|
HC PORT IMAGE
|
Facility
|
OP
|
$740.00
|
|
|
Service Code
|
CPT 77417
|
| Hospital Charge Code |
904810803
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$20,000.00 |
| Rate for Payer: Adventist Health Commercial |
$148.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$106.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$629.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$407.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$555.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.94
|
| Rate for Payer: Blue Shield of California Commercial |
$311.54
|
| Rate for Payer: Blue Shield of California Commercial |
$472.12
|
| Rate for Payer: Cash Price |
$333.00
|
| Rate for Payer: Cash Price |
$333.00
|
| Rate for Payer: Cash Price |
$333.00
|
| Rate for Payer: Cash Price |
$333.00
|
| Rate for Payer: Cigna of CA HMO |
$473.60
|
| Rate for Payer: Cigna of CA PPO |
$547.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$629.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$629.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$629.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$518.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$296.00
|
| Rate for Payer: EPIC Health Plan Senior |
$296.00
|
| Rate for Payer: Galaxy Health WC |
$629.00
|
| Rate for Payer: Global Benefits Group Commercial |
$444.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$469.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$436.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$518.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$518.00
|
| Rate for Payer: Multiplan Commercial |
$592.00
|
| Rate for Payer: Networks By Design Commercial |
$481.00
|
| Rate for Payer: Prime Health Services Commercial |
$629.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$444.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,748.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,759.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,332.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,221.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$20,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$629.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$629.00
|
| Rate for Payer: Vantage Medical Group Senior |
$629.00
|
|
|
HC PORT RENASYS SOFT STAND ALONE
|
Facility
|
IP
|
$232.12
|
|
| Hospital Charge Code |
901698189
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.42 |
| Max. Negotiated Rate |
$197.30 |
| Rate for Payer: Adventist Health Commercial |
$46.42
|
| Rate for Payer: Cash Price |
$104.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$162.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.85
|
| Rate for Payer: EPIC Health Plan Senior |
$92.85
|
| Rate for Payer: Galaxy Health WC |
$197.30
|
| Rate for Payer: Global Benefits Group Commercial |
$139.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$147.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$136.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.71
|
| Rate for Payer: Multiplan Commercial |
$185.70
|
| Rate for Payer: Networks By Design Commercial |
$150.88
|
| Rate for Payer: Prime Health Services Commercial |
$197.30
|
|
|
HC PORT RENASYS SOFT STAND ALONE
|
Facility
|
OP
|
$232.12
|
|
| Hospital Charge Code |
901698189
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.42 |
| Max. Negotiated Rate |
$197.30 |
| Rate for Payer: Adventist Health Commercial |
$46.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$152.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$197.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$127.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$174.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$148.95
|
| Rate for Payer: Cash Price |
$104.45
|
| Rate for Payer: Cigna of CA HMO |
$148.56
|
| Rate for Payer: Cigna of CA PPO |
$171.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$197.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$197.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$197.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$162.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.85
|
| Rate for Payer: EPIC Health Plan Senior |
$92.85
|
| Rate for Payer: Galaxy Health WC |
$197.30
|
| Rate for Payer: Global Benefits Group Commercial |
$139.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$147.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$84.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$136.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$162.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$162.48
|
| Rate for Payer: Multiplan Commercial |
$185.70
|
| Rate for Payer: Networks By Design Commercial |
$150.88
|
| Rate for Payer: Prime Health Services Commercial |
$197.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$139.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$139.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$116.06
|
| Rate for Payer: United Healthcare All Other HMO |
$116.06
|
| Rate for Payer: United Healthcare HMO Rider |
$116.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$116.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$197.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$197.30
|
| Rate for Payer: Vantage Medical Group Senior |
$197.30
|
|
|
HC POS COMBO 43 PANEL ID
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900912490
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.54 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Cigna of CA PPO |
$54.76
|
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Adventist Health Commercial |
$14.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$67.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$67.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$83.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$83.32
|
| Rate for Payer: Blue Shield of California Commercial |
$23.05
|
| Rate for Payer: Blue Shield of California Commercial |
$34.85
|
| Rate for Payer: Blue Shield of California Commercial |
$34.11
|
| Rate for Payer: Blue Shield of California Commercial |
$51.58
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna of CA HMO |
$47.36
|
| Rate for Payer: Cigna of CA HMO |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$51.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.33
|
| Rate for Payer: EPIC Health Plan Senior |
$8.89
|
| Rate for Payer: EPIC Health Plan Senior |
$8.89
|
| Rate for Payer: Galaxy Health WC |
$62.90
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Global Benefits Group Commercial |
$44.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$46.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.83
|
| Rate for Payer: Multiplan Commercial |
$59.20
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Networks By Design Commercial |
$48.10
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$62.90
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$44.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.54
|
| Rate for Payer: United Healthcare All Other HMO |
$6.54
|
| Rate for Payer: United Healthcare All Other HMO |
$6.54
|
| Rate for Payer: United Healthcare HMO Rider |
$6.54
|
| Rate for Payer: United Healthcare HMO Rider |
$6.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.08
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
HC POS COMBO 43 PANEL ID
|
Facility
|
IP
|
$74.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900912490
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.80 |
| Max. Negotiated Rate |
$62.90 |
| Rate for Payer: Adventist Health Commercial |
$14.80
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$51.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.60
|
| Rate for Payer: EPIC Health Plan Senior |
$29.60
|
| Rate for Payer: Galaxy Health WC |
$62.90
|
| Rate for Payer: Global Benefits Group Commercial |
$44.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$46.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$43.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.76
|
| Rate for Payer: Multiplan Commercial |
$59.20
|
| Rate for Payer: Networks By Design Commercial |
$48.10
|
| Rate for Payer: Prime Health Services Commercial |
$62.90
|
|
|
HC POSITIONING GEL-E DONUT MED
|
Facility
|
OP
|
$70.93
|
|
| Hospital Charge Code |
901604725
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.19 |
| Max. Negotiated Rate |
$60.29 |
| Rate for Payer: Adventist Health Commercial |
$14.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$46.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$60.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$53.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.52
|
| Rate for Payer: Cash Price |
$31.92
|
| Rate for Payer: Cigna of CA HMO |
$45.40
|
| Rate for Payer: Cigna of CA PPO |
$52.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$60.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$60.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$60.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.37
|
| Rate for Payer: EPIC Health Plan Senior |
$28.37
|
| Rate for Payer: Galaxy Health WC |
$60.29
|
| Rate for Payer: Global Benefits Group Commercial |
$42.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$45.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$49.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.65
|
| Rate for Payer: Multiplan Commercial |
$56.74
|
| Rate for Payer: Networks By Design Commercial |
$46.10
|
| Rate for Payer: Prime Health Services Commercial |
$60.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.47
|
| Rate for Payer: United Healthcare All Other HMO |
$35.47
|
| Rate for Payer: United Healthcare HMO Rider |
$35.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$60.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$60.29
|
| Rate for Payer: Vantage Medical Group Senior |
$60.29
|
|
|
HC POSITIONING GEL-E DONUT MED
|
Facility
|
IP
|
$70.93
|
|
| Hospital Charge Code |
901604725
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.19 |
| Max. Negotiated Rate |
$60.29 |
| Rate for Payer: Adventist Health Commercial |
$14.19
|
| Rate for Payer: Cash Price |
$31.92
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.37
|
| Rate for Payer: EPIC Health Plan Senior |
$28.37
|
| Rate for Payer: Galaxy Health WC |
$60.29
|
| Rate for Payer: Global Benefits Group Commercial |
$42.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$45.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.02
|
| Rate for Payer: Multiplan Commercial |
$56.74
|
| Rate for Payer: Networks By Design Commercial |
$46.10
|
| Rate for Payer: Prime Health Services Commercial |
$60.29
|
|
|
HC POSITIONING GEL-E DONUT SMALL
|
Facility
|
OP
|
$70.93
|
|
| Hospital Charge Code |
901604727
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.19 |
| Max. Negotiated Rate |
$60.29 |
| Rate for Payer: Adventist Health Commercial |
$14.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$46.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$60.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$53.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.52
|
| Rate for Payer: Cash Price |
$31.92
|
| Rate for Payer: Cigna of CA HMO |
$45.40
|
| Rate for Payer: Cigna of CA PPO |
$52.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$60.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$60.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$60.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.37
|
| Rate for Payer: EPIC Health Plan Senior |
$28.37
|
| Rate for Payer: Galaxy Health WC |
$60.29
|
| Rate for Payer: Global Benefits Group Commercial |
$42.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$45.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$49.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.65
|
| Rate for Payer: Multiplan Commercial |
$56.74
|
| Rate for Payer: Networks By Design Commercial |
$46.10
|
| Rate for Payer: Prime Health Services Commercial |
$60.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.47
|
| Rate for Payer: United Healthcare All Other HMO |
$35.47
|
| Rate for Payer: United Healthcare HMO Rider |
$35.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$60.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$60.29
|
| Rate for Payer: Vantage Medical Group Senior |
$60.29
|
|
|
HC POSITIONING GEL-E DONUT SMALL
|
Facility
|
IP
|
$70.93
|
|
| Hospital Charge Code |
901604727
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.19 |
| Max. Negotiated Rate |
$60.29 |
| Rate for Payer: Adventist Health Commercial |
$14.19
|
| Rate for Payer: Cash Price |
$31.92
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.37
|
| Rate for Payer: EPIC Health Plan Senior |
$28.37
|
| Rate for Payer: Galaxy Health WC |
$60.29
|
| Rate for Payer: Global Benefits Group Commercial |
$42.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$45.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.02
|
| Rate for Payer: Multiplan Commercial |
$56.74
|
| Rate for Payer: Networks By Design Commercial |
$46.10
|
| Rate for Payer: Prime Health Services Commercial |
$60.29
|
|
|
HC POSITIONING GEL-E DONUT X-SM
|
Facility
|
IP
|
$63.55
|
|
| Hospital Charge Code |
901698581
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.71 |
| Max. Negotiated Rate |
$54.02 |
| Rate for Payer: Adventist Health Commercial |
$12.71
|
| Rate for Payer: Cash Price |
$28.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$44.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.42
|
| Rate for Payer: EPIC Health Plan Senior |
$25.42
|
| Rate for Payer: Galaxy Health WC |
$54.02
|
| Rate for Payer: Global Benefits Group Commercial |
$38.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$40.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$37.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.25
|
| Rate for Payer: Multiplan Commercial |
$50.84
|
| Rate for Payer: Networks By Design Commercial |
$41.31
|
| Rate for Payer: Prime Health Services Commercial |
$54.02
|
|
|
HC POSITIONING GEL-E DONUT X-SM
|
Facility
|
OP
|
$63.55
|
|
| Hospital Charge Code |
901698581
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.71 |
| Max. Negotiated Rate |
$54.02 |
| Rate for Payer: Adventist Health Commercial |
$12.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$41.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$54.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$47.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.78
|
| Rate for Payer: Cash Price |
$28.60
|
| Rate for Payer: Cigna of CA HMO |
$40.67
|
| Rate for Payer: Cigna of CA PPO |
$47.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$54.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$54.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$54.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$44.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.42
|
| Rate for Payer: EPIC Health Plan Senior |
$25.42
|
| Rate for Payer: Galaxy Health WC |
$54.02
|
| Rate for Payer: Global Benefits Group Commercial |
$38.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$40.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$37.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44.48
|
| Rate for Payer: Multiplan Commercial |
$50.84
|
| Rate for Payer: Networks By Design Commercial |
$41.31
|
| Rate for Payer: Prime Health Services Commercial |
$54.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$38.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$38.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.77
|
| Rate for Payer: United Healthcare All Other HMO |
$31.77
|
| Rate for Payer: United Healthcare HMO Rider |
$31.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$54.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$54.02
|
| Rate for Payer: Vantage Medical Group Senior |
$54.02
|
|
|
HC POST FLUIDIZED ZFLO MED
|
Facility
|
IP
|
$788.49
|
|
| Hospital Charge Code |
901605553
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$157.70 |
| Max. Negotiated Rate |
$670.22 |
| Rate for Payer: Adventist Health Commercial |
$157.70
|
| Rate for Payer: Cash Price |
$354.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$551.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$315.40
|
| Rate for Payer: EPIC Health Plan Senior |
$315.40
|
| Rate for Payer: Galaxy Health WC |
$670.22
|
| Rate for Payer: Global Benefits Group Commercial |
$473.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$500.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$465.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$189.24
|
| Rate for Payer: Multiplan Commercial |
$630.79
|
| Rate for Payer: Networks By Design Commercial |
$512.52
|
| Rate for Payer: Prime Health Services Commercial |
$670.22
|
|
|
HC POST FLUIDIZED ZFLO MED
|
Facility
|
OP
|
$788.49
|
|
| Hospital Charge Code |
901605553
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$157.70 |
| Max. Negotiated Rate |
$670.22 |
| Rate for Payer: Adventist Health Commercial |
$157.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$517.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$670.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$433.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$591.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$505.97
|
| Rate for Payer: Cash Price |
$354.82
|
| Rate for Payer: Cigna of CA HMO |
$504.63
|
| Rate for Payer: Cigna of CA PPO |
$583.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$670.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$670.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$670.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$551.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$315.40
|
| Rate for Payer: EPIC Health Plan Senior |
$315.40
|
| Rate for Payer: Galaxy Health WC |
$670.22
|
| Rate for Payer: Global Benefits Group Commercial |
$473.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$500.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$286.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$465.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$189.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$551.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$551.94
|
| Rate for Payer: Multiplan Commercial |
$630.79
|
| Rate for Payer: Networks By Design Commercial |
$512.52
|
| Rate for Payer: Prime Health Services Commercial |
$670.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$473.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$473.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$394.25
|
| Rate for Payer: United Healthcare All Other HMO |
$394.25
|
| Rate for Payer: United Healthcare HMO Rider |
$394.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$394.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$670.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$670.22
|
| Rate for Payer: Vantage Medical Group Senior |
$670.22
|
|
|
HC POST MASTECTOMY BRA
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
CPT L8000
|
| Hospital Charge Code |
915358000
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$41.04 |
| Max. Negotiated Rate |
$145.35 |
| Rate for Payer: Adventist Health Commercial |
$70.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$145.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$94.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$128.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$103.51
|
| Rate for Payer: Blue Shield of California Commercial |
$86.70
|
| Rate for Payer: Blue Shield of California Commercial |
$131.50
|
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: Cigna of CA HMO |
$119.70
|
| Rate for Payer: Cigna of CA PPO |
$119.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$145.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$145.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$145.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$119.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.40
|
| Rate for Payer: EPIC Health Plan Senior |
$68.40
|
| Rate for Payer: Galaxy Health WC |
$145.35
|
| Rate for Payer: Global Benefits Group Commercial |
$102.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$51.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$108.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$58.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$100.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$119.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$119.70
|
| Rate for Payer: Multiplan Commercial |
$136.80
|
| Rate for Payer: Networks By Design Commercial |
$85.50
|
| Rate for Payer: Prime Health Services Commercial |
$145.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$102.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$102.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$64.18
|
| Rate for Payer: United Healthcare All Other HMO |
$62.47
|
| Rate for Payer: United Healthcare HMO Rider |
$61.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$56.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$145.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$145.35
|
| Rate for Payer: Vantage Medical Group Senior |
$145.35
|
|
|
HC POST MASTECTOMY BRA
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
CPT L8000
|
| Hospital Charge Code |
905358000
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$34.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$34.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: Cigna of CA HMO |
$119.70
|
| Rate for Payer: Cigna of CA PPO |
$119.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$119.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.40
|
| Rate for Payer: EPIC Health Plan Senior |
$68.40
|
| Rate for Payer: Galaxy Health WC |
$145.35
|
| Rate for Payer: Global Benefits Group Commercial |
$102.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$108.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$100.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.04
|
| Rate for Payer: Multiplan Commercial |
$136.80
|
| Rate for Payer: Networks By Design Commercial |
$111.15
|
| Rate for Payer: Prime Health Services Commercial |
$145.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$64.18
|
| Rate for Payer: United Healthcare All Other HMO |
$62.47
|
| Rate for Payer: United Healthcare HMO Rider |
$61.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$56.00
|
|
|
HC POST MASTECTOMY BRA
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
CPT L8000
|
| Hospital Charge Code |
915358000
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$34.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$34.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: Cigna of CA HMO |
$119.70
|
| Rate for Payer: Cigna of CA PPO |
$119.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$119.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.40
|
| Rate for Payer: EPIC Health Plan Senior |
$68.40
|
| Rate for Payer: Galaxy Health WC |
$145.35
|
| Rate for Payer: Global Benefits Group Commercial |
$102.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$108.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$100.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.04
|
| Rate for Payer: Multiplan Commercial |
$136.80
|
| Rate for Payer: Networks By Design Commercial |
$111.15
|
| Rate for Payer: Prime Health Services Commercial |
$145.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$64.18
|
| Rate for Payer: United Healthcare All Other HMO |
$62.47
|
| Rate for Payer: United Healthcare HMO Rider |
$61.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$56.00
|
|
|
HC POST MASTECTOMY BRA
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
CPT L8000
|
| Hospital Charge Code |
905358000
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$41.04 |
| Max. Negotiated Rate |
$145.35 |
| Rate for Payer: Adventist Health Commercial |
$70.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$145.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$94.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$128.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$103.51
|
| Rate for Payer: Blue Shield of California Commercial |
$86.70
|
| Rate for Payer: Blue Shield of California Commercial |
$131.50
|
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: Cigna of CA HMO |
$119.70
|
| Rate for Payer: Cigna of CA PPO |
$119.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$145.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$145.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$145.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$119.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.40
|
| Rate for Payer: EPIC Health Plan Senior |
$68.40
|
| Rate for Payer: Galaxy Health WC |
$145.35
|
| Rate for Payer: Global Benefits Group Commercial |
$102.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$51.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$108.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$58.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$100.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$119.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$119.70
|
| Rate for Payer: Multiplan Commercial |
$136.80
|
| Rate for Payer: Networks By Design Commercial |
$85.50
|
| Rate for Payer: Prime Health Services Commercial |
$145.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$102.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$102.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$64.18
|
| Rate for Payer: United Healthcare All Other HMO |
$62.47
|
| Rate for Payer: United Healthcare HMO Rider |
$61.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$56.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$145.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$145.35
|
| Rate for Payer: Vantage Medical Group Senior |
$145.35
|
|
|
HC POST PARTUM PERINEAL LAC RPR
|
Facility
|
IP
|
$4,834.00
|
|
|
Service Code
|
CPT 56810
|
| Hospital Charge Code |
902400754
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$966.80 |
| Max. Negotiated Rate |
$4,108.90 |
| Rate for Payer: Adventist Health Commercial |
$966.80
|
| Rate for Payer: Cash Price |
$2,175.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,383.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,933.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,933.60
|
| Rate for Payer: Galaxy Health WC |
$4,108.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,900.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,069.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,852.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,160.16
|
| Rate for Payer: Multiplan Commercial |
$3,867.20
|
| Rate for Payer: Networks By Design Commercial |
$3,142.10
|
| Rate for Payer: Prime Health Services Commercial |
$4,108.90
|
|
|
HC POST PARTUM PERINEAL LAC RPR
|
Facility
|
OP
|
$4,834.00
|
|
|
Service Code
|
CPT 56810
|
| Hospital Charge Code |
902400754
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$417.11 |
| Max. Negotiated Rate |
$9,323.00 |
| Rate for Payer: Adventist Health Commercial |
$966.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,822.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,163.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,323.00
|
| Rate for Payer: Cash Price |
$2,175.30
|
| Rate for Payer: Cash Price |
$2,175.30
|
| Rate for Payer: Cash Price |
$2,175.30
|
| Rate for Payer: Cash Price |
$2,175.30
|
| Rate for Payer: Cigna of CA HMO |
$3,093.76
|
| Rate for Payer: Cigna of CA PPO |
$3,577.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,579.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,163.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,383.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,869.74
|
| Rate for Payer: EPIC Health Plan Senior |
$4,579.83
|
| Rate for Payer: Galaxy Health WC |
$4,108.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,900.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,828.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$417.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,163.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,069.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$471.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,828.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,160.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,245.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,579.06
|
| Rate for Payer: Multiplan Commercial |
$3,867.20
|
| Rate for Payer: Networks By Design Commercial |
$3,142.10
|
| Rate for Payer: Prime Health Services Commercial |
$4,108.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,900.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,900.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,091.00
|
| Rate for Payer: United Healthcare All Other HMO |
$839.00
|
| Rate for Payer: United Healthcare HMO Rider |
$635.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$581.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,163.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Vantage Medical Group Senior |
$4,163.48
|
|
|
HC POST TRANSFUSION INVESTIGATION
|
Facility
|
IP
|
$402.00
|
|
|
Service Code
|
CPT 86078
|
| Hospital Charge Code |
900904761
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$80.40 |
| Max. Negotiated Rate |
$341.70 |
| Rate for Payer: Adventist Health Commercial |
$80.40
|
| Rate for Payer: Cash Price |
$180.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$281.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.80
|
| Rate for Payer: EPIC Health Plan Senior |
$160.80
|
| Rate for Payer: Galaxy Health WC |
$341.70
|
| Rate for Payer: Global Benefits Group Commercial |
$241.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$255.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$237.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.48
|
| Rate for Payer: Multiplan Commercial |
$321.60
|
| Rate for Payer: Networks By Design Commercial |
$261.30
|
| Rate for Payer: Prime Health Services Commercial |
$341.70
|
|
|
HC POST TRANSFUSION INVESTIGATION
|
Facility
|
OP
|
$402.00
|
|
|
Service Code
|
CPT 86078
|
| Hospital Charge Code |
900904761
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$73.67 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Adventist Health Commercial |
$80.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$308.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$219.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$246.87
|
| Rate for Payer: Cash Price |
$180.90
|
| Rate for Payer: Cash Price |
$180.90
|
| Rate for Payer: Cash Price |
$180.90
|
| Rate for Payer: Cigna of CA HMO |
$257.28
|
| Rate for Payer: Cigna of CA PPO |
$297.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$328.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$241.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$219.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$281.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.55
|
| Rate for Payer: EPIC Health Plan Senior |
$241.03
|
| Rate for Payer: Galaxy Health WC |
$341.70
|
| Rate for Payer: Global Benefits Group Commercial |
$241.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$359.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$73.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$219.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$255.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$83.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$306.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$276.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$293.62
|
| Rate for Payer: Multiplan Commercial |
$321.60
|
| Rate for Payer: Networks By Design Commercial |
$261.30
|
| Rate for Payer: Prime Health Services Commercial |
$341.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$241.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$241.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$219.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Vantage Medical Group Senior |
$219.12
|
|
|
HC POTASSIUM
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
900910488
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$83.30 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$68.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.20
|
| Rate for Payer: EPIC Health Plan Senior |
$39.20
|
| Rate for Payer: Galaxy Health WC |
$83.30
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$62.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$57.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.52
|
| Rate for Payer: Multiplan Commercial |
$78.40
|
| Rate for Payer: Networks By Design Commercial |
$63.70
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
|
|
HC POTASSIUM
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
900910488
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$47.88 |
| Rate for Payer: Adventist Health Commercial |
$6.80
|
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$38.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$38.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.88
|
| Rate for Payer: Blue Shield of California Commercial |
$45.18
|
| Rate for Payer: Blue Shield of California Commercial |
$15.67
|
| Rate for Payer: Blue Shield of California Commercial |
$68.31
|
| Rate for Payer: Blue Shield of California Commercial |
$23.70
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cigna of CA HMO |
$62.72
|
| Rate for Payer: Cigna of CA HMO |
$21.76
|
| Rate for Payer: Cigna of CA PPO |
$25.16
|
| Rate for Payer: Cigna of CA PPO |
$72.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$68.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.85
|
| Rate for Payer: EPIC Health Plan Senior |
$5.24
|
| Rate for Payer: EPIC Health Plan Senior |
$5.24
|
| Rate for Payer: Galaxy Health WC |
$28.90
|
| Rate for Payer: Galaxy Health WC |
$83.30
|
| Rate for Payer: Global Benefits Group Commercial |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.81
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$62.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.38
|
| Rate for Payer: Multiplan Commercial |
$78.40
|
| Rate for Payer: Multiplan Commercial |
$27.20
|
| Rate for Payer: Networks By Design Commercial |
$63.70
|
| Rate for Payer: Networks By Design Commercial |
$22.10
|
| Rate for Payer: Prime Health Services Commercial |
$28.90
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.85
|
| 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 All Other HMO |
$3.85
|
| Rate for Payer: United Healthcare HMO Rider |
$3.85
|
| Rate for Payer: United Healthcare HMO Rider |
$3.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.85
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.76
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.24
|
| Rate for Payer: Vantage Medical Group Senior |
$4.76
|
| Rate for Payer: Vantage Medical Group Senior |
$4.76
|
|
|
HC POTASSIUM
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
900910266
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$83.30 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$68.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.20
|
| Rate for Payer: EPIC Health Plan Senior |
$39.20
|
| Rate for Payer: Galaxy Health WC |
$83.30
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$62.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$57.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.52
|
| Rate for Payer: Multiplan Commercial |
$78.40
|
| Rate for Payer: Networks By Design Commercial |
$63.70
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
|
|
HC POTASSIUM
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
900910266
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$47.88 |
| Rate for Payer: Adventist Health Commercial |
$6.80
|
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$38.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$38.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.88
|
| Rate for Payer: Blue Shield of California Commercial |
$45.18
|
| Rate for Payer: Blue Shield of California Commercial |
$15.67
|
| Rate for Payer: Blue Shield of California Commercial |
$68.31
|
| Rate for Payer: Blue Shield of California Commercial |
$23.70
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cigna of CA HMO |
$62.72
|
| Rate for Payer: Cigna of CA HMO |
$21.76
|
| Rate for Payer: Cigna of CA PPO |
$25.16
|
| Rate for Payer: Cigna of CA PPO |
$72.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$68.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.85
|
| Rate for Payer: EPIC Health Plan Senior |
$5.24
|
| Rate for Payer: EPIC Health Plan Senior |
$5.24
|
| Rate for Payer: Galaxy Health WC |
$28.90
|
| Rate for Payer: Galaxy Health WC |
$83.30
|
| Rate for Payer: Global Benefits Group Commercial |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.81
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$62.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.38
|
| Rate for Payer: Multiplan Commercial |
$78.40
|
| Rate for Payer: Multiplan Commercial |
$27.20
|
| Rate for Payer: Networks By Design Commercial |
$63.70
|
| Rate for Payer: Networks By Design Commercial |
$22.10
|
| Rate for Payer: Prime Health Services Commercial |
$28.90
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.85
|
| 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 All Other HMO |
$3.85
|
| Rate for Payer: United Healthcare HMO Rider |
$3.85
|
| Rate for Payer: United Healthcare HMO Rider |
$3.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.85
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.76
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.24
|
| Rate for Payer: Vantage Medical Group Senior |
$4.76
|
| Rate for Payer: Vantage Medical Group Senior |
$4.76
|
|
