|
HC XRAY SKULL RADIOGRAPH LTD
|
Facility
|
IP
|
$1,173.00
|
|
|
Service Code
|
CPT 70250
|
| Hospital Charge Code |
908801144
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$234.60 |
| Max. Negotiated Rate |
$1,055.70 |
| Rate for Payer: Adventist Health Commercial |
$234.60
|
| Rate for Payer: Cash Price |
$527.85
|
| Rate for Payer: Central Health Plan Commercial |
$938.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$821.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$469.20
|
| Rate for Payer: EPIC Health Plan Senior |
$469.20
|
| Rate for Payer: Galaxy Health WC |
$997.05
|
| Rate for Payer: Global Benefits Group Commercial |
$703.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,055.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$744.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$692.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.60
|
| Rate for Payer: Multiplan Commercial |
$879.75
|
| Rate for Payer: Networks By Design Commercial |
$762.45
|
| Rate for Payer: Prime Health Services Commercial |
$997.05
|
|
|
HC XR RIBS UNI & PA CHEST
|
Facility
|
IP
|
$1,190.00
|
|
|
Service Code
|
CPT 71101
|
| Hospital Charge Code |
950463101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$238.00 |
| Max. Negotiated Rate |
$1,071.00 |
| Rate for Payer: Adventist Health Commercial |
$238.00
|
| Rate for Payer: Cash Price |
$535.50
|
| Rate for Payer: Central Health Plan Commercial |
$952.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$833.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$476.00
|
| Rate for Payer: EPIC Health Plan Senior |
$476.00
|
| Rate for Payer: Galaxy Health WC |
$1,011.50
|
| Rate for Payer: Global Benefits Group Commercial |
$714.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,071.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$755.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$702.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$238.00
|
| Rate for Payer: Multiplan Commercial |
$892.50
|
| Rate for Payer: Networks By Design Commercial |
$773.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,011.50
|
|
|
HC XR RIBS UNI & PA CHEST
|
Facility
|
OP
|
$1,190.00
|
|
|
Service Code
|
CPT 71101
|
| Hospital Charge Code |
950463101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$55.59 |
| Max. Negotiated Rate |
$1,071.00 |
| Rate for Payer: Adventist Health Commercial |
$238.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$134.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$167.75
|
| 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 Exchange |
$140.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$194.81
|
| Rate for Payer: Blue Shield of California Commercial |
$749.70
|
| Rate for Payer: Blue Shield of California EPN |
$472.43
|
| Rate for Payer: Cash Price |
$535.50
|
| Rate for Payer: Cash Price |
$535.50
|
| Rate for Payer: Central Health Plan Commercial |
$952.00
|
| Rate for Payer: Cigna of CA HMO |
$761.60
|
| Rate for Payer: Cigna of CA PPO |
$880.60
|
| 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 |
$833.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$1,011.50
|
| Rate for Payer: Global Benefits Group Commercial |
$714.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,071.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$55.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$755.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$61.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$238.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$892.50
|
| Rate for Payer: Networks By Design Commercial |
$773.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$134.46
|
| Rate for Payer: Prime Health Services Commercial |
$1,011.50
|
| Rate for Payer: Prime Health Services Medicare |
$142.53
|
| Rate for Payer: Riverside University Health System MISP |
$147.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$714.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$714.00
|
| 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 XR RIBS W PA CXR
|
Facility
|
IP
|
$1,514.00
|
|
|
Service Code
|
CPT 71111
|
| Hospital Charge Code |
950463102
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$302.80 |
| Max. Negotiated Rate |
$1,362.60 |
| Rate for Payer: Adventist Health Commercial |
$302.80
|
| Rate for Payer: Cash Price |
$681.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,211.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,059.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$605.60
|
| Rate for Payer: EPIC Health Plan Senior |
$605.60
|
| Rate for Payer: Galaxy Health WC |
$1,286.90
|
| Rate for Payer: Global Benefits Group Commercial |
$908.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,362.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$961.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$893.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$302.80
|
| Rate for Payer: Multiplan Commercial |
$1,135.50
|
| Rate for Payer: Networks By Design Commercial |
$984.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,286.90
|
|
|
HC XR RIBS W PA CXR
|
Facility
|
OP
|
$1,514.00
|
|
|
Service Code
|
CPT 71111
|
| Hospital Charge Code |
950463102
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$72.93 |
| Max. Negotiated Rate |
$1,362.60 |
| Rate for Payer: Adventist Health Commercial |
$302.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$134.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$236.90
|
| 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 Exchange |
$186.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$259.08
|
| Rate for Payer: Blue Shield of California Commercial |
$953.82
|
| Rate for Payer: Blue Shield of California EPN |
$601.06
|
| Rate for Payer: Cash Price |
$681.30
|
| Rate for Payer: Cash Price |
$681.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,211.20
|
| Rate for Payer: Cigna of CA HMO |
$968.96
|
| Rate for Payer: Cigna of CA PPO |
$1,120.36
|
| 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 |
$1,059.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$1,286.90
|
| Rate for Payer: Global Benefits Group Commercial |
$908.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,362.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$72.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$961.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$80.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$302.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$1,135.50
|
| Rate for Payer: Networks By Design Commercial |
$984.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$134.46
|
| Rate for Payer: Prime Health Services Commercial |
$1,286.90
|
| Rate for Payer: Prime Health Services Medicare |
$142.53
|
| Rate for Payer: Riverside University Health System MISP |
$147.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$908.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$908.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$193.23
|
| Rate for Payer: United Healthcare All Other HMO |
$193.23
|
| Rate for Payer: United Healthcare HMO Rider |
$193.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$193.23
|
| 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 XR TEMP MANDIBULAR BILAT
|
Facility
|
OP
|
$1,137.00
|
|
|
Service Code
|
CPT 70330
|
| Hospital Charge Code |
909020170
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$65.51 |
| Max. Negotiated Rate |
$1,023.30 |
| Rate for Payer: Adventist Health Commercial |
$227.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$230.46
|
| 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 Exchange |
$173.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$241.79
|
| Rate for Payer: Blue Shield of California Commercial |
$716.31
|
| Rate for Payer: Blue Shield of California EPN |
$451.39
|
| Rate for Payer: Cash Price |
$511.65
|
| Rate for Payer: Cash Price |
$511.65
|
| Rate for Payer: Central Health Plan Commercial |
$909.60
|
| Rate for Payer: Cigna of CA HMO |
$727.68
|
| Rate for Payer: Cigna of CA PPO |
$841.38
|
| 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 |
$795.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| Rate for Payer: Galaxy Health WC |
$966.45
|
| Rate for Payer: Global Benefits Group Commercial |
$682.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,023.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$65.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$722.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$72.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$227.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$852.75
|
| Rate for Payer: Networks By Design Commercial |
$739.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.93
|
| Rate for Payer: Prime Health Services Commercial |
$966.45
|
| Rate for Payer: Prime Health Services Medicare |
$118.65
|
| Rate for Payer: Riverside University Health System MISP |
$123.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$682.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$682.20
|
| 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 XR TEMP MANDIBULAR BILAT
|
Facility
|
IP
|
$1,137.00
|
|
|
Service Code
|
CPT 70330
|
| Hospital Charge Code |
909020170
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$227.40 |
| Max. Negotiated Rate |
$1,023.30 |
| Rate for Payer: Adventist Health Commercial |
$227.40
|
| Rate for Payer: Cash Price |
$511.65
|
| Rate for Payer: Central Health Plan Commercial |
$909.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$795.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$454.80
|
| Rate for Payer: EPIC Health Plan Senior |
$454.80
|
| Rate for Payer: Galaxy Health WC |
$966.45
|
| Rate for Payer: Global Benefits Group Commercial |
$682.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,023.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$722.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$670.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$227.40
|
| Rate for Payer: Multiplan Commercial |
$852.75
|
| Rate for Payer: Networks By Design Commercial |
$739.05
|
| Rate for Payer: Prime Health Services Commercial |
$966.45
|
|
|
HC X STNT NUMED CP
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906881017
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.55
|
| Rate for Payer: Blue Shield of California Commercial |
$0.80
|
| Rate for Payer: Blue Shield of California EPN |
$0.50
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Central Health Plan Commercial |
$0.80
|
| Rate for Payer: Cigna of CA HMO |
$0.70
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: EPIC Health Plan Senior |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.85
|
| Rate for Payer: Global Benefits Group Commercial |
$0.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.70
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
| Rate for Payer: Networks By Design Commercial |
$0.50
|
| Rate for Payer: Prime Health Services Commercial |
$0.85
|
| Rate for Payer: Riverside University Health System MISP |
$0.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.38
|
| Rate for Payer: United Healthcare All Other HMO |
$0.37
|
| Rate for Payer: United Healthcare HMO Rider |
$0.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.85
|
| Rate for Payer: Vantage Medical Group Senior |
$0.85
|
|
|
HC X STNT NUMED CP
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906881017
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California Commercial |
$0.80
|
| Rate for Payer: Blue Shield of California EPN |
$0.50
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Central Health Plan Commercial |
$0.80
|
| Rate for Payer: Cigna of CA HMO |
$0.70
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: EPIC Health Plan Senior |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.85
|
| Rate for Payer: Global Benefits Group Commercial |
$0.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
| Rate for Payer: Networks By Design Commercial |
$0.50
|
| Rate for Payer: Prime Health Services Commercial |
$0.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.38
|
| Rate for Payer: United Healthcare All Other HMO |
$0.37
|
| Rate for Payer: United Healthcare HMO Rider |
$0.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.33
|
|
|
HC XYLOSE TOLERANCE BLD
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
CPT 84620
|
| Hospital Charge Code |
900910321
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.46 |
| Max. Negotiated Rate |
$211.50 |
| Rate for Payer: Adventist Health Commercial |
$47.00
|
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.91
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$86.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$86.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$86.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$86.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$119.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$119.77
|
| Rate for Payer: Blue Shield of California Commercial |
$34.65
|
| Rate for Payer: Blue Shield of California Commercial |
$148.05
|
| Rate for Payer: Blue Shield of California EPN |
$21.84
|
| Rate for Payer: Blue Shield of California EPN |
$93.30
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Cash Price |
$105.75
|
| Rate for Payer: Cash Price |
$105.75
|
| Rate for Payer: Central Health Plan Commercial |
$188.00
|
| Rate for Payer: Central Health Plan Commercial |
$44.00
|
| Rate for Payer: Cigna of CA HMO |
$35.20
|
| Rate for Payer: Cigna of CA HMO |
$150.40
|
| Rate for Payer: Cigna of CA PPO |
$40.70
|
| Rate for Payer: Cigna of CA PPO |
$173.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.91
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$164.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$38.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.30
|
| Rate for Payer: EPIC Health Plan Senior |
$14.20
|
| Rate for Payer: EPIC Health Plan Senior |
$14.20
|
| Rate for Payer: Galaxy Health WC |
$46.75
|
| Rate for Payer: Galaxy Health WC |
$199.75
|
| Rate for Payer: Global Benefits Group Commercial |
$33.00
|
| Rate for Payer: Global Benefits Group Commercial |
$141.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$49.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$211.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.17
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$149.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.30
|
| Rate for Payer: Multiplan Commercial |
$41.25
|
| Rate for Payer: Multiplan Commercial |
$176.25
|
| Rate for Payer: Networks By Design Commercial |
$152.75
|
| Rate for Payer: Networks By Design Commercial |
$35.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.91
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.91
|
| Rate for Payer: Prime Health Services Commercial |
$46.75
|
| Rate for Payer: Prime Health Services Commercial |
$199.75
|
| Rate for Payer: Prime Health Services Medicare |
$13.68
|
| Rate for Payer: Prime Health Services Medicare |
$13.68
|
| Rate for Payer: Riverside University Health System MISP |
$14.20
|
| Rate for Payer: Riverside University Health System MISP |
$14.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$141.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$141.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.46
|
| Rate for Payer: United Healthcare All Other HMO |
$10.46
|
| Rate for Payer: United Healthcare All Other HMO |
$10.46
|
| Rate for Payer: United Healthcare HMO Rider |
$10.46
|
| Rate for Payer: United Healthcare HMO Rider |
$10.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.91
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.20
|
| Rate for Payer: Vantage Medical Group Senior |
$12.91
|
| Rate for Payer: Vantage Medical Group Senior |
$12.91
|
|
|
HC XYLOSE TOLERANCE BLD
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
CPT 84620
|
| Hospital Charge Code |
900910321
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.00 |
| Max. Negotiated Rate |
$211.50 |
| Rate for Payer: Adventist Health Commercial |
$47.00
|
| Rate for Payer: Cash Price |
$105.75
|
| Rate for Payer: Central Health Plan Commercial |
$188.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$164.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.00
|
| Rate for Payer: EPIC Health Plan Senior |
$94.00
|
| Rate for Payer: Galaxy Health WC |
$199.75
|
| Rate for Payer: Global Benefits Group Commercial |
$141.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$211.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$149.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$138.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.00
|
| Rate for Payer: Multiplan Commercial |
$176.25
|
| Rate for Payer: Networks By Design Commercial |
$152.75
|
| Rate for Payer: Prime Health Services Commercial |
$199.75
|
|
|
HC Y90 MICROSPHERES
|
Facility
|
IP
|
$28,943.00
|
|
|
Service Code
|
CPT C2616
|
| Hospital Charge Code |
909301347
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,788.60 |
| Max. Negotiated Rate |
$26,048.70 |
| Rate for Payer: Adventist Health Commercial |
$5,788.60
|
| Rate for Payer: Blue Shield of California Commercial |
$23,212.29
|
| Rate for Payer: Blue Shield of California EPN |
$14,587.27
|
| Rate for Payer: Cash Price |
$13,024.35
|
| Rate for Payer: Central Health Plan Commercial |
$23,154.40
|
| Rate for Payer: Cigna of CA HMO |
$20,260.10
|
| Rate for Payer: Cigna of CA PPO |
$20,260.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20,260.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,577.20
|
| Rate for Payer: EPIC Health Plan Senior |
$11,577.20
|
| Rate for Payer: Galaxy Health WC |
$24,601.55
|
| Rate for Payer: Global Benefits Group Commercial |
$17,365.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$26,048.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18,378.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17,076.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,788.60
|
| Rate for Payer: Multiplan Commercial |
$21,707.25
|
| Rate for Payer: Networks By Design Commercial |
$14,471.50
|
| Rate for Payer: Prime Health Services Commercial |
$24,601.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,862.31
|
| Rate for Payer: United Healthcare All Other HMO |
$10,572.88
|
| Rate for Payer: United Healthcare HMO Rider |
$10,344.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,478.83
|
|
|
HC Y90 MICROSPHERES
|
Facility
|
OP
|
$28,943.00
|
|
|
Service Code
|
CPT C2616
|
| Hospital Charge Code |
909301347
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,788.60 |
| Max. Negotiated Rate |
$36,913.67 |
| Rate for Payer: Adventist Health Commercial |
$5,788.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$22,371.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33,557.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24,609.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,371.92
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13,215.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,872.34
|
| Rate for Payer: Blue Shield of California Commercial |
$23,212.29
|
| Rate for Payer: Blue Shield of California EPN |
$14,587.27
|
| Rate for Payer: Cash Price |
$13,024.35
|
| Rate for Payer: Cash Price |
$13,024.35
|
| Rate for Payer: Central Health Plan Commercial |
$23,154.40
|
| Rate for Payer: Cigna of CA HMO |
$20,260.10
|
| Rate for Payer: Cigna of CA PPO |
$20,260.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33,557.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,609.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,371.92
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20,260.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$36,913.67
|
| Rate for Payer: EPIC Health Plan Senior |
$24,609.11
|
| Rate for Payer: Galaxy Health WC |
$24,601.55
|
| Rate for Payer: Global Benefits Group Commercial |
$17,365.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$26,048.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$36,689.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,371.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18,378.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31,320.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,788.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$29,978.37
|
| Rate for Payer: Multiplan Commercial |
$21,707.25
|
| Rate for Payer: Networks By Design Commercial |
$14,471.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$22,371.92
|
| Rate for Payer: Prime Health Services Commercial |
$24,601.55
|
| Rate for Payer: Prime Health Services Medicare |
$23,714.24
|
| Rate for Payer: Riverside University Health System MISP |
$24,609.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17,365.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17,365.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,862.31
|
| Rate for Payer: United Healthcare All Other HMO |
$10,572.88
|
| Rate for Payer: United Healthcare HMO Rider |
$10,344.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,478.83
|
| Rate for Payer: Upland Medical Group Pediatric |
$22,371.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33,557.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,609.11
|
| Rate for Payer: Vantage Medical Group Senior |
$22,371.92
|
|
|
HC Y-90 ZEVALIN UP TO 40 MCI
|
Facility
|
OP
|
$107,795.00
|
|
|
Service Code
|
CPT A9543
|
| Hospital Charge Code |
909301343
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$21,559.00 |
| Max. Negotiated Rate |
$408,253.71 |
| Rate for Payer: Adventist Health Commercial |
$21,559.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$56,824.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$408,253.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$71,030.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$62,507.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62,507.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$109,989.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$137,257.60
|
| Rate for Payer: Blue Shield of California Commercial |
$67,910.85
|
| Rate for Payer: Blue Shield of California EPN |
$42,794.61
|
| Rate for Payer: Cash Price |
$48,507.75
|
| Rate for Payer: Cash Price |
$48,507.75
|
| Rate for Payer: Central Health Plan Commercial |
$86,236.00
|
| Rate for Payer: Cigna of CA HMO |
$68,988.80
|
| Rate for Payer: Cigna of CA PPO |
$79,768.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$71,030.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$62,507.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$62,507.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$75,456.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$93,760.51
|
| Rate for Payer: EPIC Health Plan Senior |
$62,507.00
|
| Rate for Payer: Galaxy Health WC |
$91,625.75
|
| Rate for Payer: Global Benefits Group Commercial |
$64,677.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$97,015.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$93,192.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$116,627.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$56,824.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$68,449.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$128,832.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$79,554.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21,559.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$76,144.90
|
| Rate for Payer: Multiplan Commercial |
$80,846.25
|
| Rate for Payer: Networks By Design Commercial |
$70,066.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$56,824.55
|
| Rate for Payer: Prime Health Services Commercial |
$91,625.75
|
| Rate for Payer: Prime Health Services Medicare |
$60,234.02
|
| Rate for Payer: Riverside University Health System MISP |
$62,507.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$64,677.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$64,677.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$40,455.46
|
| Rate for Payer: United Healthcare All Other HMO |
$39,377.51
|
| Rate for Payer: United Healthcare HMO Rider |
$38,525.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35,302.86
|
| Rate for Payer: Upland Medical Group Pediatric |
$56,824.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$71,030.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$62,507.00
|
| Rate for Payer: Vantage Medical Group Senior |
$62,507.00
|
|
|
HC Y-90 ZEVALIN UP TO 40 MCI
|
Facility
|
IP
|
$107,795.00
|
|
|
Service Code
|
CPT A9543
|
| Hospital Charge Code |
909301343
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$21,559.00 |
| Max. Negotiated Rate |
$97,015.50 |
| Rate for Payer: Adventist Health Commercial |
$21,559.00
|
| Rate for Payer: Blue Shield of California Commercial |
$86,451.59
|
| Rate for Payer: Blue Shield of California EPN |
$54,328.68
|
| Rate for Payer: Cash Price |
$48,507.75
|
| Rate for Payer: Central Health Plan Commercial |
$86,236.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$75,456.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$43,118.00
|
| Rate for Payer: EPIC Health Plan Senior |
$43,118.00
|
| Rate for Payer: Galaxy Health WC |
$91,625.75
|
| Rate for Payer: Global Benefits Group Commercial |
$64,677.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$97,015.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$68,449.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$63,599.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21,559.00
|
| Rate for Payer: Multiplan Commercial |
$80,846.25
|
| Rate for Payer: Networks By Design Commercial |
$70,066.75
|
| Rate for Payer: Prime Health Services Commercial |
$91,625.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$40,455.46
|
| Rate for Payer: United Healthcare All Other HMO |
$39,377.51
|
| Rate for Payer: United Healthcare HMO Rider |
$38,525.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35,302.86
|
|
|
HC YANKAUER BULB TIP ON/OFF CNTRL
|
Facility
|
IP
|
$7.38
|
|
| Hospital Charge Code |
901698562
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$6.64 |
| Rate for Payer: Adventist Health Commercial |
$1.48
|
| Rate for Payer: Cash Price |
$3.32
|
| Rate for Payer: Central Health Plan Commercial |
$5.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.95
|
| Rate for Payer: EPIC Health Plan Senior |
$2.95
|
| Rate for Payer: Galaxy Health WC |
$6.27
|
| Rate for Payer: Global Benefits Group Commercial |
$4.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.48
|
| Rate for Payer: Multiplan Commercial |
$5.54
|
| Rate for Payer: Networks By Design Commercial |
$4.80
|
| Rate for Payer: Prime Health Services Commercial |
$6.27
|
|
|
HC YANKAUER BULB TIP ON/OFF CNTRL
|
Facility
|
OP
|
$7.38
|
|
| Hospital Charge Code |
901698562
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$6.64 |
| Rate for Payer: Adventist Health Commercial |
$1.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.29
|
| Rate for Payer: Blue Shield of California Commercial |
$4.68
|
| Rate for Payer: Blue Shield of California EPN |
$2.94
|
| Rate for Payer: Cash Price |
$3.32
|
| Rate for Payer: Central Health Plan Commercial |
$5.90
|
| Rate for Payer: Cigna of CA HMO |
$4.72
|
| Rate for Payer: Cigna of CA PPO |
$5.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.95
|
| Rate for Payer: EPIC Health Plan Senior |
$2.95
|
| Rate for Payer: Galaxy Health WC |
$6.27
|
| Rate for Payer: Global Benefits Group Commercial |
$4.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.17
|
| Rate for Payer: Multiplan Commercial |
$5.54
|
| Rate for Payer: Networks By Design Commercial |
$4.80
|
| Rate for Payer: Prime Health Services Commercial |
$6.27
|
| Rate for Payer: Riverside University Health System MISP |
$2.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.69
|
| Rate for Payer: United Healthcare All Other HMO |
$3.69
|
| Rate for Payer: United Healthcare HMO Rider |
$3.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.27
|
| Rate for Payer: Vantage Medical Group Senior |
$6.27
|
|
|
HC YANKAUER BULB TIP VENT
|
Facility
|
OP
|
$3.77
|
|
|
Service Code
|
CPT A4628
|
| Hospital Charge Code |
901607940
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$9.45 |
| Rate for Payer: Adventist Health Commercial |
$0.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.19
|
| Rate for Payer: Blue Shield of California Commercial |
$2.39
|
| Rate for Payer: Blue Shield of California EPN |
$1.50
|
| Rate for Payer: Cash Price |
$1.70
|
| Rate for Payer: Cash Price |
$1.70
|
| Rate for Payer: Central Health Plan Commercial |
$3.02
|
| Rate for Payer: Cigna of CA HMO |
$2.41
|
| Rate for Payer: Cigna of CA PPO |
$2.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.51
|
| Rate for Payer: EPIC Health Plan Senior |
$1.51
|
| Rate for Payer: Galaxy Health WC |
$3.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.64
|
| Rate for Payer: Multiplan Commercial |
$2.83
|
| Rate for Payer: Networks By Design Commercial |
$2.45
|
| Rate for Payer: Prime Health Services Commercial |
$3.20
|
| Rate for Payer: Riverside University Health System MISP |
$1.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.89
|
| Rate for Payer: United Healthcare All Other HMO |
$1.89
|
| Rate for Payer: United Healthcare HMO Rider |
$1.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.20
|
| Rate for Payer: Vantage Medical Group Senior |
$3.20
|
|
|
HC YANKAUER BULB TIP VENT
|
Facility
|
IP
|
$3.77
|
|
|
Service Code
|
CPT A4628
|
| Hospital Charge Code |
901607940
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$3.39 |
| Rate for Payer: Adventist Health Commercial |
$0.75
|
| Rate for Payer: Cash Price |
$1.70
|
| Rate for Payer: Central Health Plan Commercial |
$3.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.51
|
| Rate for Payer: EPIC Health Plan Senior |
$1.51
|
| Rate for Payer: Galaxy Health WC |
$3.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.75
|
| Rate for Payer: Multiplan Commercial |
$2.83
|
| Rate for Payer: Networks By Design Commercial |
$2.45
|
| Rate for Payer: Prime Health Services Commercial |
$3.20
|
|
|
HC YANKAUER FINE CAP FLANGE
|
Facility
|
IP
|
$5.00
|
|
| Hospital Charge Code |
901607936
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Adventist Health Commercial |
$1.00
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Central Health Plan Commercial |
$4.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2.00
|
| Rate for Payer: Galaxy Health WC |
$4.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.00
|
| Rate for Payer: Multiplan Commercial |
$3.75
|
| Rate for Payer: Networks By Design Commercial |
$3.25
|
| Rate for Payer: Prime Health Services Commercial |
$4.25
|
|
|
HC YANKAUER FINE CAP FLANGE
|
Facility
|
OP
|
$5.00
|
|
| Hospital Charge Code |
901607936
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Adventist Health Commercial |
$1.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.91
|
| Rate for Payer: Blue Shield of California Commercial |
$3.17
|
| Rate for Payer: Blue Shield of California EPN |
$2.00
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Central Health Plan Commercial |
$4.00
|
| Rate for Payer: Cigna of CA HMO |
$3.20
|
| Rate for Payer: Cigna of CA PPO |
$3.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2.00
|
| Rate for Payer: Galaxy Health WC |
$4.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.50
|
| Rate for Payer: Multiplan Commercial |
$3.75
|
| Rate for Payer: Networks By Design Commercial |
$3.25
|
| Rate for Payer: Prime Health Services Commercial |
$4.25
|
| Rate for Payer: Riverside University Health System MISP |
$2.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.25
|
| Rate for Payer: Vantage Medical Group Senior |
$4.25
|
|
|
HC YANKAUER FLANGE TIP FINE CAP
|
Facility
|
IP
|
$7.05
|
|
| Hospital Charge Code |
901698750
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.41 |
| Max. Negotiated Rate |
$6.34 |
| Rate for Payer: Adventist Health Commercial |
$1.41
|
| Rate for Payer: Cash Price |
$3.17
|
| Rate for Payer: Central Health Plan Commercial |
$5.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.82
|
| Rate for Payer: EPIC Health Plan Senior |
$2.82
|
| Rate for Payer: Galaxy Health WC |
$5.99
|
| Rate for Payer: Global Benefits Group Commercial |
$4.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.41
|
| Rate for Payer: Multiplan Commercial |
$5.29
|
| Rate for Payer: Networks By Design Commercial |
$4.58
|
| Rate for Payer: Prime Health Services Commercial |
$5.99
|
|
|
HC YANKAUER FLANGE TIP FINE CAP
|
Facility
|
OP
|
$7.05
|
|
| Hospital Charge Code |
901698750
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.41 |
| Max. Negotiated Rate |
$6.34 |
| Rate for Payer: Adventist Health Commercial |
$1.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.10
|
| Rate for Payer: Blue Shield of California Commercial |
$4.47
|
| Rate for Payer: Blue Shield of California EPN |
$2.81
|
| Rate for Payer: Cash Price |
$3.17
|
| Rate for Payer: Central Health Plan Commercial |
$5.64
|
| Rate for Payer: Cigna of CA HMO |
$4.51
|
| Rate for Payer: Cigna of CA PPO |
$5.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.82
|
| Rate for Payer: EPIC Health Plan Senior |
$2.82
|
| Rate for Payer: Galaxy Health WC |
$5.99
|
| Rate for Payer: Global Benefits Group Commercial |
$4.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.93
|
| Rate for Payer: Multiplan Commercial |
$5.29
|
| Rate for Payer: Networks By Design Commercial |
$4.58
|
| Rate for Payer: Prime Health Services Commercial |
$5.99
|
| Rate for Payer: Riverside University Health System MISP |
$2.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.52
|
| Rate for Payer: United Healthcare All Other HMO |
$3.52
|
| Rate for Payer: United Healthcare HMO Rider |
$3.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.99
|
| Rate for Payer: Vantage Medical Group Senior |
$5.99
|
|
|
HC YANKAUER FLEX W/FLANGE TIP STL
|
Facility
|
OP
|
$4.59
|
|
| Hospital Charge Code |
901698717
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Adventist Health Commercial |
$0.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.67
|
| Rate for Payer: Blue Shield of California Commercial |
$2.91
|
| Rate for Payer: Blue Shield of California EPN |
$1.83
|
| Rate for Payer: Cash Price |
$2.07
|
| Rate for Payer: Central Health Plan Commercial |
$3.67
|
| Rate for Payer: Cigna of CA HMO |
$2.94
|
| Rate for Payer: Cigna of CA PPO |
$3.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.84
|
| Rate for Payer: EPIC Health Plan Senior |
$1.84
|
| Rate for Payer: Galaxy Health WC |
$3.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.21
|
| Rate for Payer: Multiplan Commercial |
$3.44
|
| Rate for Payer: Networks By Design Commercial |
$2.98
|
| Rate for Payer: Prime Health Services Commercial |
$3.90
|
| Rate for Payer: Riverside University Health System MISP |
$1.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.75
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.29
|
| Rate for Payer: United Healthcare All Other HMO |
$2.29
|
| Rate for Payer: United Healthcare HMO Rider |
$2.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.90
|
| Rate for Payer: Vantage Medical Group Senior |
$3.90
|
|
|
HC YANKAUER FLEX W/FLANGE TIP STL
|
Facility
|
IP
|
$4.59
|
|
| Hospital Charge Code |
901698717
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Adventist Health Commercial |
$0.92
|
| Rate for Payer: Cash Price |
$2.07
|
| Rate for Payer: Central Health Plan Commercial |
$3.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.84
|
| Rate for Payer: EPIC Health Plan Senior |
$1.84
|
| Rate for Payer: Galaxy Health WC |
$3.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.92
|
| Rate for Payer: Multiplan Commercial |
$3.44
|
| Rate for Payer: Networks By Design Commercial |
$2.98
|
| Rate for Payer: Prime Health Services Commercial |
$3.90
|
|
