
|
OP
|
$29.00
|
|
| Hospital Charge Code |
900100043
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.80 |
| Max. Negotiated Rate |
$24.65 |
| Rate for Payer: Adventist Health Commercial |
$5.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.81
|
| Rate for Payer: Cash Price |
$15.95
|
| Rate for Payer: Cigna of CA HMO |
$18.56
|
| Rate for Payer: Cigna of CA PPO |
$21.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.60
|
| Rate for Payer: EPIC Health Plan Senior |
$11.60
|
| Rate for Payer: Galaxy Health WC |
$24.65
|
| Rate for Payer: Global Benefits Group Commercial |
$17.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.30
|
| Rate for Payer: Multiplan Commercial |
$23.20
|
| Rate for Payer: Networks By Design Commercial |
$18.85
|
| Rate for Payer: Prime Health Services Commercial |
$24.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.50
|
| Rate for Payer: United Healthcare All Other HMO |
$14.50
|
| Rate for Payer: United Healthcare HMO Rider |
$14.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.65
|
| Rate for Payer: Vantage Medical Group Senior |
$24.65
|
|
|
HC P32 CHROMIC PHOSPHATE PER MCI
|
Facility
|
OP
|
$23,326.00
|
|
|
Service Code
|
CPT A9564
|
| Hospital Charge Code |
909301556
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$883.04 |
| Max. Negotiated Rate |
$19,827.10 |
| Rate for Payer: Adventist Health Commercial |
$4,665.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15,299.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19,827.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12,829.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17,494.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,324.50
|
| Rate for Payer: Blue Shield of California Commercial |
$14,275.51
|
| Rate for Payer: Blue Shield of California EPN |
$9,423.70
|
| Rate for Payer: Cash Price |
$12,829.30
|
| Rate for Payer: Cash Price |
$12,829.30
|
| Rate for Payer: Cigna of CA HMO |
$14,928.64
|
| Rate for Payer: Cigna of CA PPO |
$17,261.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19,827.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$19,827.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19,827.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,330.40
|
| Rate for Payer: EPIC Health Plan Senior |
$9,330.40
|
| Rate for Payer: Galaxy Health WC |
$19,827.10
|
| Rate for Payer: Global Benefits Group Commercial |
$13,995.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$883.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,558.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$998.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,438.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,598.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16,328.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16,328.20
|
| Rate for Payer: Multiplan Commercial |
$18,660.80
|
| Rate for Payer: Networks By Design Commercial |
$15,161.90
|
| Rate for Payer: Prime Health Services Commercial |
$19,827.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13,995.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13,995.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,663.00
|
| Rate for Payer: United Healthcare All Other HMO |
$11,663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$11,663.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,663.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19,827.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19,827.10
|
| Rate for Payer: Vantage Medical Group Senior |
$19,827.10
|
|
|
HC P32 CHROMIC PHOSPHATE PER MCI
|
Facility
|
IP
|
$23,326.00
|
|
|
Service Code
|
CPT A9564
|
| Hospital Charge Code |
909301556
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$4,665.20 |
| Max. Negotiated Rate |
$19,827.10 |
| Rate for Payer: Adventist Health Commercial |
$4,665.20
|
| Rate for Payer: Cash Price |
$12,829.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,330.40
|
| Rate for Payer: EPIC Health Plan Senior |
$9,330.40
|
| Rate for Payer: Galaxy Health WC |
$19,827.10
|
| Rate for Payer: Global Benefits Group Commercial |
$13,995.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,558.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,887.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,438.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,598.24
|
| Rate for Payer: Multiplan Commercial |
$18,660.80
|
| Rate for Payer: Networks By Design Commercial |
$15,161.90
|
| Rate for Payer: Prime Health Services Commercial |
$19,827.10
|
|
|
HC P32 SODIUM PHOSPHATE PER MCI
|
Facility
|
OP
|
$4,647.00
|
|
|
Service Code
|
CPT A9563
|
| Hospital Charge Code |
909301555
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$164.94 |
| Max. Negotiated Rate |
$3,949.95 |
| Rate for Payer: Adventist Health Commercial |
$929.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,047.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$223.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$197.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$197.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,853.72
|
| Rate for Payer: Blue Shield of California Commercial |
$2,843.96
|
| Rate for Payer: Blue Shield of California EPN |
$1,877.39
|
| Rate for Payer: Cash Price |
$2,555.85
|
| Rate for Payer: Cash Price |
$2,555.85
|
| Rate for Payer: Cigna of CA HMO |
$2,974.08
|
| Rate for Payer: Cigna of CA PPO |
$3,438.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$223.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$197.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$197.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$241.81
|
| Rate for Payer: EPIC Health Plan Senior |
$179.12
|
| Rate for Payer: Galaxy Health WC |
$3,949.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,788.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$293.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$164.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$179.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,099.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$186.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$179.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,115.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$225.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$240.02
|
| Rate for Payer: Multiplan Commercial |
$3,717.60
|
| Rate for Payer: Networks By Design Commercial |
$3,020.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,949.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,788.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,788.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,744.02
|
| Rate for Payer: United Healthcare All Other HMO |
$1,697.55
|
| Rate for Payer: United Healthcare HMO Rider |
$1,660.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,521.89
|
| Rate for Payer: Upland Medical Group Pediatric |
$179.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$223.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$197.03
|
| Rate for Payer: Vantage Medical Group Senior |
$197.03
|
|
|
HC P32 SODIUM PHOSPHATE PER MCI
|
Facility
|
IP
|
$4,647.00
|
|
|
Service Code
|
CPT A9563
|
| Hospital Charge Code |
909301555
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$929.40 |
| Max. Negotiated Rate |
$3,949.95 |
| Rate for Payer: Adventist Health Commercial |
$929.40
|
| Rate for Payer: Blue Shield of California Commercial |
$3,429.49
|
| Rate for Payer: Blue Shield of California EPN |
$2,258.44
|
| Rate for Payer: Cash Price |
$2,555.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,858.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,858.80
|
| Rate for Payer: Galaxy Health WC |
$3,949.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,788.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,099.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,770.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,876.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,115.28
|
| Rate for Payer: Multiplan Commercial |
$3,717.60
|
| Rate for Payer: Networks By Design Commercial |
$3,020.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,949.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,744.02
|
| Rate for Payer: United Healthcare All Other HMO |
$1,697.55
|
| Rate for Payer: United Healthcare HMO Rider |
$1,660.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,521.89
|
|
