|
HC TUBE TRACH SHILEY PEDS 3MM
|
Facility
|
IP
|
$206.08
|
|
| Hospital Charge Code |
901601130
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.22 |
| Max. Negotiated Rate |
$185.47 |
| Rate for Payer: Adventist Health Commercial |
$41.22
|
| Rate for Payer: Cash Price |
$92.74
|
| Rate for Payer: Central Health Plan Commercial |
$164.86
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$144.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$82.43
|
| Rate for Payer: EPIC Health Plan Senior |
$82.43
|
| Rate for Payer: Galaxy Health WC |
$175.17
|
| Rate for Payer: Global Benefits Group Commercial |
$123.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$185.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$130.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$121.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.22
|
| Rate for Payer: Multiplan Commercial |
$154.56
|
| Rate for Payer: Networks By Design Commercial |
$133.95
|
| Rate for Payer: Prime Health Services Commercial |
$175.17
|
|
|
HC TUBE TRACH SHILEY PEDS 3MM
|
Facility
|
OP
|
$206.08
|
|
| Hospital Charge Code |
901601130
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.22 |
| Max. Negotiated Rate |
$185.47 |
| Rate for Payer: Adventist Health Commercial |
$41.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$125.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$175.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$113.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$154.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$99.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$119.88
|
| Rate for Payer: Blue Shield of California Commercial |
$130.65
|
| Rate for Payer: Blue Shield of California EPN |
$82.23
|
| Rate for Payer: Cash Price |
$92.74
|
| Rate for Payer: Central Health Plan Commercial |
$164.86
|
| Rate for Payer: Cigna of CA HMO |
$131.89
|
| Rate for Payer: Cigna of CA PPO |
$152.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$175.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$175.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$144.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$82.43
|
| Rate for Payer: EPIC Health Plan Senior |
$82.43
|
| Rate for Payer: Galaxy Health WC |
$175.17
|
| Rate for Payer: Global Benefits Group Commercial |
$123.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$185.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$130.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$74.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$121.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$144.26
|
| Rate for Payer: Multiplan Commercial |
$154.56
|
| Rate for Payer: Networks By Design Commercial |
$133.95
|
| Rate for Payer: Prime Health Services Commercial |
$175.17
|
| Rate for Payer: Riverside University Health System MISP |
$82.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$123.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$123.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$103.04
|
| Rate for Payer: United Healthcare All Other HMO |
$103.04
|
| Rate for Payer: United Healthcare HMO Rider |
$103.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$103.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$175.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.17
|
| Rate for Payer: Vantage Medical Group Senior |
$175.17
|
|
|
HC TUBE TRACH SHILEY PEDS 4.5
|
Facility
|
IP
|
$224.98
|
|
| Hospital Charge Code |
901603785
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$202.48 |
| Rate for Payer: Adventist Health Commercial |
$45.00
|
| Rate for Payer: Cash Price |
$101.24
|
| Rate for Payer: Central Health Plan Commercial |
$179.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$157.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.99
|
| Rate for Payer: EPIC Health Plan Senior |
$89.99
|
| Rate for Payer: Galaxy Health WC |
$191.23
|
| Rate for Payer: Global Benefits Group Commercial |
$134.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$202.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$142.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$132.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.00
|
| Rate for Payer: Multiplan Commercial |
$168.74
|
| Rate for Payer: Networks By Design Commercial |
$146.24
|
| Rate for Payer: Prime Health Services Commercial |
$191.23
|
|
|
HC TUBE TRACH SHILEY PEDS 4.5
|
Facility
|
OP
|
$224.98
|
|
| Hospital Charge Code |
901603785
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$202.48 |
| Rate for Payer: Adventist Health Commercial |
$45.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$136.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$191.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$168.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$108.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.87
|
| Rate for Payer: Blue Shield of California Commercial |
$142.64
|
| Rate for Payer: Blue Shield of California EPN |
$89.77
|
| Rate for Payer: Cash Price |
$101.24
|
| Rate for Payer: Central Health Plan Commercial |
$179.98
|
| Rate for Payer: Cigna of CA HMO |
$143.99
|
| Rate for Payer: Cigna of CA PPO |
$166.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$191.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$191.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$191.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$157.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.99
|
| Rate for Payer: EPIC Health Plan Senior |
$89.99
|
| Rate for Payer: Galaxy Health WC |
$191.23
|
| Rate for Payer: Global Benefits Group Commercial |
$134.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$202.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$142.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$81.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$132.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$157.49
|
| Rate for Payer: Multiplan Commercial |
$168.74
|
| Rate for Payer: Networks By Design Commercial |
$146.24
|
| Rate for Payer: Prime Health Services Commercial |
$191.23
|
| Rate for Payer: Riverside University Health System MISP |
$89.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$134.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$134.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$112.49
|
| Rate for Payer: United Healthcare All Other HMO |
$112.49
|
| Rate for Payer: United Healthcare HMO Rider |
$112.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$112.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$191.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$191.23
|
| Rate for Payer: Vantage Medical Group Senior |
$191.23
|
|
|
HC TUBE TRACH SHILEY PEDS 4.5MM
|
Facility
|
OP
|
$318.43
|
|
| Hospital Charge Code |
901698484
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.69 |
| Max. Negotiated Rate |
$286.59 |
| Rate for Payer: Adventist Health Commercial |
$63.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$193.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$270.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$175.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$238.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$154.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$185.23
|
| Rate for Payer: Blue Shield of California Commercial |
$201.88
|
| Rate for Payer: Blue Shield of California EPN |
$127.05
|
| Rate for Payer: Cash Price |
$143.29
|
| Rate for Payer: Central Health Plan Commercial |
$254.74
|
| Rate for Payer: Cigna of CA HMO |
$203.80
|
| Rate for Payer: Cigna of CA PPO |
$235.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$270.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$270.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$270.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$222.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$127.37
|
| Rate for Payer: EPIC Health Plan Senior |
$127.37
|
| Rate for Payer: Galaxy Health WC |
$270.67
|
| Rate for Payer: Global Benefits Group Commercial |
$191.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$286.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$202.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$115.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$187.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$222.90
|
| Rate for Payer: Multiplan Commercial |
$238.82
|
| Rate for Payer: Networks By Design Commercial |
$206.98
|
| Rate for Payer: Prime Health Services Commercial |
$270.67
|
| Rate for Payer: Riverside University Health System MISP |
$127.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$191.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$191.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$159.22
|
| Rate for Payer: United Healthcare All Other HMO |
$159.22
|
| Rate for Payer: United Healthcare HMO Rider |
$159.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$159.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$270.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$270.67
|
| Rate for Payer: Vantage Medical Group Senior |
$270.67
|
|
|
HC TUBE TRACH SHILEY PEDS 4.5MM
|
Facility
|
IP
|
$318.43
|
|
| Hospital Charge Code |
901698484
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.69 |
| Max. Negotiated Rate |
$286.59 |
| Rate for Payer: Adventist Health Commercial |
$63.69
|
| Rate for Payer: Cash Price |
$143.29
|
| Rate for Payer: Central Health Plan Commercial |
$254.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$222.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$127.37
|
| Rate for Payer: EPIC Health Plan Senior |
$127.37
|
| Rate for Payer: Galaxy Health WC |
$270.67
|
| Rate for Payer: Global Benefits Group Commercial |
$191.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$286.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$202.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$187.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.69
|
| Rate for Payer: Multiplan Commercial |
$238.82
|
| Rate for Payer: Networks By Design Commercial |
$206.98
|
| Rate for Payer: Prime Health Services Commercial |
$270.67
|
|
|
HC TUBE TRACH SHILEY PEDS 4MM
|
Facility
|
OP
|
$224.98
|
|
| Hospital Charge Code |
901601132
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$202.48 |
| Rate for Payer: Adventist Health Commercial |
$45.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$136.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$191.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$168.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$108.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.87
|
| Rate for Payer: Blue Shield of California Commercial |
$142.64
|
| Rate for Payer: Blue Shield of California EPN |
$89.77
|
| Rate for Payer: Cash Price |
$101.24
|
| Rate for Payer: Central Health Plan Commercial |
$179.98
|
| Rate for Payer: Cigna of CA HMO |
$143.99
|
| Rate for Payer: Cigna of CA PPO |
$166.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$191.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$191.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$191.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$157.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.99
|
| Rate for Payer: EPIC Health Plan Senior |
$89.99
|
| Rate for Payer: Galaxy Health WC |
$191.23
|
| Rate for Payer: Global Benefits Group Commercial |
$134.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$202.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$142.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$81.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$132.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$157.49
|
| Rate for Payer: Multiplan Commercial |
$168.74
|
| Rate for Payer: Networks By Design Commercial |
$146.24
|
| Rate for Payer: Prime Health Services Commercial |
$191.23
|
| Rate for Payer: Riverside University Health System MISP |
$89.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$134.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$134.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$112.49
|
| Rate for Payer: United Healthcare All Other HMO |
$112.49
|
| Rate for Payer: United Healthcare HMO Rider |
$112.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$112.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$191.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$191.23
|
| Rate for Payer: Vantage Medical Group Senior |
$191.23
|
|
|
HC TUBE TRACH SHILEY PEDS 4MM
|
Facility
|
IP
|
$224.98
|
|
| Hospital Charge Code |
901601132
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$202.48 |
| Rate for Payer: Adventist Health Commercial |
$45.00
|
| Rate for Payer: Cash Price |
$101.24
|
| Rate for Payer: Central Health Plan Commercial |
$179.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$157.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.99
|
| Rate for Payer: EPIC Health Plan Senior |
$89.99
|
| Rate for Payer: Galaxy Health WC |
$191.23
|
| Rate for Payer: Global Benefits Group Commercial |
$134.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$202.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$142.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$132.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.00
|
| Rate for Payer: Multiplan Commercial |
$168.74
|
| Rate for Payer: Networks By Design Commercial |
$146.24
|
| Rate for Payer: Prime Health Services Commercial |
$191.23
|
|
|
HC TUBE TRACH SHILEY PEDS 5MM
|
Facility
|
OP
|
$224.98
|
|
| Hospital Charge Code |
901603786
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$202.48 |
| Rate for Payer: Adventist Health Commercial |
$45.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$136.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$191.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$168.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$108.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.87
|
| Rate for Payer: Blue Shield of California Commercial |
$142.64
|
| Rate for Payer: Blue Shield of California EPN |
$89.77
|
| Rate for Payer: Cash Price |
$101.24
|
| Rate for Payer: Central Health Plan Commercial |
$179.98
|
| Rate for Payer: Cigna of CA HMO |
$143.99
|
| Rate for Payer: Cigna of CA PPO |
$166.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$191.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$191.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$191.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$157.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.99
|
| Rate for Payer: EPIC Health Plan Senior |
$89.99
|
| Rate for Payer: Galaxy Health WC |
$191.23
|
| Rate for Payer: Global Benefits Group Commercial |
$134.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$202.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$142.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$81.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$132.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$157.49
|
| Rate for Payer: Multiplan Commercial |
$168.74
|
| Rate for Payer: Networks By Design Commercial |
$146.24
|
| Rate for Payer: Prime Health Services Commercial |
$191.23
|
| Rate for Payer: Riverside University Health System MISP |
$89.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$134.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$134.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$112.49
|
| Rate for Payer: United Healthcare All Other HMO |
$112.49
|
| Rate for Payer: United Healthcare HMO Rider |
$112.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$112.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$191.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$191.23
|
| Rate for Payer: Vantage Medical Group Senior |
$191.23
|
|
|
HC TUBE TRACH SHILEY PEDS 5MM
|
Facility
|
IP
|
$224.98
|
|
| Hospital Charge Code |
901603786
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$202.48 |
| Rate for Payer: Adventist Health Commercial |
$45.00
|
| Rate for Payer: Cash Price |
$101.24
|
| Rate for Payer: Central Health Plan Commercial |
$179.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$157.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.99
|
| Rate for Payer: EPIC Health Plan Senior |
$89.99
|
| Rate for Payer: Galaxy Health WC |
$191.23
|
| Rate for Payer: Global Benefits Group Commercial |
$134.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$202.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$142.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$132.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.00
|
| Rate for Payer: Multiplan Commercial |
$168.74
|
| Rate for Payer: Networks By Design Commercial |
$146.24
|
| Rate for Payer: Prime Health Services Commercial |
$191.23
|
|
|
HC TUBE TRANSFER CAPD REG 48"
|
Facility
|
IP
|
$95.91
|
|
| Hospital Charge Code |
901601947
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.18 |
| Max. Negotiated Rate |
$86.32 |
| Rate for Payer: Adventist Health Commercial |
$19.18
|
| Rate for Payer: Cash Price |
$43.16
|
| Rate for Payer: Central Health Plan Commercial |
$76.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$67.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.36
|
| Rate for Payer: EPIC Health Plan Senior |
$38.36
|
| Rate for Payer: Galaxy Health WC |
$81.52
|
| Rate for Payer: Global Benefits Group Commercial |
$57.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$86.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$60.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$56.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.18
|
| Rate for Payer: Multiplan Commercial |
$71.93
|
| Rate for Payer: Networks By Design Commercial |
$62.34
|
| Rate for Payer: Prime Health Services Commercial |
$81.52
|
|
|
HC TUBE TRANSFER CAPD REG 48"
|
Facility
|
OP
|
$95.91
|
|
| Hospital Charge Code |
901601947
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.18 |
| Max. Negotiated Rate |
$86.32 |
| Rate for Payer: Adventist Health Commercial |
$19.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$58.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$81.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$71.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$46.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$55.79
|
| Rate for Payer: Blue Shield of California Commercial |
$60.81
|
| Rate for Payer: Blue Shield of California EPN |
$38.27
|
| Rate for Payer: Cash Price |
$43.16
|
| Rate for Payer: Central Health Plan Commercial |
$76.73
|
| Rate for Payer: Cigna of CA HMO |
$61.38
|
| Rate for Payer: Cigna of CA PPO |
$70.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$81.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$81.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$81.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$67.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.36
|
| Rate for Payer: EPIC Health Plan Senior |
$38.36
|
| Rate for Payer: Galaxy Health WC |
$81.52
|
| Rate for Payer: Global Benefits Group Commercial |
$57.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$86.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$60.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$56.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$67.14
|
| Rate for Payer: Multiplan Commercial |
$71.93
|
| Rate for Payer: Networks By Design Commercial |
$62.34
|
| Rate for Payer: Prime Health Services Commercial |
$81.52
|
| Rate for Payer: Riverside University Health System MISP |
$38.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$47.95
|
| Rate for Payer: United Healthcare All Other HMO |
$47.95
|
| Rate for Payer: United Healthcare HMO Rider |
$47.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$47.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$81.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$81.52
|
| Rate for Payer: Vantage Medical Group Senior |
$81.52
|
|
|
HC TUBE VAC ULTA VERATRAC DUO SET
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901698620
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.12 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$280.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$337.39
|
| Rate for Payer: Blue Shield of California Commercial |
$367.72
|
| Rate for Payer: Blue Shield of California EPN |
$231.42
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Cigna of CA HMO |
$371.20
|
| Rate for Payer: Cigna of CA PPO |
$429.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$493.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$406.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$36.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$368.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$342.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Riverside University Health System MISP |
$232.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$290.00
|
| Rate for Payer: United Healthcare All Other HMO |
$290.00
|
| Rate for Payer: United Healthcare HMO Rider |
$290.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC TUBE VAC ULTA VERATRAC DUO SET
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901698620
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$406.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$368.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$342.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
|
|
HC TUBE YANKAUER SUCTION REG
|
Facility
|
IP
|
$5.99
|
|
|
Service Code
|
CPT A4628
|
| Hospital Charge Code |
901698726
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$5.39 |
| Rate for Payer: Adventist Health Commercial |
$1.20
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Central Health Plan Commercial |
$4.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2.40
|
| Rate for Payer: Galaxy Health WC |
$5.09
|
| Rate for Payer: Global Benefits Group Commercial |
$3.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.20
|
| Rate for Payer: Multiplan Commercial |
$4.49
|
| Rate for Payer: Networks By Design Commercial |
$3.89
|
| Rate for Payer: Prime Health Services Commercial |
$5.09
|
|
|
HC TUBE YANKAUER SUCTION REG
|
Facility
|
OP
|
$5.99
|
|
|
Service Code
|
CPT A4628
|
| Hospital Charge Code |
901698726
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$9.45 |
| Rate for Payer: Adventist Health Commercial |
$1.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.48
|
| Rate for Payer: Blue Shield of California Commercial |
$3.80
|
| Rate for Payer: Blue Shield of California EPN |
$2.39
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Central Health Plan Commercial |
$4.79
|
| Rate for Payer: Cigna of CA HMO |
$3.83
|
| Rate for Payer: Cigna of CA PPO |
$4.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2.40
|
| Rate for Payer: Galaxy Health WC |
$5.09
|
| Rate for Payer: Global Benefits Group Commercial |
$3.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.19
|
| Rate for Payer: Multiplan Commercial |
$4.49
|
| Rate for Payer: Networks By Design Commercial |
$3.89
|
| Rate for Payer: Prime Health Services Commercial |
$5.09
|
| Rate for Payer: Riverside University Health System MISP |
$2.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.09
|
| Rate for Payer: Vantage Medical Group Senior |
$5.09
|
|
|
HC TUMOR LOCAL I-111 ZEVALIN DIAGNOSTIC
|
Facility
|
IP
|
$3,199.00
|
|
|
Service Code
|
CPT 78804
|
| Hospital Charge Code |
909301340
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$639.80 |
| Max. Negotiated Rate |
$2,879.10 |
| Rate for Payer: Adventist Health Commercial |
$639.80
|
| Rate for Payer: Cash Price |
$1,439.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,559.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,239.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,279.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,279.60
|
| Rate for Payer: Galaxy Health WC |
$2,719.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,919.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,879.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,031.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,887.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$639.80
|
| Rate for Payer: Multiplan Commercial |
$2,399.25
|
| Rate for Payer: Networks By Design Commercial |
$2,079.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,719.15
|
|
|
HC TUMOR LOCAL I-111 ZEVALIN DIAGNOSTIC
|
Facility
|
OP
|
$3,199.00
|
|
|
Service Code
|
CPT 78804
|
| Hospital Charge Code |
909301340
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$326.28 |
| Max. Negotiated Rate |
$3,357.21 |
| Rate for Payer: Adventist Health Commercial |
$639.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$698.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,357.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$768.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$698.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$903.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,860.86
|
| Rate for Payer: Blue Shield of California Commercial |
$2,015.37
|
| Rate for Payer: Blue Shield of California EPN |
$1,270.00
|
| Rate for Payer: Cash Price |
$1,439.55
|
| Rate for Payer: Cash Price |
$1,439.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,559.20
|
| Rate for Payer: Cigna of CA HMO |
$2,047.36
|
| Rate for Payer: Cigna of CA PPO |
$2,367.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$768.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$698.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,239.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,152.28
|
| Rate for Payer: EPIC Health Plan Senior |
$768.18
|
| Rate for Payer: Galaxy Health WC |
$2,719.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,919.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,879.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,145.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$326.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$698.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,031.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$360.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$977.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$639.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$935.79
|
| Rate for Payer: Multiplan Commercial |
$2,399.25
|
| Rate for Payer: Networks By Design Commercial |
$2,079.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$698.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,719.15
|
| Rate for Payer: Prime Health Services Medicare |
$740.25
|
| Rate for Payer: Riverside University Health System MISP |
$768.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,919.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,919.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,519.84
|
| Rate for Payer: United Healthcare All Other HMO |
$2,519.84
|
| Rate for Payer: United Healthcare HMO Rider |
$2,519.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,519.84
|
| Rate for Payer: Upland Medical Group Pediatric |
$698.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$768.18
|
| Rate for Payer: Vantage Medical Group Senior |
$698.35
|
|
|
HC TUMOR LOCLIZATN SPECT SNGL DAY
|
Facility
|
IP
|
$3,934.00
|
|
|
Service Code
|
CPT 78803
|
| Hospital Charge Code |
909301254
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$786.80 |
| Max. Negotiated Rate |
$3,540.60 |
| Rate for Payer: Adventist Health Commercial |
$786.80
|
| Rate for Payer: Cash Price |
$1,770.30
|
| Rate for Payer: Central Health Plan Commercial |
$3,147.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,753.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,573.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,573.60
|
| Rate for Payer: Galaxy Health WC |
$3,343.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,360.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,540.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,498.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,321.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$786.80
|
| Rate for Payer: Multiplan Commercial |
$2,950.50
|
| Rate for Payer: Networks By Design Commercial |
$2,557.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,343.90
|
|
|
HC TUMOR LOCLIZATN SPECT SNGL DAY
|
Facility
|
OP
|
$3,934.00
|
|
|
Service Code
|
CPT 78803
|
| Hospital Charge Code |
909301254
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$698.35 |
| Max. Negotiated Rate |
$3,540.60 |
| Rate for Payer: Adventist Health Commercial |
$786.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$698.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,895.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$768.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$698.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,236.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,288.41
|
| Rate for Payer: Blue Shield of California Commercial |
$2,478.42
|
| Rate for Payer: Blue Shield of California EPN |
$1,561.80
|
| Rate for Payer: Cash Price |
$1,770.30
|
| Rate for Payer: Cash Price |
$1,770.30
|
| Rate for Payer: Central Health Plan Commercial |
$3,147.20
|
| Rate for Payer: Cigna of CA HMO |
$2,517.76
|
| Rate for Payer: Cigna of CA PPO |
$2,911.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$768.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$698.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,753.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,152.28
|
| Rate for Payer: EPIC Health Plan Senior |
$768.18
|
| Rate for Payer: Galaxy Health WC |
$3,343.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,360.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,540.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,145.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$698.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,498.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,428.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$977.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$786.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$935.79
|
| Rate for Payer: Multiplan Commercial |
$2,950.50
|
| Rate for Payer: Networks By Design Commercial |
$2,557.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$698.35
|
| Rate for Payer: Prime Health Services Commercial |
$3,343.90
|
| Rate for Payer: Prime Health Services Medicare |
$740.25
|
| Rate for Payer: Riverside University Health System MISP |
$768.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,360.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,360.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,260.70
|
| Rate for Payer: United Healthcare All Other HMO |
$1,260.70
|
| Rate for Payer: United Healthcare HMO Rider |
$1,260.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,260.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$698.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$768.18
|
| Rate for Payer: Vantage Medical Group Senior |
$698.35
|
|
|
HC TURBO TRACKER 2-TIP
|
Facility
|
OP
|
$1,170.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909081811
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$188.37 |
| Max. Negotiated Rate |
$1,053.00 |
| Rate for Payer: Adventist Health Commercial |
$234.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$188.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$994.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$643.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$877.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$566.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$680.59
|
| Rate for Payer: Blue Shield of California Commercial |
$741.78
|
| Rate for Payer: Blue Shield of California EPN |
$466.83
|
| Rate for Payer: Cash Price |
$526.50
|
| Rate for Payer: Cash Price |
$526.50
|
| Rate for Payer: Central Health Plan Commercial |
$936.00
|
| Rate for Payer: Cigna of CA HMO |
$748.80
|
| Rate for Payer: Cigna of CA PPO |
$865.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$994.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$994.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$994.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$819.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$468.00
|
| Rate for Payer: EPIC Health Plan Senior |
$468.00
|
| Rate for Payer: Galaxy Health WC |
$994.50
|
| Rate for Payer: Global Benefits Group Commercial |
$702.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,053.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$742.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$424.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$690.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$819.00
|
| Rate for Payer: Multiplan Commercial |
$877.50
|
| Rate for Payer: Networks By Design Commercial |
$760.50
|
| Rate for Payer: Prime Health Services Commercial |
$994.50
|
| Rate for Payer: Riverside University Health System MISP |
$468.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$702.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$702.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$585.00
|
| Rate for Payer: United Healthcare All Other HMO |
$585.00
|
| Rate for Payer: United Healthcare HMO Rider |
$585.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$585.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$994.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$994.50
|
| Rate for Payer: Vantage Medical Group Senior |
$994.50
|
|
|
HC TURBO TRACKER 2-TIP
|
Facility
|
IP
|
$1,170.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909081811
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$234.00 |
| Max. Negotiated Rate |
$1,053.00 |
| Rate for Payer: Adventist Health Commercial |
$234.00
|
| Rate for Payer: Cash Price |
$526.50
|
| Rate for Payer: Central Health Plan Commercial |
$936.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$819.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$468.00
|
| Rate for Payer: EPIC Health Plan Senior |
$468.00
|
| Rate for Payer: Galaxy Health WC |
$994.50
|
| Rate for Payer: Global Benefits Group Commercial |
$702.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,053.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$742.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$690.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.00
|
| Rate for Payer: Multiplan Commercial |
$877.50
|
| Rate for Payer: Networks By Design Commercial |
$760.50
|
| Rate for Payer: Prime Health Services Commercial |
$994.50
|
|
|
HC TVSWG VARIABLESTIFFNESS(TAD/II
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081230
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.60 |
| Max. Negotiated Rate |
$83.70 |
| Rate for Payer: Adventist Health Commercial |
$18.60
|
| Rate for Payer: Cash Price |
$41.85
|
| Rate for Payer: Central Health Plan Commercial |
$74.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$65.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.20
|
| Rate for Payer: EPIC Health Plan Senior |
$37.20
|
| Rate for Payer: Galaxy Health WC |
$79.05
|
| Rate for Payer: Global Benefits Group Commercial |
$55.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$83.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$59.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$54.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.60
|
| Rate for Payer: Multiplan Commercial |
$69.75
|
| Rate for Payer: Networks By Design Commercial |
$60.45
|
| Rate for Payer: Prime Health Services Commercial |
$79.05
|
|
|
HC TVSWG VARIABLESTIFFNESS(TAD/II
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081230
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.60 |
| Max. Negotiated Rate |
$396.30 |
| Rate for Payer: Adventist Health Commercial |
$18.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$396.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$79.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$51.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$69.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$45.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.10
|
| Rate for Payer: Blue Shield of California Commercial |
$58.96
|
| Rate for Payer: Blue Shield of California EPN |
$37.11
|
| Rate for Payer: Cash Price |
$41.85
|
| Rate for Payer: Cash Price |
$41.85
|
| Rate for Payer: Central Health Plan Commercial |
$74.40
|
| Rate for Payer: Cigna of CA HMO |
$59.52
|
| Rate for Payer: Cigna of CA PPO |
$68.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$79.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$79.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$79.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$65.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.20
|
| Rate for Payer: EPIC Health Plan Senior |
$37.20
|
| Rate for Payer: Galaxy Health WC |
$79.05
|
| Rate for Payer: Global Benefits Group Commercial |
$55.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$83.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$59.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$54.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$65.10
|
| Rate for Payer: Multiplan Commercial |
$69.75
|
| Rate for Payer: Networks By Design Commercial |
$60.45
|
| Rate for Payer: Prime Health Services Commercial |
$79.05
|
| Rate for Payer: Riverside University Health System MISP |
$37.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$55.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$55.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$46.50
|
| Rate for Payer: United Healthcare All Other HMO |
$46.50
|
| Rate for Payer: United Healthcare HMO Rider |
$46.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$46.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$79.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$79.05
|
| Rate for Payer: Vantage Medical Group Senior |
$79.05
|
|
|
HC T-WAVE ALTERNANS
|
Facility
|
OP
|
$2,422.00
|
|
|
Service Code
|
CPT 93025
|
| Hospital Charge Code |
900200153
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$165.49 |
| Max. Negotiated Rate |
$8,136.21 |
| Rate for Payer: Adventist Health Commercial |
$484.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$165.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,001.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,815.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,408.88
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$1,089.90
|
| Rate for Payer: Cash Price |
$1,089.90
|
| Rate for Payer: Cash Price |
$1,089.90
|
| Rate for Payer: Cash Price |
$1,089.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,937.60
|
| Rate for Payer: Cigna of CA HMO |
$1,550.08
|
| Rate for Payer: Cigna of CA PPO |
$1,792.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$248.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$182.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$165.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,695.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.06
|
| Rate for Payer: EPIC Health Plan Senior |
$182.04
|
| Rate for Payer: Galaxy Health WC |
$2,058.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,453.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,179.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$271.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$401.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$165.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,537.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$443.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$231.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$484.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$221.76
|
| Rate for Payer: Multiplan Commercial |
$1,816.50
|
| Rate for Payer: Networks By Design Commercial |
$1,574.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$165.49
|
| Rate for Payer: Prime Health Services Commercial |
$2,058.70
|
| Rate for Payer: Prime Health Services Medicare |
$175.42
|
| Rate for Payer: Riverside University Health System MISP |
$182.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,453.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,453.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$165.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Vantage Medical Group Senior |
$165.49
|
|
