|
HC RHC & LHC W/WO LV
|
Facility
|
IP
|
$15,902.00
|
|
|
Service Code
|
CPT 93453
|
| Hospital Charge Code |
906811400
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,180.40 |
| Max. Negotiated Rate |
$13,516.70 |
| Rate for Payer: Adventist Health Commercial |
$3,180.40
|
| Rate for Payer: Cash Price |
$7,155.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11,131.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,360.80
|
| Rate for Payer: EPIC Health Plan Senior |
$6,360.80
|
| Rate for Payer: Galaxy Health WC |
$13,516.70
|
| Rate for Payer: Global Benefits Group Commercial |
$9,541.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,097.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,382.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,816.48
|
| Rate for Payer: Multiplan Commercial |
$12,721.60
|
| Rate for Payer: Networks By Design Commercial |
$10,336.30
|
| Rate for Payer: Prime Health Services Commercial |
$13,516.70
|
|
|
HC RHC & LHC W/WO LV
|
Facility
|
OP
|
$15,902.00
|
|
|
Service Code
|
CPT 93453
|
| Hospital Charge Code |
906811400
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,677.38 |
| Max. Negotiated Rate |
$26,788.00 |
| Rate for Payer: Adventist Health Commercial |
$3,180.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,254.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,586.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,169.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,261.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,743.74
|
| Rate for Payer: Blue Shield of California Commercial |
$8,695.24
|
| Rate for Payer: Cash Price |
$7,155.90
|
| Rate for Payer: Cash Price |
$7,155.90
|
| Rate for Payer: Cash Price |
$7,155.90
|
| Rate for Payer: Cigna of CA HMO |
$10,336.30
|
| Rate for Payer: Cigna of CA PPO |
$11,767.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,254.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,586.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,169.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11,131.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,879.96
|
| Rate for Payer: EPIC Health Plan Senior |
$4,586.64
|
| Rate for Payer: Galaxy Health WC |
$13,516.70
|
| Rate for Payer: Global Benefits Group Commercial |
$9,541.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,838.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,677.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,169.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,097.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,897.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,837.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,816.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,253.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,587.36
|
| Rate for Payer: Multiplan Commercial |
$12,721.60
|
| Rate for Payer: Networks By Design Commercial |
$10,336.30
|
| Rate for Payer: Prime Health Services Commercial |
$13,516.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,541.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,800.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,951.00
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,169.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,254.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,586.64
|
| Rate for Payer: Vantage Medical Group Senior |
$4,169.67
|
|
|
HC RHEUMATOID FACTOR
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
CPT 86431
|
| Hospital Charge Code |
900910868
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.59 |
| Max. Negotiated Rate |
$144.50 |
| Rate for Payer: Adventist Health Commercial |
$34.00
|
| Rate for Payer: Adventist Health Commercial |
$11.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$47.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$47.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.68
|
| Rate for Payer: Blue Shield of California Commercial |
$26.74
|
| Rate for Payer: Blue Shield of California Commercial |
$118.49
|
| Rate for Payer: Blue Shield of California Commercial |
$40.43
|
| Rate for Payer: Blue Shield of California Commercial |
$78.37
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cigna of CA HMO |
$37.12
|
| Rate for Payer: Cigna of CA HMO |
$108.80
|
| Rate for Payer: Cigna of CA PPO |
$125.80
|
| Rate for Payer: Cigna of CA PPO |
$42.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$119.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$40.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.36
|
| Rate for Payer: EPIC Health Plan Senior |
$6.24
|
| Rate for Payer: EPIC Health Plan Senior |
$6.24
|
| Rate for Payer: Galaxy Health WC |
$144.50
|
| Rate for Payer: Galaxy Health WC |
$49.30
|
| Rate for Payer: Global Benefits Group Commercial |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$34.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$107.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$36.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.60
|
| Rate for Payer: Multiplan Commercial |
$46.40
|
| Rate for Payer: Multiplan Commercial |
$136.00
|
| Rate for Payer: Networks By Design Commercial |
$37.70
|
| Rate for Payer: Networks By Design Commercial |
$110.50
|
| Rate for Payer: Prime Health Services Commercial |
$144.50
|
| Rate for Payer: Prime Health Services Commercial |
$49.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$102.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$102.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$34.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.59
|
| Rate for Payer: United Healthcare All Other HMO |
$4.59
|
| Rate for Payer: United Healthcare All Other HMO |
$4.59
|
| Rate for Payer: United Healthcare HMO Rider |
$4.59
|
| Rate for Payer: United Healthcare HMO Rider |
$4.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.59
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.67
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.24
|
| Rate for Payer: Vantage Medical Group Senior |
$5.67
|
| Rate for Payer: Vantage Medical Group Senior |
$5.67
|
|
|
HC RHEUMATOID FACTOR
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT 86431
|
| Hospital Charge Code |
900910868
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$144.50 |
| Rate for Payer: Adventist Health Commercial |
$34.00
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$119.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.00
|
| Rate for Payer: EPIC Health Plan Senior |
$68.00
|
| Rate for Payer: Galaxy Health WC |
$144.50
|
| Rate for Payer: Global Benefits Group Commercial |
$102.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$107.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$100.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.80
|
| Rate for Payer: Multiplan Commercial |
$136.00
|
| Rate for Payer: Networks By Design Commercial |
$110.50
|
| Rate for Payer: Prime Health Services Commercial |
$144.50
|
|
|
HC RH IMMUNE GLOBULIN
|
Facility
|
IP
|
$217.00
|
|
|
Service Code
|
CPT J2790
|
| Hospital Charge Code |
900904586
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.40 |
| Max. Negotiated Rate |
$184.45 |
| Rate for Payer: Adventist Health Commercial |
$43.40
|
| Rate for Payer: Blue Shield of California Commercial |
$110.02
|
| Rate for Payer: Blue Shield of California Commercial |
$166.87
|
| Rate for Payer: Cash Price |
$97.65
|
| Rate for Payer: Cigna of CA HMO |
$151.90
|
| Rate for Payer: Cigna of CA PPO |
$151.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$151.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.80
|
| Rate for Payer: EPIC Health Plan Senior |
$86.80
|
| Rate for Payer: Galaxy Health WC |
$184.45
|
| Rate for Payer: Global Benefits Group Commercial |
$130.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$137.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$128.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.08
|
| Rate for Payer: Multiplan Commercial |
$173.60
|
| Rate for Payer: Networks By Design Commercial |
$108.50
|
| Rate for Payer: Prime Health Services Commercial |
$184.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$81.44
|
| Rate for Payer: United Healthcare All Other HMO |
$79.27
|
| Rate for Payer: United Healthcare HMO Rider |
$77.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$71.07
|
|
|
HC RH IMMUNE GLOBULIN
|
Facility
|
OP
|
$217.00
|
|
|
Service Code
|
CPT J2790
|
| Hospital Charge Code |
900904586
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.40 |
| Max. Negotiated Rate |
$485.29 |
| Rate for Payer: Adventist Health Commercial |
$43.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$485.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$184.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$119.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$162.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$255.51
|
| Rate for Payer: Blue Shield of California Commercial |
$99.40
|
| Rate for Payer: Cash Price |
$97.65
|
| Rate for Payer: Cash Price |
$97.65
|
| Rate for Payer: Cigna of CA HMO |
$151.90
|
| Rate for Payer: Cigna of CA PPO |
$151.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$184.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$184.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$184.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$151.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.80
|
| Rate for Payer: EPIC Health Plan Senior |
$86.80
|
| Rate for Payer: Galaxy Health WC |
$184.45
|
| Rate for Payer: Global Benefits Group Commercial |
$130.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$85.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$137.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$161.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$128.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$151.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$151.90
|
| Rate for Payer: Multiplan Commercial |
$173.60
|
| Rate for Payer: Networks By Design Commercial |
$108.50
|
| Rate for Payer: Prime Health Services Commercial |
$184.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$130.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$130.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$81.44
|
| Rate for Payer: United Healthcare All Other HMO |
$79.27
|
| Rate for Payer: United Healthcare HMO Rider |
$77.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$71.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$184.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$184.45
|
| Rate for Payer: Vantage Medical Group Senior |
$184.45
|
|
|
HC RH UNIT CONFIRMATION
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
CPT 86901
|
| Hospital Charge Code |
900904621
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$99.45 |
| Rate for Payer: Adventist Health Commercial |
$23.40
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$81.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.80
|
| Rate for Payer: EPIC Health Plan Senior |
$46.80
|
| Rate for Payer: Galaxy Health WC |
$99.45
|
| Rate for Payer: Global Benefits Group Commercial |
$70.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$74.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$69.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.08
|
| Rate for Payer: Multiplan Commercial |
$93.60
|
| Rate for Payer: Networks By Design Commercial |
$76.05
|
| Rate for Payer: Prime Health Services Commercial |
$99.45
|
|
|
HC RH UNIT CONFIRMATION
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
CPT 86901
|
| Hospital Charge Code |
900904621
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Galaxy Health WC |
$99.45
|
| Rate for Payer: Adventist Health Commercial |
$23.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$71.85
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Cigna of CA HMO |
$74.88
|
| Rate for Payer: Cigna of CA PPO |
$86.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$81.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3.29
|
| Rate for Payer: Global Benefits Group Commercial |
$70.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$74.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.01
|
| Rate for Payer: Multiplan Commercial |
$93.60
|
| Rate for Payer: Networks By Design Commercial |
$76.05
|
| Rate for Payer: Prime Health Services Commercial |
$99.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$70.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$70.20
|
| 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 |
$2.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.29
|
| Rate for Payer: Vantage Medical Group Senior |
$2.99
|
|
|
HC RHYTHM ECG TRACING ONLY
|
Facility
|
IP
|
$442.00
|
|
|
Service Code
|
CPT 93041
|
| Hospital Charge Code |
900200102
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$88.40 |
| Max. Negotiated Rate |
$375.70 |
| Rate for Payer: Adventist Health Commercial |
$88.40
|
| Rate for Payer: Cash Price |
$198.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$309.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$176.80
|
| Rate for Payer: EPIC Health Plan Senior |
$176.80
|
| Rate for Payer: Galaxy Health WC |
$375.70
|
| Rate for Payer: Global Benefits Group Commercial |
$265.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$280.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$260.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.08
|
| Rate for Payer: Multiplan Commercial |
$353.60
|
| Rate for Payer: Networks By Design Commercial |
$287.30
|
| Rate for Payer: Prime Health Services Commercial |
$375.70
|
|
|
HC RHYTHM ECG TRACING ONLY
|
Facility
|
OP
|
$442.00
|
|
|
Service Code
|
CPT 93041
|
| Hospital Charge Code |
900200102
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$30.53 |
| Max. Negotiated Rate |
$3,171.00 |
| Rate for Payer: Adventist Health Commercial |
$88.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,601.00
|
| Rate for Payer: Cash Price |
$198.90
|
| Rate for Payer: Cash Price |
$198.90
|
| Rate for Payer: Cash Price |
$198.90
|
| Rate for Payer: Cigna of CA HMO |
$282.88
|
| Rate for Payer: Cigna of CA PPO |
$327.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$309.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.19
|
| Rate for Payer: EPIC Health Plan Senior |
$83.46
|
| Rate for Payer: Galaxy Health WC |
$375.70
|
| Rate for Payer: Global Benefits Group Commercial |
$265.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$124.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$280.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$81.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.67
|
| Rate for Payer: Multiplan Commercial |
$353.60
|
| Rate for Payer: Multiplan WC |
$120.25
|
| Rate for Payer: Networks By Design Commercial |
$287.30
|
| Rate for Payer: Prime Health Services Commercial |
$375.70
|
| Rate for Payer: Prime Health Services WC |
$119.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$265.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$221.00
|
| Rate for Payer: United Healthcare All Other HMO |
$221.00
|
| Rate for Payer: United Healthcare HMO Rider |
$221.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$221.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$75.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Vantage Medical Group Senior |
$75.87
|
|
|
HC RHYTHM ECG TRACING ONLY
|
Facility
|
IP
|
$442.00
|
|
|
Service Code
|
CPT 93041
|
| Hospital Charge Code |
900200102
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$88.40 |
| Max. Negotiated Rate |
$375.70 |
| Rate for Payer: Adventist Health Commercial |
$88.40
|
| Rate for Payer: Cash Price |
$198.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$309.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$176.80
|
| Rate for Payer: EPIC Health Plan Senior |
$176.80
|
| Rate for Payer: Galaxy Health WC |
$375.70
|
| Rate for Payer: Global Benefits Group Commercial |
$265.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$280.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$260.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.08
|
| Rate for Payer: Multiplan Commercial |
$353.60
|
| Rate for Payer: Networks By Design Commercial |
$287.30
|
| Rate for Payer: Prime Health Services Commercial |
$375.70
|
|
|
HC RHYTHM ECG TRACING ONLY
|
Facility
|
OP
|
$442.00
|
|
|
Service Code
|
CPT 93041
|
| Hospital Charge Code |
900200102
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$30.53 |
| Max. Negotiated Rate |
$2,601.00 |
| Rate for Payer: Adventist Health Commercial |
$181.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$41.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,601.00
|
| Rate for Payer: Cash Price |
$198.90
|
| Rate for Payer: Cash Price |
$198.90
|
| Rate for Payer: Cash Price |
$198.90
|
| Rate for Payer: Cigna of CA HMO |
$282.88
|
| Rate for Payer: Cigna of CA PPO |
$327.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$309.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.19
|
| Rate for Payer: EPIC Health Plan Senior |
$83.46
|
| Rate for Payer: Galaxy Health WC |
$375.70
|
| Rate for Payer: Global Benefits Group Commercial |
$265.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$124.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$280.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$81.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.67
|
| Rate for Payer: Multiplan Commercial |
$353.60
|
| Rate for Payer: Multiplan WC |
$120.25
|
| Rate for Payer: Networks By Design Commercial |
$287.30
|
| Rate for Payer: Prime Health Services Commercial |
$375.70
|
| Rate for Payer: Prime Health Services WC |
$119.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$265.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$265.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$75.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Vantage Medical Group Senior |
$75.87
|
|
|
HC RIB BELT CUSTOM FABRICATED
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
CPT L0220
|
| Hospital Charge Code |
905350220
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$57.93 |
| Max. Negotiated Rate |
$212.50 |
| Rate for Payer: Adventist Health Commercial |
$102.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$212.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$137.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$187.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$151.32
|
| Rate for Payer: Blue Shield of California Commercial |
$192.25
|
| Rate for Payer: Blue Shield of California Commercial |
$126.75
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna of CA HMO |
$175.00
|
| Rate for Payer: Cigna of CA PPO |
$175.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$212.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$212.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$212.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$175.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.00
|
| Rate for Payer: EPIC Health Plan Senior |
$100.00
|
| Rate for Payer: Galaxy Health WC |
$212.50
|
| Rate for Payer: Global Benefits Group Commercial |
$150.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$57.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$158.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$65.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$147.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$175.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$175.00
|
| Rate for Payer: Multiplan Commercial |
$200.00
|
| Rate for Payer: Networks By Design Commercial |
$125.00
|
| Rate for Payer: Prime Health Services Commercial |
$212.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$150.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$150.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$93.83
|
| Rate for Payer: United Healthcare All Other HMO |
$91.33
|
| Rate for Payer: United Healthcare HMO Rider |
$89.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$212.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$212.50
|
| Rate for Payer: Vantage Medical Group Senior |
$212.50
|
|
|
HC RIB BELT CUSTOM FABRICATED
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
CPT L0220
|
| Hospital Charge Code |
915350220
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$57.93 |
| Max. Negotiated Rate |
$212.50 |
| Rate for Payer: Adventist Health Commercial |
$102.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$212.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$137.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$187.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$151.32
|
| Rate for Payer: Blue Shield of California Commercial |
$192.25
|
| Rate for Payer: Blue Shield of California Commercial |
$126.75
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna of CA HMO |
$175.00
|
| Rate for Payer: Cigna of CA PPO |
$175.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$212.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$212.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$212.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$175.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.00
|
| Rate for Payer: EPIC Health Plan Senior |
$100.00
|
| Rate for Payer: Galaxy Health WC |
$212.50
|
| Rate for Payer: Global Benefits Group Commercial |
$150.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$57.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$158.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$65.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$147.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$175.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$175.00
|
| Rate for Payer: Multiplan Commercial |
$200.00
|
| Rate for Payer: Networks By Design Commercial |
$125.00
|
| Rate for Payer: Prime Health Services Commercial |
$212.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$150.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$150.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$93.83
|
| Rate for Payer: United Healthcare All Other HMO |
$91.33
|
| Rate for Payer: United Healthcare HMO Rider |
$89.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$212.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$212.50
|
| Rate for Payer: Vantage Medical Group Senior |
$212.50
|
|
|
HC RIB BELT CUSTOM FABRICATED
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
CPT L0220
|
| Hospital Charge Code |
905350220
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$50.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna of CA HMO |
$175.00
|
| Rate for Payer: Cigna of CA PPO |
$175.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$175.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.00
|
| Rate for Payer: EPIC Health Plan Senior |
$100.00
|
| Rate for Payer: Galaxy Health WC |
$212.50
|
| Rate for Payer: Global Benefits Group Commercial |
$150.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$158.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$147.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Multiplan Commercial |
$200.00
|
| Rate for Payer: Networks By Design Commercial |
$162.50
|
| Rate for Payer: Prime Health Services Commercial |
$212.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$93.83
|
| Rate for Payer: United Healthcare All Other HMO |
$91.33
|
| Rate for Payer: United Healthcare HMO Rider |
$89.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.88
|
|
|
HC RIB BELT CUSTOM FABRICATED
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
CPT L0220
|
| Hospital Charge Code |
915350220
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$50.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna of CA HMO |
$175.00
|
| Rate for Payer: Cigna of CA PPO |
$175.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$175.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.00
|
| Rate for Payer: EPIC Health Plan Senior |
$100.00
|
| Rate for Payer: Galaxy Health WC |
$212.50
|
| Rate for Payer: Global Benefits Group Commercial |
$150.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$158.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$147.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Multiplan Commercial |
$200.00
|
| Rate for Payer: Networks By Design Commercial |
$162.50
|
| Rate for Payer: Prime Health Services Commercial |
$212.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$93.83
|
| Rate for Payer: United Healthcare All Other HMO |
$91.33
|
| Rate for Payer: United Healthcare HMO Rider |
$89.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.88
|
|
|
HC RIB BELT CUSTOM FITTED
|
Facility
|
IP
|
$156.00
|
|
| Hospital Charge Code |
905350210
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$31.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna of CA HMO |
$109.20
|
| Rate for Payer: Cigna of CA PPO |
$109.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$109.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.40
|
| Rate for Payer: EPIC Health Plan Senior |
$62.40
|
| Rate for Payer: Galaxy Health WC |
$132.60
|
| Rate for Payer: Global Benefits Group Commercial |
$93.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$99.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$92.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.44
|
| Rate for Payer: Multiplan Commercial |
$124.80
|
| Rate for Payer: Networks By Design Commercial |
$101.40
|
| Rate for Payer: Prime Health Services Commercial |
$132.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$58.55
|
| Rate for Payer: United Healthcare All Other HMO |
$56.99
|
| Rate for Payer: United Healthcare HMO Rider |
$55.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$51.09
|
|
|
HC RIB BELT CUSTOM FITTED
|
Facility
|
OP
|
$156.00
|
|
| Hospital Charge Code |
905350210
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$37.44 |
| Max. Negotiated Rate |
$132.60 |
| Rate for Payer: Adventist Health Commercial |
$63.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$132.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$85.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$117.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$94.43
|
| Rate for Payer: Blue Shield of California Commercial |
$119.96
|
| Rate for Payer: Blue Shield of California Commercial |
$79.09
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna of CA HMO |
$109.20
|
| Rate for Payer: Cigna of CA PPO |
$109.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$132.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$132.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$132.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$109.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.40
|
| Rate for Payer: EPIC Health Plan Senior |
$62.40
|
| Rate for Payer: Galaxy Health WC |
$132.60
|
| Rate for Payer: Global Benefits Group Commercial |
$93.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$99.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$56.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$92.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$109.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$109.20
|
| Rate for Payer: Multiplan Commercial |
$124.80
|
| Rate for Payer: Networks By Design Commercial |
$78.00
|
| Rate for Payer: Prime Health Services Commercial |
$132.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$93.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$93.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$58.55
|
| Rate for Payer: United Healthcare All Other HMO |
$56.99
|
| Rate for Payer: United Healthcare HMO Rider |
$55.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$51.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$132.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$132.60
|
| Rate for Payer: Vantage Medical Group Senior |
$132.60
|
|
|
HC RIBOPIGG
|
Facility
|
IP
|
$22.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913708
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$18.70 |
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.80
|
| Rate for Payer: EPIC Health Plan Senior |
$8.80
|
| Rate for Payer: Galaxy Health WC |
$18.70
|
| Rate for Payer: Global Benefits Group Commercial |
$13.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.28
|
| Rate for Payer: Multiplan Commercial |
$17.60
|
| Rate for Payer: Networks By Design Commercial |
$14.30
|
| Rate for Payer: Prime Health Services Commercial |
$18.70
|
|
|
HC RIBOPIGG
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913708
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$157.18 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$136.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$136.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.18
|
| Rate for Payer: Blue Shield of California Commercial |
$10.14
|
| Rate for Payer: Blue Shield of California Commercial |
$12.55
|
| Rate for Payer: Blue Shield of California Commercial |
$15.33
|
| Rate for Payer: Blue Shield of California Commercial |
$8.30
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna of CA HMO |
$14.08
|
| Rate for Payer: Cigna of CA HMO |
$11.52
|
| Rate for Payer: Cigna of CA PPO |
$13.32
|
| Rate for Payer: Cigna of CA PPO |
$16.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.58
|
| Rate for Payer: EPIC Health Plan Senior |
$19.72
|
| Rate for Payer: EPIC Health Plan Senior |
$19.72
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Galaxy Health WC |
$18.70
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Global Benefits Group Commercial |
$13.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.41
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.03
|
| Rate for Payer: Multiplan Commercial |
$17.60
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Networks By Design Commercial |
$14.30
|
| Rate for Payer: Networks By Design Commercial |
$11.70
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: Prime Health Services Commercial |
$18.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.53
|
| Rate for Payer: United Healthcare All Other HMO |
$14.53
|
| Rate for Payer: United Healthcare All Other HMO |
$14.53
|
| Rate for Payer: United Healthcare HMO Rider |
$14.53
|
| Rate for Payer: United Healthcare HMO Rider |
$14.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.93
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC RIBS BILATERAL
|
Facility
|
IP
|
$1,110.00
|
|
|
Service Code
|
CPT 71110
|
| Hospital Charge Code |
909001425
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$222.00 |
| Max. Negotiated Rate |
$943.50 |
| Rate for Payer: Adventist Health Commercial |
$222.00
|
| Rate for Payer: Cash Price |
$499.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$777.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$444.00
|
| Rate for Payer: EPIC Health Plan Senior |
$444.00
|
| Rate for Payer: Galaxy Health WC |
$943.50
|
| Rate for Payer: Global Benefits Group Commercial |
$666.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$704.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$654.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$266.40
|
| Rate for Payer: Multiplan Commercial |
$888.00
|
| Rate for Payer: Networks By Design Commercial |
$721.50
|
| Rate for Payer: Prime Health Services Commercial |
$943.50
|
|
|
HC RIBS BILATERAL
|
Facility
|
OP
|
$1,110.00
|
|
|
Service Code
|
CPT 71110
|
| Hospital Charge Code |
909001425
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$55.96 |
| Max. Negotiated Rate |
$943.50 |
| Rate for Payer: Adventist Health Commercial |
$222.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$199.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$233.27
|
| Rate for Payer: Blue Shield of California Commercial |
$467.31
|
| Rate for Payer: Blue Shield of California Commercial |
$708.18
|
| Rate for Payer: Cash Price |
$499.50
|
| Rate for Payer: Cash Price |
$499.50
|
| Rate for Payer: Cigna of CA HMO |
$710.40
|
| Rate for Payer: Cigna of CA PPO |
$821.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$777.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$943.50
|
| Rate for Payer: Global Benefits Group Commercial |
$666.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$55.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$704.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$63.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$266.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$169.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$888.00
|
| Rate for Payer: Networks By Design Commercial |
$721.50
|
| Rate for Payer: Prime Health Services Commercial |
$943.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$666.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$666.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC RIBS UNILATERAL
|
Facility
|
IP
|
$872.00
|
|
|
Service Code
|
CPT 71100
|
| Hospital Charge Code |
909001376
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$174.40 |
| Max. Negotiated Rate |
$741.20 |
| Rate for Payer: Adventist Health Commercial |
$174.40
|
| Rate for Payer: Cash Price |
$392.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$610.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$348.80
|
| Rate for Payer: EPIC Health Plan Senior |
$348.80
|
| Rate for Payer: Galaxy Health WC |
$741.20
|
| Rate for Payer: Global Benefits Group Commercial |
$523.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$553.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$514.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$209.28
|
| Rate for Payer: Multiplan Commercial |
$697.60
|
| Rate for Payer: Networks By Design Commercial |
$566.80
|
| Rate for Payer: Prime Health Services Commercial |
$741.20
|
|
|
HC RIBS UNILATERAL
|
Facility
|
OP
|
$872.00
|
|
|
Service Code
|
CPT 71100
|
| Hospital Charge Code |
909001376
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.63 |
| Max. Negotiated Rate |
$741.20 |
| Rate for Payer: Adventist Health Commercial |
$174.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$155.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$169.28
|
| Rate for Payer: Blue Shield of California Commercial |
$367.11
|
| Rate for Payer: Blue Shield of California Commercial |
$556.34
|
| Rate for Payer: Cash Price |
$392.40
|
| Rate for Payer: Cash Price |
$392.40
|
| Rate for Payer: Cigna of CA HMO |
$558.08
|
| Rate for Payer: Cigna of CA PPO |
$645.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$610.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| Rate for Payer: Galaxy Health WC |
$741.20
|
| Rate for Payer: Global Benefits Group Commercial |
$523.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$45.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$553.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$51.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$209.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$141.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$697.60
|
| Rate for Payer: Networks By Design Commercial |
$566.80
|
| Rate for Payer: Prime Health Services Commercial |
$741.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$523.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$523.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
HC RIGHT HEART CATH
|
Facility
|
IP
|
$14,533.00
|
|
|
Service Code
|
CPT 93451
|
| Hospital Charge Code |
906811398
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,906.60 |
| Max. Negotiated Rate |
$12,353.05 |
| Rate for Payer: Adventist Health Commercial |
$2,906.60
|
| Rate for Payer: Cash Price |
$6,539.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,173.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,813.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5,813.20
|
| Rate for Payer: Galaxy Health WC |
$12,353.05
|
| Rate for Payer: Global Benefits Group Commercial |
$8,719.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,228.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,574.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,487.92
|
| Rate for Payer: Multiplan Commercial |
$11,626.40
|
| Rate for Payer: Networks By Design Commercial |
$9,446.45
|
| Rate for Payer: Prime Health Services Commercial |
$12,353.05
|
|
