|
HC PIPERACILLIN/TAZOBACTAM E TEST
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
900912422
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$22.28 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.28
|
| Rate for Payer: Blue Shield of California Commercial |
$12.04
|
| Rate for Payer: Blue Shield of California EPN |
$7.96
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna of CA HMO |
$11.52
|
| Rate for Payer: Cigna of CA PPO |
$13.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.41
|
| Rate for Payer: EPIC Health Plan Senior |
$4.75
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.37
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Networks By Design Commercial |
$11.70
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.85
|
| Rate for Payer: United Healthcare All Other HMO |
$3.85
|
| Rate for Payer: United Healthcare HMO Rider |
$3.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.85
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Vantage Medical Group Senior |
$4.75
|
|
|
HC PIPERACILLIN/TAZOBACTAM E TEST
|
Facility
|
IP
|
$103.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
900912422
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$20.60 |
| Max. Negotiated Rate |
$87.55 |
| Rate for Payer: Adventist Health Commercial |
$20.60
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.20
|
| Rate for Payer: EPIC Health Plan Senior |
$41.20
|
| Rate for Payer: Galaxy Health WC |
$87.55
|
| Rate for Payer: Global Benefits Group Commercial |
$61.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$68.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$63.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.72
|
| Rate for Payer: Multiplan Commercial |
$82.40
|
| Rate for Payer: Networks By Design Commercial |
$66.95
|
| Rate for Payer: Prime Health Services Commercial |
$87.55
|
|
|
HC PIV ADULT IV START KIT
|
Facility
|
IP
|
$54.12
|
|
| Hospital Charge Code |
901698428
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$46.00 |
| Rate for Payer: Adventist Health Commercial |
$10.82
|
| Rate for Payer: Cash Price |
$24.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.65
|
| Rate for Payer: EPIC Health Plan Senior |
$21.65
|
| Rate for Payer: Galaxy Health WC |
$46.00
|
| Rate for Payer: Global Benefits Group Commercial |
$32.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.99
|
| Rate for Payer: Multiplan Commercial |
$43.30
|
| Rate for Payer: Networks By Design Commercial |
$35.18
|
| Rate for Payer: Prime Health Services Commercial |
$46.00
|
|
|
HC PIV ADULT IV START KIT
|
Facility
|
OP
|
$54.12
|
|
| Hospital Charge Code |
901698428
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$46.00 |
| Rate for Payer: Adventist Health Commercial |
$10.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$35.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.24
|
| Rate for Payer: Cash Price |
$24.35
|
| Rate for Payer: Cigna of CA HMO |
$34.64
|
| Rate for Payer: Cigna of CA PPO |
$40.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$46.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$46.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.65
|
| Rate for Payer: EPIC Health Plan Senior |
$21.65
|
| Rate for Payer: Galaxy Health WC |
$46.00
|
| Rate for Payer: Global Benefits Group Commercial |
$32.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37.88
|
| Rate for Payer: Multiplan Commercial |
$43.30
|
| Rate for Payer: Networks By Design Commercial |
$35.18
|
| Rate for Payer: Prime Health Services Commercial |
$46.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.06
|
| Rate for Payer: United Healthcare All Other HMO |
$27.06
|
| Rate for Payer: United Healthcare HMO Rider |
$27.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$46.00
|
| Rate for Payer: Vantage Medical Group Senior |
$46.00
|
|
|
HC PIV DRESSING CHANGE KIT
|
Facility
|
IP
|
$62.16
|
|
| Hospital Charge Code |
901698273
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.43 |
| Max. Negotiated Rate |
$52.84 |
| Rate for Payer: Adventist Health Commercial |
$12.43
|
| Rate for Payer: Cash Price |
$27.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.86
|
| Rate for Payer: EPIC Health Plan Senior |
$24.86
|
| Rate for Payer: Galaxy Health WC |
$52.84
|
| Rate for Payer: Global Benefits Group Commercial |
$37.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$41.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$38.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.92
|
| Rate for Payer: Multiplan Commercial |
$49.73
|
| Rate for Payer: Networks By Design Commercial |
$40.40
|
| Rate for Payer: Prime Health Services Commercial |
$52.84
|
|
|
HC PIV DRESSING CHANGE KIT
|
Facility
|
OP
|
$62.16
|
|
| Hospital Charge Code |
901698273
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.43 |
| Max. Negotiated Rate |
$52.84 |
| Rate for Payer: Adventist Health Commercial |
$12.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$40.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$46.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.17
|
| Rate for Payer: Cash Price |
$27.97
|
| Rate for Payer: Cigna of CA HMO |
$39.78
|
| Rate for Payer: Cigna of CA PPO |
$46.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$52.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.86
|
| Rate for Payer: EPIC Health Plan Senior |
$24.86
|
| Rate for Payer: Galaxy Health WC |
$52.84
|
| Rate for Payer: Global Benefits Group Commercial |
$37.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$41.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$38.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$43.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$43.51
|
| Rate for Payer: Multiplan Commercial |
$49.73
|
| Rate for Payer: Networks By Design Commercial |
$40.40
|
| Rate for Payer: Prime Health Services Commercial |
$52.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$37.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$37.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.08
|
| Rate for Payer: United Healthcare All Other HMO |
$31.08
|
| Rate for Payer: United Healthcare HMO Rider |
$31.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.84
|
| Rate for Payer: Vantage Medical Group Senior |
$52.84
|
|
|
HC PIV EXTND DWELL 2FR 22GA
|
Facility
|
IP
|
$238.00
|
|
| Hospital Charge Code |
901698220
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$202.30 |
| Rate for Payer: Adventist Health Commercial |
$47.60
|
| Rate for Payer: Cash Price |
$107.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$95.20
|
| Rate for Payer: EPIC Health Plan Senior |
$95.20
|
| Rate for Payer: Galaxy Health WC |
$202.30
|
| Rate for Payer: Global Benefits Group Commercial |
$142.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$158.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$90.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$147.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.12
|
| Rate for Payer: Multiplan Commercial |
$190.40
|
| Rate for Payer: Networks By Design Commercial |
$154.70
|
| Rate for Payer: Prime Health Services Commercial |
$202.30
|
|
|
HC PIV EXTND DWELL 2FR 22GA
|
Facility
|
OP
|
$238.00
|
|
| Hospital Charge Code |
901698220
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$202.30 |
| Rate for Payer: Adventist Health Commercial |
$47.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$156.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$130.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$178.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$146.16
|
| Rate for Payer: Cash Price |
$107.10
|
| Rate for Payer: Cigna of CA HMO |
$152.32
|
| Rate for Payer: Cigna of CA PPO |
$176.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$202.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$202.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$95.20
|
| Rate for Payer: EPIC Health Plan Senior |
$95.20
|
| Rate for Payer: Galaxy Health WC |
$202.30
|
| Rate for Payer: Global Benefits Group Commercial |
$142.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$158.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$90.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$147.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$166.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$166.60
|
| Rate for Payer: Multiplan Commercial |
$190.40
|
| Rate for Payer: Networks By Design Commercial |
$154.70
|
| Rate for Payer: Prime Health Services Commercial |
$202.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$142.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$142.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$119.00
|
| Rate for Payer: United Healthcare All Other HMO |
$119.00
|
| Rate for Payer: United Healthcare HMO Rider |
$119.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$119.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$202.30
|
| Rate for Payer: Vantage Medical Group Senior |
$202.30
|
|
|
HC PIV KIT W/STNDR BORE EXT SET
|
Facility
|
IP
|
$22.06
|
|
| Hospital Charge Code |
901698435
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.41 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Adventist Health Commercial |
$4.41
|
| Rate for Payer: Cash Price |
$9.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.82
|
| Rate for Payer: EPIC Health Plan Senior |
$8.82
|
| Rate for Payer: Galaxy Health WC |
$18.75
|
| Rate for Payer: Global Benefits Group Commercial |
$13.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.29
|
| Rate for Payer: Multiplan Commercial |
$17.65
|
| Rate for Payer: Networks By Design Commercial |
$14.34
|
| Rate for Payer: Prime Health Services Commercial |
$18.75
|
|
|
HC PIV KIT W/STNDR BORE EXT SET
|
Facility
|
OP
|
$22.06
|
|
| Hospital Charge Code |
901698435
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.41 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Adventist Health Commercial |
$4.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.55
|
| Rate for Payer: Cash Price |
$9.93
|
| Rate for Payer: Cigna of CA HMO |
$14.12
|
| Rate for Payer: Cigna of CA PPO |
$16.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.82
|
| Rate for Payer: EPIC Health Plan Senior |
$8.82
|
| Rate for Payer: Galaxy Health WC |
$18.75
|
| Rate for Payer: Global Benefits Group Commercial |
$13.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.44
|
| Rate for Payer: Multiplan Commercial |
$17.65
|
| Rate for Payer: Networks By Design Commercial |
$14.34
|
| Rate for Payer: Prime Health Services Commercial |
$18.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.03
|
| Rate for Payer: United Healthcare All Other HMO |
$11.03
|
| Rate for Payer: United Healthcare HMO Rider |
$11.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.75
|
| Rate for Payer: Vantage Medical Group Senior |
$18.75
|
|
|
HC PIV OUTPT START KIT
|
Facility
|
OP
|
$8.28
|
|
| Hospital Charge Code |
901698365
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.66 |
| Max. Negotiated Rate |
$7.04 |
| Rate for Payer: Adventist Health Commercial |
$1.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.08
|
| Rate for Payer: Cash Price |
$3.73
|
| Rate for Payer: Cigna of CA HMO |
$5.30
|
| Rate for Payer: Cigna of CA PPO |
$6.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.31
|
| Rate for Payer: EPIC Health Plan Senior |
$3.31
|
| Rate for Payer: Galaxy Health WC |
$7.04
|
| Rate for Payer: Global Benefits Group Commercial |
$4.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.80
|
| Rate for Payer: Multiplan Commercial |
$6.62
|
| Rate for Payer: Networks By Design Commercial |
$5.38
|
| Rate for Payer: Prime Health Services Commercial |
$7.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.97
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.14
|
| Rate for Payer: United Healthcare All Other HMO |
$4.14
|
| Rate for Payer: United Healthcare HMO Rider |
$4.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.04
|
| Rate for Payer: Vantage Medical Group Senior |
$7.04
|
|
|
HC PIV OUTPT START KIT
|
Facility
|
IP
|
$8.28
|
|
| Hospital Charge Code |
901698365
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.66 |
| Max. Negotiated Rate |
$7.04 |
| Rate for Payer: Adventist Health Commercial |
$1.66
|
| Rate for Payer: Cash Price |
$3.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.31
|
| Rate for Payer: EPIC Health Plan Senior |
$3.31
|
| Rate for Payer: Galaxy Health WC |
$7.04
|
| Rate for Payer: Global Benefits Group Commercial |
$4.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.99
|
| Rate for Payer: Multiplan Commercial |
$6.62
|
| Rate for Payer: Networks By Design Commercial |
$5.38
|
| Rate for Payer: Prime Health Services Commercial |
$7.04
|
|
|
HC PLACEMENT OF IVC FILTER
|
Facility
|
OP
|
$20,172.00
|
|
|
Service Code
|
CPT 37191
|
| Hospital Charge Code |
906820197
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$329.62 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$4,034.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,868.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,712.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,470.08
|
| Rate for Payer: Cash Price |
$9,077.40
|
| Rate for Payer: Cash Price |
$9,077.40
|
| Rate for Payer: Cash Price |
$9,077.40
|
| Rate for Payer: Cigna of CA HMO |
$12,910.08
|
| Rate for Payer: Cigna of CA PPO |
$14,927.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,555.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,868.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,272.45
|
| Rate for Payer: EPIC Health Plan Senior |
$6,868.48
|
| Rate for Payer: Galaxy Health WC |
$17,146.20
|
| Rate for Payer: Global Benefits Group Commercial |
$12,103.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,264.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$329.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,868.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,454.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$372.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,868.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,841.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,654.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,203.76
|
| Rate for Payer: Multiplan Commercial |
$16,137.60
|
| Rate for Payer: Multiplan WC |
$10,943.70
|
| Rate for Payer: Networks By Design Commercial |
$13,111.80
|
| Rate for Payer: Prime Health Services Commercial |
$17,146.20
|
| Rate for Payer: Prime Health Services WC |
$10,832.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12,103.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$6,868.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Vantage Medical Group Senior |
$6,868.48
|
|
|
HC PLACEMENT OF IVC FILTER
|
Facility
|
OP
|
$11,700.00
|
|
|
Service Code
|
CPT 37191
|
| Hospital Charge Code |
909081666
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$329.62 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$2,340.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,868.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,712.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,470.08
|
| Rate for Payer: Cash Price |
$5,265.00
|
| Rate for Payer: Cash Price |
$5,265.00
|
| Rate for Payer: Cash Price |
$5,265.00
|
| Rate for Payer: Cigna of CA HMO |
$7,488.00
|
| Rate for Payer: Cigna of CA PPO |
$8,658.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,555.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,868.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,272.45
|
| Rate for Payer: EPIC Health Plan Senior |
$6,868.48
|
| Rate for Payer: Galaxy Health WC |
$9,945.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,020.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,264.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$329.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,868.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,803.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$372.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,868.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,808.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,654.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,203.76
|
| Rate for Payer: Multiplan Commercial |
$9,360.00
|
| Rate for Payer: Multiplan WC |
$10,943.70
|
| Rate for Payer: Networks By Design Commercial |
$7,605.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,945.00
|
| Rate for Payer: Prime Health Services WC |
$10,832.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,020.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$6,868.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Vantage Medical Group Senior |
$6,868.48
|
|
|
HC PLACEMENT OF IVC FILTER
|
Facility
|
IP
|
$11,700.00
|
|
|
Service Code
|
CPT 37191
|
| Hospital Charge Code |
909081666
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,340.00 |
| Max. Negotiated Rate |
$9,945.00 |
| Rate for Payer: Adventist Health Commercial |
$2,340.00
|
| Rate for Payer: Cash Price |
$5,265.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,680.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,680.00
|
| Rate for Payer: Galaxy Health WC |
$9,945.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,020.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,803.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,457.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,242.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,808.00
|
| Rate for Payer: Multiplan Commercial |
$9,360.00
|
| Rate for Payer: Networks By Design Commercial |
$7,605.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,945.00
|
|
|
HC PLACEMENT OF IVC FILTER
|
Facility
|
IP
|
$20,172.00
|
|
|
Service Code
|
CPT 37191
|
| Hospital Charge Code |
906820197
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,034.40 |
| Max. Negotiated Rate |
$17,146.20 |
| Rate for Payer: Adventist Health Commercial |
$4,034.40
|
| Rate for Payer: Cash Price |
$9,077.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,068.80
|
| Rate for Payer: EPIC Health Plan Senior |
$8,068.80
|
| Rate for Payer: Galaxy Health WC |
$17,146.20
|
| Rate for Payer: Global Benefits Group Commercial |
$12,103.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,454.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,685.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,486.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,841.28
|
| Rate for Payer: Multiplan Commercial |
$16,137.60
|
| Rate for Payer: Networks By Design Commercial |
$13,111.80
|
| Rate for Payer: Prime Health Services Commercial |
$17,146.20
|
|
|
HC PLACENTAL ALPHA MICROGLOB-1POC
|
Facility
|
IP
|
$960.00
|
|
|
Service Code
|
CPT 84112
|
| Hospital Charge Code |
900912139
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$192.00 |
| Max. Negotiated Rate |
$816.00 |
| Rate for Payer: Adventist Health Commercial |
$192.00
|
| Rate for Payer: Cash Price |
$432.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$384.00
|
| Rate for Payer: EPIC Health Plan Senior |
$384.00
|
| Rate for Payer: Galaxy Health WC |
$816.00
|
| Rate for Payer: Global Benefits Group Commercial |
$576.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$640.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$365.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$594.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$230.40
|
| Rate for Payer: Multiplan Commercial |
$768.00
|
| Rate for Payer: Networks By Design Commercial |
$624.00
|
| Rate for Payer: Prime Health Services Commercial |
$816.00
|
|
|
HC PLACENTAL ALPHA MICROGLOB-1POC
|
Facility
|
OP
|
$272.00
|
|
|
Service Code
|
CPT 84112
|
| Hospital Charge Code |
900912139
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$54.40 |
| Max. Negotiated Rate |
$504.45 |
| Rate for Payer: Adventist Health Commercial |
$54.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$178.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$147.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$107.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$98.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$504.45
|
| Rate for Payer: Blue Shield of California Commercial |
$181.97
|
| Rate for Payer: Blue Shield of California EPN |
$120.22
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cigna of CA HMO |
$174.08
|
| Rate for Payer: Cigna of CA PPO |
$201.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$147.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$107.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$98.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$132.45
|
| Rate for Payer: EPIC Health Plan Senior |
$98.11
|
| Rate for Payer: Galaxy Health WC |
$231.20
|
| Rate for Payer: Global Benefits Group Commercial |
$163.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$160.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$98.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$181.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$103.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$98.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$123.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$131.47
|
| Rate for Payer: Multiplan Commercial |
$217.60
|
| Rate for Payer: Networks By Design Commercial |
$176.80
|
| Rate for Payer: Prime Health Services Commercial |
$231.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$163.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$163.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$79.47
|
| Rate for Payer: United Healthcare All Other HMO |
$79.47
|
| Rate for Payer: United Healthcare HMO Rider |
$79.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$79.47
|
| Rate for Payer: Upland Medical Group Pediatric |
$98.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$147.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$107.92
|
| Rate for Payer: Vantage Medical Group Senior |
$98.11
|
|
|
HC PLASMA IRON TURNOVER
|
Facility
|
OP
|
$1,416.00
|
|
| Hospital Charge Code |
909301337
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$283.20 |
| Max. Negotiated Rate |
$1,203.60 |
| Rate for Payer: Adventist Health Commercial |
$283.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$928.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,203.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$778.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,062.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$869.57
|
| Rate for Payer: Blue Shield of California Commercial |
$866.59
|
| Rate for Payer: Blue Shield of California EPN |
$572.06
|
| Rate for Payer: Cash Price |
$637.20
|
| Rate for Payer: Cigna of CA HMO |
$906.24
|
| Rate for Payer: Cigna of CA PPO |
$1,047.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,203.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,203.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,203.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$566.40
|
| Rate for Payer: EPIC Health Plan Senior |
$566.40
|
| Rate for Payer: Galaxy Health WC |
$1,203.60
|
| Rate for Payer: Global Benefits Group Commercial |
$849.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$944.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$539.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$876.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$991.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$991.20
|
| Rate for Payer: Multiplan Commercial |
$1,132.80
|
| Rate for Payer: Networks By Design Commercial |
$920.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,203.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$849.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$849.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$708.00
|
| Rate for Payer: United Healthcare All Other HMO |
$708.00
|
| Rate for Payer: United Healthcare HMO Rider |
$708.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$708.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,203.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,203.60
|
| Rate for Payer: Vantage Medical Group Senior |
$1,203.60
|
|
|
HC PLASMA IRON TURNOVER
|
Facility
|
IP
|
$1,416.00
|
|
| Hospital Charge Code |
909301337
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$283.20 |
| Max. Negotiated Rate |
$1,203.60 |
| Rate for Payer: Adventist Health Commercial |
$283.20
|
| Rate for Payer: Cash Price |
$637.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$566.40
|
| Rate for Payer: EPIC Health Plan Senior |
$566.40
|
| Rate for Payer: Galaxy Health WC |
$1,203.60
|
| Rate for Payer: Global Benefits Group Commercial |
$849.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$944.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$539.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$876.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.84
|
| Rate for Payer: Multiplan Commercial |
$1,132.80
|
| Rate for Payer: Networks By Design Commercial |
$920.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,203.60
|
|
|
HC PLASTIC REPAIR OF CANALICULI
|
Facility
|
IP
|
$6,877.00
|
|
|
Service Code
|
CPT 68700
|
| Hospital Charge Code |
900501395
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,375.40 |
| Max. Negotiated Rate |
$5,845.45 |
| Rate for Payer: Adventist Health Commercial |
$1,375.40
|
| Rate for Payer: Cash Price |
$3,094.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,750.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,750.80
|
| Rate for Payer: Galaxy Health WC |
$5,845.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,126.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,586.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,620.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,256.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,650.48
|
| Rate for Payer: Multiplan Commercial |
$5,501.60
|
| Rate for Payer: Networks By Design Commercial |
$4,470.05
|
| Rate for Payer: Prime Health Services Commercial |
$5,845.45
|
|
|
HC PLASTIC REPAIR OF CANALICULI
|
Facility
|
OP
|
$6,877.00
|
|
|
Service Code
|
CPT 68700
|
| Hospital Charge Code |
900501395
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$973.00 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$1,375.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,446.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,260.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,964.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$3,094.65
|
| Rate for Payer: Cash Price |
$3,094.65
|
| Rate for Payer: Cash Price |
$3,094.65
|
| Rate for Payer: Cigna of CA HMO |
$4,401.28
|
| Rate for Payer: Cigna of CA PPO |
$5,088.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,446.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,260.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,964.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,001.75
|
| Rate for Payer: EPIC Health Plan Senior |
$2,964.26
|
| Rate for Payer: Galaxy Health WC |
$5,845.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,126.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,861.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,964.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,586.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,576.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,964.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,650.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,734.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,972.11
|
| Rate for Payer: Multiplan Commercial |
$5,501.60
|
| Rate for Payer: Multiplan WC |
$4,723.01
|
| Rate for Payer: Networks By Design Commercial |
$4,470.05
|
| Rate for Payer: Prime Health Services Commercial |
$5,845.45
|
| Rate for Payer: Prime Health Services WC |
$4,674.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,126.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,438.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,438.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,438.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,438.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,964.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,446.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,260.69
|
| Rate for Payer: Vantage Medical Group Senior |
$2,964.26
|
|
|
HC PLASTY BALLOON/ACCENT
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909081210
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$255.00 |
| Rate for Payer: Adventist Health Commercial |
$60.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$255.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$165.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$173.76
|
| Rate for Payer: Blue Shield of California Commercial |
$221.40
|
| Rate for Payer: Blue Shield of California EPN |
$145.80
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna of CA HMO |
$210.00
|
| Rate for Payer: Cigna of CA PPO |
$210.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$255.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$255.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$255.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.00
|
| Rate for Payer: EPIC Health Plan Senior |
$120.00
|
| Rate for Payer: Galaxy Health WC |
$255.00
|
| Rate for Payer: Global Benefits Group Commercial |
$180.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$200.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$185.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$210.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$210.00
|
| Rate for Payer: Multiplan Commercial |
$240.00
|
| Rate for Payer: Networks By Design Commercial |
$150.00
|
| Rate for Payer: Prime Health Services Commercial |
$255.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$180.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$180.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$112.59
|
| Rate for Payer: United Healthcare All Other HMO |
$109.59
|
| Rate for Payer: United Healthcare HMO Rider |
$107.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$98.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$255.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$255.00
|
| Rate for Payer: Vantage Medical Group Senior |
$255.00
|
|
|
HC PLASTY BALLOON/ACCENT
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909081210
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$60.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna of CA HMO |
$210.00
|
| Rate for Payer: Cigna of CA PPO |
$210.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.00
|
| Rate for Payer: EPIC Health Plan Senior |
$120.00
|
| Rate for Payer: Galaxy Health WC |
$255.00
|
| Rate for Payer: Global Benefits Group Commercial |
$180.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$200.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$185.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.00
|
| Rate for Payer: Multiplan Commercial |
$240.00
|
| Rate for Payer: Networks By Design Commercial |
$150.00
|
| Rate for Payer: Prime Health Services Commercial |
$255.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$112.59
|
| Rate for Payer: United Healthcare All Other HMO |
$109.59
|
| Rate for Payer: United Healthcare HMO Rider |
$107.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$98.25
|
|
|
HC PLASTY BALLOON/LP/PF+ CORDIS
|
Facility
|
OP
|
$720.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909081212
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$144.00 |
| Max. Negotiated Rate |
$612.00 |
| Rate for Payer: Adventist Health Commercial |
$144.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$612.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$396.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$540.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$417.02
|
| Rate for Payer: Blue Shield of California Commercial |
$531.36
|
| Rate for Payer: Blue Shield of California EPN |
$349.92
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cigna of CA HMO |
$504.00
|
| Rate for Payer: Cigna of CA PPO |
$504.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$612.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$612.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$612.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$288.00
|
| Rate for Payer: EPIC Health Plan Senior |
$288.00
|
| Rate for Payer: Galaxy Health WC |
$612.00
|
| Rate for Payer: Global Benefits Group Commercial |
$432.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$480.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$274.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$445.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$504.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$504.00
|
| Rate for Payer: Multiplan Commercial |
$576.00
|
| Rate for Payer: Networks By Design Commercial |
$360.00
|
| Rate for Payer: Prime Health Services Commercial |
$612.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$432.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$432.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$270.22
|
| Rate for Payer: United Healthcare All Other HMO |
$263.02
|
| Rate for Payer: United Healthcare HMO Rider |
$257.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$235.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$612.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$612.00
|
| Rate for Payer: Vantage Medical Group Senior |
$612.00
|
|
