|
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 |
$28.02 |
| Rate for Payer: Adventist Health Commercial |
$2.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28.02
|
| 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 |
$7.32
|
| Rate for Payer: Cash Price |
$5.13
|
| Rate for Payer: Cash Price |
$5.13
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.98
|
| 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 Foundation Hospitals Commercial/Self Funded |
$7.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.73
|
| 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 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,015.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$2,283.75
|
| Rate for Payer: Cash Price |
$2,283.75
|
| Rate for Payer: Cigna of CA HMO |
$3,552.50
|
| Rate for Payer: Cigna of CA PPO |
$3,552.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$3,222.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,994.25
|
| 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 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: Networks By Design Commercial |
$2,537.50
|
| 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 |
$3,071.90
|
| Rate for Payer: Blue Shield of California Commercial |
$2,573.03
|
| Rate for Payer: Blue Shield of California Commercial |
$3,902.68
|
| Rate for Payer: Cash Price |
$2,283.75
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$3,222.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,842.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,994.25
|
| 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: 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 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna of CA HMO |
$70.00
|
| Rate for Payer: Cigna of CA PPO |
$70.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$63.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.00
|
| 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 |
$65.00
|
| 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 |
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 |
$60.53
|
| Rate for Payer: Blue Shield of California Commercial |
$76.90
|
| Rate for Payer: Blue Shield of California Commercial |
$50.70
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$31.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$63.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$36.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.00
|
| 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
|
IP
|
$100.00
|
|
|
Service Code
|
CPT L3390
|
| Hospital Charge Code |
905353390
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna of CA HMO |
$70.00
|
| Rate for Payer: Cigna of CA PPO |
$70.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$63.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.00
|
| 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 |
$65.00
|
| 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 |
$60.53
|
| Rate for Payer: Blue Shield of California Commercial |
$76.90
|
| Rate for Payer: Blue Shield of California Commercial |
$50.70
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$31.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$63.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$36.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.00
|
| 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
|
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 |
$63.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$99.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$90.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$83.78
|
| 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 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: Adventist Health Commercial |
$19.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$73.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$73.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.35
|
| 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 Medi-Cal |
$9.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$91.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$91.38
|
| Rate for Payer: Blue Shield of California Commercial |
$43.80
|
| Rate for Payer: Blue Shield of California Commercial |
$65.46
|
| Rate for Payer: Blue Shield of California Commercial |
$66.22
|
| Rate for Payer: Blue Shield of California Commercial |
$98.97
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cigna of CA HMO |
$60.80
|
| Rate for Payer: Cigna of CA HMO |
$90.88
|
| Rate for Payer: Cigna of CA PPO |
$105.08
|
| Rate for Payer: Cigna of CA PPO |
$70.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.79
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$99.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$66.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.69
|
| Rate for Payer: EPIC Health Plan Senior |
$9.79
|
| Rate for Payer: EPIC Health Plan Senior |
$9.79
|
| Rate for Payer: Galaxy Health WC |
$120.70
|
| Rate for Payer: Galaxy Health WC |
$80.75
|
| Rate for Payer: Global Benefits Group Commercial |
$85.20
|
| Rate for Payer: Global Benefits Group Commercial |
$57.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.06
|
| 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: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$90.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$60.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.93
|
| Rate for Payer: Multiplan Commercial |
$76.00
|
| Rate for Payer: Multiplan Commercial |
$113.60
|
| Rate for Payer: Networks By Design Commercial |
$61.75
|
| Rate for Payer: Networks By Design Commercial |
$92.30
|
| Rate for Payer: Prime Health Services Commercial |
$120.70
|
| Rate for Payer: Prime Health Services Commercial |
$80.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$85.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$85.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.21
|
| 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 All Other HMO |
$7.21
|
| Rate for Payer: United Healthcare HMO Rider |
$7.21
|
| Rate for Payer: United Healthcare HMO Rider |
$7.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.21
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.90
|
| 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 Commercial/Exchange |
$13.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.79
|
| Rate for Payer: Vantage Medical Group Senior |
$8.90
|
| Rate for Payer: Vantage Medical Group Senior |
$8.90
|
|
|
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 |
$13.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$18.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.11
|
| 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
|
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 |
$18.61
|
| Rate for Payer: Cash Price |
$13.05
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$18.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.11
|
| 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 |
$19.25
|
| Rate for Payer: Cash Price |
$13.50
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$19.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.70
|
| 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
|
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: Galaxy Health WC |
$25.50
|
| Rate for Payer: EPIC Health Plan Senior |
$12.00
|
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.70
|
| 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 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: Networks By Design Commercial |
$18.85
|
| Rate for Payer: Adventist Health Commercial |
$5.80
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$18.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.96
|
| Rate for Payer: Multiplan Commercial |
$23.20
|
| 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 |
$18.61
|
| Rate for Payer: Cash Price |
$13.05
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$18.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.11
|
| 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
|
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 |
$10,496.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16,328.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$14,812.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13,762.34
|
| 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 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 |
$1,801.53
|
| 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 |
$1,840.29
|
| Rate for Payer: Blue Shield of California Commercial |
$9,820.25
|
| Rate for Payer: Blue Shield of California Commercial |
$14,881.99
|
| Rate for Payer: Cash Price |
$10,496.70
|
| Rate for Payer: Cash Price |
$10,496.70
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$16,328.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$14,812.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$998.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13,762.34
|
| 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 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 |
$2,356.03
|
| Rate for Payer: Blue Shield of California Commercial |
$3,573.54
|
| Rate for Payer: Cash Price |
$2,091.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,252.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2,950.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,741.73
|
| 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
|
|
|
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 |
$1,890.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$347.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$306.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$181.77
|
| Rate for Payer: Blue Shield of California Commercial |
$1,956.39
|
| Rate for Payer: Blue Shield of California Commercial |
$2,964.79
|
| Rate for Payer: Cash Price |
$2,091.15
|
| Rate for Payer: Cash Price |
$2,091.15
|
| 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 |
$347.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$306.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,252.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$459.10
|
| Rate for Payer: EPIC Health Plan Senior |
$306.06
|
| 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/Senior |
$456.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$164.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$278.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,950.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$186.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$389.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,115.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$350.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$372.84
|
| 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 |
$278.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$347.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$306.06
|
| Rate for Payer: Vantage Medical Group Senior |
$306.06
|
|
|
HC PACE INSERT EXIST MULT HC LEADS
|
Facility
|
OP
|
$26,727.00
|
|
|
Service Code
|
CPT 33221
|
| Hospital Charge Code |
906811421
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$489.12 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$5,345.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37,160.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27,251.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24,773.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,934.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Cash Price |
$12,027.15
|
| Rate for Payer: Cash Price |
$12,027.15
|
| Rate for Payer: Cash Price |
$12,027.15
|
| Rate for Payer: Cigna of CA HMO |
$17,105.28
|
| Rate for Payer: Cigna of CA PPO |
$19,777.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37,160.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$27,251.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24,773.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18,708.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$40,876.69
|
| Rate for Payer: EPIC Health Plan Senior |
$27,251.12
|
| Rate for Payer: Galaxy Health WC |
$22,717.95
|
| Rate for Payer: Global Benefits Group Commercial |
$16,036.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$40,628.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$489.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24,773.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16,971.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$553.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$34,683.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,414.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31,214.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33,196.82
|
| Rate for Payer: Multiplan Commercial |
$21,381.60
|
| Rate for Payer: Multiplan WC |
$38,609.08
|
| Rate for Payer: Networks By Design Commercial |
$17,372.55
|
| Rate for Payer: Prime Health Services Commercial |
$22,717.95
|
| Rate for Payer: Prime Health Services WC |
$38,215.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16,036.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,363.50
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$24,773.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37,160.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27,251.12
|
| Rate for Payer: Vantage Medical Group Senior |
$24,773.75
|
|
|
HC PACE INSERT EXIST MULT HC LEADS
|
Facility
|
IP
|
$26,727.00
|
|
|
Service Code
|
CPT 33221
|
| Hospital Charge Code |
906811421
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,345.40 |
| Max. Negotiated Rate |
$22,717.95 |
| Rate for Payer: Adventist Health Commercial |
$5,345.40
|
| Rate for Payer: Cash Price |
$12,027.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18,708.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,690.80
|
| Rate for Payer: EPIC Health Plan Senior |
$10,690.80
|
| Rate for Payer: Galaxy Health WC |
$22,717.95
|
| Rate for Payer: Global Benefits Group Commercial |
$16,036.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16,971.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15,768.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,414.48
|
| Rate for Payer: Multiplan Commercial |
$21,381.60
|
| Rate for Payer: Networks By Design Commercial |
$17,372.55
|
| Rate for Payer: Prime Health Services Commercial |
$22,717.95
|
|
|
HC PACEMAKER INSERTION KIT
|
Facility
|
IP
|
$508.97
|
|
| Hospital Charge Code |
901698281
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.79 |
| Max. Negotiated Rate |
$432.62 |
| Rate for Payer: Adventist Health Commercial |
$101.79
|
| Rate for Payer: Cash Price |
$229.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$356.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$203.59
|
| Rate for Payer: EPIC Health Plan Senior |
$203.59
|
| Rate for Payer: Galaxy Health WC |
$432.62
|
| Rate for Payer: Global Benefits Group Commercial |
$305.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$323.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$300.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.15
|
| Rate for Payer: Multiplan Commercial |
$407.18
|
| Rate for Payer: Networks By Design Commercial |
$330.83
|
| Rate for Payer: Prime Health Services Commercial |
$432.62
|
|
|
HC PACEMAKER INSERTION KIT
|
Facility
|
OP
|
$508.97
|
|
| Hospital Charge Code |
901698281
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.79 |
| Max. Negotiated Rate |
$432.62 |
| Rate for Payer: Adventist Health Commercial |
$101.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$333.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$432.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$279.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$381.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$326.61
|
| Rate for Payer: Cash Price |
$229.04
|
| Rate for Payer: Cigna of CA HMO |
$325.74
|
| Rate for Payer: Cigna of CA PPO |
$376.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$432.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$432.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$432.62
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$356.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$203.59
|
| Rate for Payer: EPIC Health Plan Senior |
$203.59
|
| Rate for Payer: Galaxy Health WC |
$432.62
|
| Rate for Payer: Global Benefits Group Commercial |
$305.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$323.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$184.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$300.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$356.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$356.28
|
| Rate for Payer: Multiplan Commercial |
$407.18
|
| Rate for Payer: Networks By Design Commercial |
$330.83
|
| Rate for Payer: Prime Health Services Commercial |
$432.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$305.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$305.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$254.49
|
| Rate for Payer: United Healthcare All Other HMO |
$254.49
|
| Rate for Payer: United Healthcare HMO Rider |
$254.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$254.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$432.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$432.62
|
| Rate for Payer: Vantage Medical Group Senior |
$432.62
|
|
|
HC PACE MAKER MODEL KIT
|
Facility
|
OP
|
$265.44
|
|
| Hospital Charge Code |
901698277
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.09 |
| Max. Negotiated Rate |
$225.62 |
| Rate for Payer: Adventist Health Commercial |
$53.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$174.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$225.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$145.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$199.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.33
|
| Rate for Payer: Cash Price |
$119.45
|
| Rate for Payer: Cigna of CA HMO |
$169.88
|
| Rate for Payer: Cigna of CA PPO |
$196.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$225.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.62
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$185.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.18
|
| Rate for Payer: EPIC Health Plan Senior |
$106.18
|
| Rate for Payer: Galaxy Health WC |
$225.62
|
| Rate for Payer: Global Benefits Group Commercial |
$159.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$168.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$96.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$185.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$185.81
|
| Rate for Payer: Multiplan Commercial |
$212.35
|
| Rate for Payer: Networks By Design Commercial |
$172.54
|
| Rate for Payer: Prime Health Services Commercial |
$225.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$159.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$159.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$132.72
|
| Rate for Payer: United Healthcare All Other HMO |
$132.72
|
| Rate for Payer: United Healthcare HMO Rider |
$132.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$225.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$225.62
|
| Rate for Payer: Vantage Medical Group Senior |
$225.62
|
|
|
HC PACE MAKER MODEL KIT
|
Facility
|
IP
|
$265.44
|
|
| Hospital Charge Code |
901698277
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.09 |
| Max. Negotiated Rate |
$225.62 |
| Rate for Payer: Adventist Health Commercial |
$53.09
|
| Rate for Payer: Cash Price |
$119.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$185.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.18
|
| Rate for Payer: EPIC Health Plan Senior |
$106.18
|
| Rate for Payer: Galaxy Health WC |
$225.62
|
| Rate for Payer: Global Benefits Group Commercial |
$159.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$168.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.71
|
| Rate for Payer: Multiplan Commercial |
$212.35
|
| Rate for Payer: Networks By Design Commercial |
$172.54
|
| Rate for Payer: Prime Health Services Commercial |
$225.62
|
|
