|
HC TTG IGG
|
Facility
OP
|
$39.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900913670
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$207.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$11.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.17
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$170.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$207.60
|
| Rate for Payer: BCBS Transplant Transplant |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$24.10
|
| Rate for Payer: Blue Shield of California EPN |
$18.95
|
| Rate for Payer: Caremore Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Central Health Plan Commercial |
$31.20
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$11.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.53
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$29.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18.91
|
| Rate for Payer: IEHP medi-cal |
$19.02
|
| Rate for Payer: IEHP Medicare Advantage |
$11.53
|
| Rate for Payer: Innovage PACE Commercial |
$17.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.45
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Prime Health Services Medicare |
$12.22
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: Riverside University Health MISP |
$12.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.34
|
| Rate for Payer: United Healthcare All Other HMO |
$9.34
|
| Rate for Payer: United Healthcare HMO Rider |
$9.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
|
HC TTG IGG
|
Facility
IP
|
$58.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900913670
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.60 |
| Max. Negotiated Rate |
$52.20 |
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Central Health Plan Commercial |
$46.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.20
|
| Rate for Payer: Galaxy Health WC |
$49.30
|
| Rate for Payer: Global Benefits Group Commercial |
$34.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$52.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.60
|
| Rate for Payer: Multiplan Commercial |
$43.50
|
| Rate for Payer: Networks By Design Commercial |
$37.70
|
| Rate for Payer: Prime Health Services Commercial |
$49.30
|
|
|
HC TTS BIVNA NEO/PEDS FLXTD 3.0FR
|
Facility
OP
|
$983.85
|
|
| Hospital Charge Code |
900800901
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$196.77 |
| Max. Negotiated Rate |
$885.46 |
| Rate for Payer: Aetna of CA HMO/PPO |
$597.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$836.27
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$541.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$541.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$476.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$581.26
|
| Rate for Payer: BCBS Transplant Transplant |
$590.31
|
| Rate for Payer: Blue Shield of California Commercial |
$618.84
|
| Rate for Payer: Blue Shield of California EPN |
$481.10
|
| Rate for Payer: Cash Price |
$442.73
|
| Rate for Payer: Central Health Plan Commercial |
$787.08
|
| Rate for Payer: Cigna of CA HMO |
$629.66
|
| Rate for Payer: Cigna of CA PPO |
$728.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$836.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$393.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$393.54
|
| Rate for Payer: Galaxy Health WC |
$836.27
|
| Rate for Payer: Global Benefits Group Commercial |
$590.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$885.46
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$737.89
|
| Rate for Payer: IEHP medi-cal |
$344.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$656.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.77
|
| Rate for Payer: Multiplan Commercial |
$737.89
|
| Rate for Payer: Networks By Design Commercial |
$639.50
|
| Rate for Payer: Prime Health Services Commercial |
$836.27
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$590.31
|
| Rate for Payer: Riverside University Health MISP |
$393.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$590.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$590.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$491.92
|
| Rate for Payer: United Healthcare All Other HMO |
$491.92
|
| Rate for Payer: United Healthcare HMO Rider |
$491.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$491.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$836.27
|
| Rate for Payer: Vantage Medical Group Senior |
$836.27
|
|
|
HC TTS BIVNA NEO/PEDS FLXTD 3.0FR
|
Facility
IP
|
$983.85
|
|
| Hospital Charge Code |
900800901
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$196.77 |
| Max. Negotiated Rate |
$885.46 |
| Rate for Payer: Cash Price |
$442.73
|
| Rate for Payer: Central Health Plan Commercial |
$787.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$393.54
|
| Rate for Payer: Galaxy Health WC |
$836.27
|
| Rate for Payer: Global Benefits Group Commercial |
$590.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$885.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$656.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.77
|
| Rate for Payer: Multiplan Commercial |
$737.89
|
| Rate for Payer: Networks By Design Commercial |
$639.50
|
| Rate for Payer: Prime Health Services Commercial |
$836.27
|
|
|
HC TTS BIVNA NEO/PEDS FLXTD 3.5FR
|
Facility
IP
|
$983.85
|
|
| Hospital Charge Code |
900800902
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$196.77 |
| Max. Negotiated Rate |
$885.46 |
| Rate for Payer: Cash Price |
$442.73
|
| Rate for Payer: Central Health Plan Commercial |
$787.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$393.54
|
| Rate for Payer: Galaxy Health WC |
$836.27
|
| Rate for Payer: Global Benefits Group Commercial |
$590.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$885.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$656.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.77
|
| Rate for Payer: Multiplan Commercial |
$737.89
|
| Rate for Payer: Networks By Design Commercial |
$639.50
|
| Rate for Payer: Prime Health Services Commercial |
$836.27
|
|
|
HC TTS BIVNA NEO/PEDS FLXTD 3.5FR
|
Facility
OP
|
$983.85
|
|
| Hospital Charge Code |
900800902
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$196.77 |
| Max. Negotiated Rate |
$885.46 |
| Rate for Payer: Aetna of CA HMO/PPO |
$597.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$836.27
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$541.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$541.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$476.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$581.26
|
| Rate for Payer: BCBS Transplant Transplant |
$590.31
|
| Rate for Payer: Blue Shield of California Commercial |
$618.84
|
| Rate for Payer: Blue Shield of California EPN |
$481.10
|
| Rate for Payer: Cash Price |
$442.73
|
| Rate for Payer: Central Health Plan Commercial |
$787.08
|
| Rate for Payer: Cigna of CA HMO |
$629.66
|
| Rate for Payer: Cigna of CA PPO |
$728.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$836.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$393.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$393.54
|
| Rate for Payer: Galaxy Health WC |
$836.27
|
| Rate for Payer: Global Benefits Group Commercial |
$590.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$885.46
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$737.89
|
| Rate for Payer: IEHP medi-cal |
$344.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$656.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.77
|
| Rate for Payer: Multiplan Commercial |
$737.89
|
| Rate for Payer: Networks By Design Commercial |
$639.50
|
| Rate for Payer: Prime Health Services Commercial |
$836.27
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$590.31
|
| Rate for Payer: Riverside University Health MISP |
$393.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$590.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$590.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$491.92
|
| Rate for Payer: United Healthcare All Other HMO |
$491.92
|
| Rate for Payer: United Healthcare HMO Rider |
$491.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$491.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$836.27
|
| Rate for Payer: Vantage Medical Group Senior |
$836.27
|
|
|
HC TTS BIVNA NEO/PEDS FLXTD 4.0FR
|
Facility
IP
|
$983.85
|
|
| Hospital Charge Code |
900800903
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$196.77 |
| Max. Negotiated Rate |
$885.46 |
| Rate for Payer: Cash Price |
$442.73
|
| Rate for Payer: Central Health Plan Commercial |
$787.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$393.54
|
| Rate for Payer: Galaxy Health WC |
$836.27
|
| Rate for Payer: Global Benefits Group Commercial |
$590.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$885.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$656.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.77
|
| Rate for Payer: Multiplan Commercial |
$737.89
|
| Rate for Payer: Networks By Design Commercial |
$639.50
|
| Rate for Payer: Prime Health Services Commercial |
$836.27
|
|
|
HC TTS BIVNA NEO/PEDS FLXTD 4.0FR
|
Facility
OP
|
$983.85
|
|
| Hospital Charge Code |
900800903
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$196.77 |
| Max. Negotiated Rate |
$885.46 |
| Rate for Payer: Aetna of CA HMO/PPO |
$597.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$836.27
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$541.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$541.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$476.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$581.26
|
| Rate for Payer: BCBS Transplant Transplant |
$590.31
|
| Rate for Payer: Blue Shield of California Commercial |
$618.84
|
| Rate for Payer: Blue Shield of California EPN |
$481.10
|
| Rate for Payer: Cash Price |
$442.73
|
| Rate for Payer: Central Health Plan Commercial |
$787.08
|
| Rate for Payer: Cigna of CA HMO |
$629.66
|
| Rate for Payer: Cigna of CA PPO |
$728.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$836.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$393.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$393.54
|
| Rate for Payer: Galaxy Health WC |
$836.27
|
| Rate for Payer: Global Benefits Group Commercial |
$590.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$885.46
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$737.89
|
| Rate for Payer: IEHP medi-cal |
$344.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$656.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.77
|
| Rate for Payer: Multiplan Commercial |
$737.89
|
| Rate for Payer: Networks By Design Commercial |
$639.50
|
| Rate for Payer: Prime Health Services Commercial |
$836.27
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$590.31
|
| Rate for Payer: Riverside University Health MISP |
$393.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$590.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$590.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$491.92
|
| Rate for Payer: United Healthcare All Other HMO |
$491.92
|
| Rate for Payer: United Healthcare HMO Rider |
$491.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$491.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$836.27
|
| Rate for Payer: Vantage Medical Group Senior |
$836.27
|
|
|
HC TTS BIVONA NEO CUFFED 3.0MM
|
Facility
IP
|
$843.41
|
|
| Hospital Charge Code |
900800909
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$168.68 |
| Max. Negotiated Rate |
$759.07 |
| Rate for Payer: Cash Price |
$379.53
|
| Rate for Payer: Central Health Plan Commercial |
$674.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.36
|
| Rate for Payer: Galaxy Health WC |
$716.90
|
| Rate for Payer: Global Benefits Group Commercial |
$506.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$759.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$562.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.68
|
| Rate for Payer: Multiplan Commercial |
$632.56
|
| Rate for Payer: Networks By Design Commercial |
$548.22
|
| Rate for Payer: Prime Health Services Commercial |
$716.90
|
|
|
HC TTS BIVONA NEO CUFFED 3.0MM
|
Facility
OP
|
$843.41
|
|
| Hospital Charge Code |
900800909
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$168.68 |
| Max. Negotiated Rate |
$759.07 |
| Rate for Payer: Aetna of CA HMO/PPO |
$512.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$716.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$463.88
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$463.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$408.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$498.29
|
| Rate for Payer: BCBS Transplant Transplant |
$506.05
|
| Rate for Payer: Blue Shield of California Commercial |
$530.50
|
| Rate for Payer: Blue Shield of California EPN |
$412.43
|
| Rate for Payer: Cash Price |
$379.53
|
| Rate for Payer: Central Health Plan Commercial |
$674.73
|
| Rate for Payer: Cigna of CA HMO |
$539.78
|
| Rate for Payer: Cigna of CA PPO |
$624.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$716.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$337.36
|
| Rate for Payer: Galaxy Health WC |
$716.90
|
| Rate for Payer: Global Benefits Group Commercial |
$506.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$759.07
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$632.56
|
| Rate for Payer: IEHP medi-cal |
$295.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$562.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.68
|
| Rate for Payer: Multiplan Commercial |
$632.56
|
| Rate for Payer: Networks By Design Commercial |
$548.22
|
| Rate for Payer: Prime Health Services Commercial |
$716.90
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$506.05
|
| Rate for Payer: Riverside University Health MISP |
$337.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$506.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$506.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$421.70
|
| Rate for Payer: United Healthcare All Other HMO |
$421.70
|
| Rate for Payer: United Healthcare HMO Rider |
$421.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$421.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$716.90
|
| Rate for Payer: Vantage Medical Group Senior |
$716.90
|
|
|
HC TTS BIVONA NEO CUFFED 3.5MM
|
Facility
OP
|
$843.41
|
|
| Hospital Charge Code |
900800908
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$168.68 |
| Max. Negotiated Rate |
$759.07 |
| Rate for Payer: Aetna of CA HMO/PPO |
$512.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$716.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$463.88
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$463.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$408.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$498.29
|
| Rate for Payer: BCBS Transplant Transplant |
$506.05
|
| Rate for Payer: Blue Shield of California Commercial |
$530.50
|
| Rate for Payer: Blue Shield of California EPN |
$412.43
|
| Rate for Payer: Cash Price |
$379.53
|
| Rate for Payer: Central Health Plan Commercial |
$674.73
|
| Rate for Payer: Cigna of CA HMO |
$539.78
|
| Rate for Payer: Cigna of CA PPO |
$624.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$716.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$337.36
|
| Rate for Payer: Galaxy Health WC |
$716.90
|
| Rate for Payer: Global Benefits Group Commercial |
$506.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$759.07
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$632.56
|
| Rate for Payer: IEHP medi-cal |
$295.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$562.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.68
|
| Rate for Payer: Multiplan Commercial |
$632.56
|
| Rate for Payer: Networks By Design Commercial |
$548.22
|
| Rate for Payer: Prime Health Services Commercial |
$716.90
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$506.05
|
| Rate for Payer: Riverside University Health MISP |
$337.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$506.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$506.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$421.70
|
| Rate for Payer: United Healthcare All Other HMO |
$421.70
|
| Rate for Payer: United Healthcare HMO Rider |
$421.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$421.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$716.90
|
| Rate for Payer: Vantage Medical Group Senior |
$716.90
|
|
|
HC TTS BIVONA NEO CUFFED 3.5MM
|
Facility
IP
|
$843.41
|
|
| Hospital Charge Code |
900800908
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$168.68 |
| Max. Negotiated Rate |
$759.07 |
| Rate for Payer: Cash Price |
$379.53
|
| Rate for Payer: Central Health Plan Commercial |
$674.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.36
|
| Rate for Payer: Galaxy Health WC |
$716.90
|
| Rate for Payer: Global Benefits Group Commercial |
$506.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$759.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$562.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.68
|
| Rate for Payer: Multiplan Commercial |
$632.56
|
| Rate for Payer: Networks By Design Commercial |
$548.22
|
| Rate for Payer: Prime Health Services Commercial |
$716.90
|
|
|
HC TTS BIVONA NEO CUFFED 4.0MM
|
Facility
IP
|
$843.41
|
|
| Hospital Charge Code |
900800907
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$168.68 |
| Max. Negotiated Rate |
$759.07 |
| Rate for Payer: Cash Price |
$379.53
|
| Rate for Payer: Central Health Plan Commercial |
$674.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.36
|
| Rate for Payer: Galaxy Health WC |
$716.90
|
| Rate for Payer: Global Benefits Group Commercial |
$506.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$759.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$562.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.68
|
| Rate for Payer: Multiplan Commercial |
$632.56
|
| Rate for Payer: Networks By Design Commercial |
$548.22
|
| Rate for Payer: Prime Health Services Commercial |
$716.90
|
|
|
HC TTS BIVONA NEO CUFFED 4.0MM
|
Facility
OP
|
$843.41
|
|
| Hospital Charge Code |
900800907
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$168.68 |
| Max. Negotiated Rate |
$759.07 |
| Rate for Payer: Aetna of CA HMO/PPO |
$512.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$716.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$463.88
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$463.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$408.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$498.29
|
| Rate for Payer: BCBS Transplant Transplant |
$506.05
|
| Rate for Payer: Blue Shield of California Commercial |
$530.50
|
| Rate for Payer: Blue Shield of California EPN |
$412.43
|
| Rate for Payer: Cash Price |
$379.53
|
| Rate for Payer: Central Health Plan Commercial |
$674.73
|
| Rate for Payer: Cigna of CA HMO |
$539.78
|
| Rate for Payer: Cigna of CA PPO |
$624.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$716.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$337.36
|
| Rate for Payer: Galaxy Health WC |
$716.90
|
| Rate for Payer: Global Benefits Group Commercial |
$506.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$759.07
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$632.56
|
| Rate for Payer: IEHP medi-cal |
$295.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$562.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.68
|
| Rate for Payer: Multiplan Commercial |
$632.56
|
| Rate for Payer: Networks By Design Commercial |
$548.22
|
| Rate for Payer: Prime Health Services Commercial |
$716.90
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$506.05
|
| Rate for Payer: Riverside University Health MISP |
$337.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$506.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$506.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$421.70
|
| Rate for Payer: United Healthcare All Other HMO |
$421.70
|
| Rate for Payer: United Healthcare HMO Rider |
$421.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$421.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$716.90
|
| Rate for Payer: Vantage Medical Group Senior |
$716.90
|
|
|
HC TTS BIVONA PEDS CUFFED 3.5MM
|
Facility
OP
|
$843.41
|
|
| Hospital Charge Code |
900800906
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$168.68 |
| Max. Negotiated Rate |
$759.07 |
| Rate for Payer: Aetna of CA HMO/PPO |
$512.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$716.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$463.88
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$463.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$408.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$498.29
|
| Rate for Payer: BCBS Transplant Transplant |
$506.05
|
| Rate for Payer: Blue Shield of California Commercial |
$530.50
|
| Rate for Payer: Blue Shield of California EPN |
$412.43
|
| Rate for Payer: Cash Price |
$379.53
|
| Rate for Payer: Central Health Plan Commercial |
$674.73
|
| Rate for Payer: Cigna of CA HMO |
$539.78
|
| Rate for Payer: Cigna of CA PPO |
$624.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$716.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$337.36
|
| Rate for Payer: Galaxy Health WC |
$716.90
|
| Rate for Payer: Global Benefits Group Commercial |
$506.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$759.07
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$632.56
|
| Rate for Payer: IEHP medi-cal |
$295.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$562.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.68
|
| Rate for Payer: Multiplan Commercial |
$632.56
|
| Rate for Payer: Networks By Design Commercial |
$548.22
|
| Rate for Payer: Prime Health Services Commercial |
$716.90
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$506.05
|
| Rate for Payer: Riverside University Health MISP |
$337.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$506.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$506.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$421.70
|
| Rate for Payer: United Healthcare All Other HMO |
$421.70
|
| Rate for Payer: United Healthcare HMO Rider |
$421.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$421.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$716.90
|
| Rate for Payer: Vantage Medical Group Senior |
$716.90
|
|
|
HC TTS BIVONA PEDS CUFFED 3.5MM
|
Facility
IP
|
$843.41
|
|
| Hospital Charge Code |
900800906
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$168.68 |
| Max. Negotiated Rate |
$759.07 |
| Rate for Payer: Cash Price |
$379.53
|
| Rate for Payer: Central Health Plan Commercial |
$674.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.36
|
| Rate for Payer: Galaxy Health WC |
$716.90
|
| Rate for Payer: Global Benefits Group Commercial |
$506.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$759.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$562.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.68
|
| Rate for Payer: Multiplan Commercial |
$632.56
|
| Rate for Payer: Networks By Design Commercial |
$548.22
|
| Rate for Payer: Prime Health Services Commercial |
$716.90
|
|
|
HC TTS BIVONA PEDS CUFFED 4.0MM
|
Facility
OP
|
$843.41
|
|
| Hospital Charge Code |
900800905
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$168.68 |
| Max. Negotiated Rate |
$759.07 |
| Rate for Payer: Aetna of CA HMO/PPO |
$512.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$716.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$463.88
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$463.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$408.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$498.29
|
| Rate for Payer: BCBS Transplant Transplant |
$506.05
|
| Rate for Payer: Blue Shield of California Commercial |
$530.50
|
| Rate for Payer: Blue Shield of California EPN |
$412.43
|
| Rate for Payer: Cash Price |
$379.53
|
| Rate for Payer: Central Health Plan Commercial |
$674.73
|
| Rate for Payer: Cigna of CA HMO |
$539.78
|
| Rate for Payer: Cigna of CA PPO |
$624.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$716.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$337.36
|
| Rate for Payer: Galaxy Health WC |
$716.90
|
| Rate for Payer: Global Benefits Group Commercial |
$506.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$759.07
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$632.56
|
| Rate for Payer: IEHP medi-cal |
$295.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$562.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.68
|
| Rate for Payer: Multiplan Commercial |
$632.56
|
| Rate for Payer: Networks By Design Commercial |
$548.22
|
| Rate for Payer: Prime Health Services Commercial |
$716.90
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$506.05
|
| Rate for Payer: Riverside University Health MISP |
$337.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$506.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$506.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$421.70
|
| Rate for Payer: United Healthcare All Other HMO |
$421.70
|
| Rate for Payer: United Healthcare HMO Rider |
$421.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$421.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$716.90
|
| Rate for Payer: Vantage Medical Group Senior |
$716.90
|
|
|
HC TTS BIVONA PEDS CUFFED 4.0MM
|
Facility
IP
|
$843.41
|
|
| Hospital Charge Code |
900800905
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$168.68 |
| Max. Negotiated Rate |
$759.07 |
| Rate for Payer: Cash Price |
$379.53
|
| Rate for Payer: Central Health Plan Commercial |
$674.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.36
|
| Rate for Payer: Galaxy Health WC |
$716.90
|
| Rate for Payer: Global Benefits Group Commercial |
$506.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$759.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$562.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.68
|
| Rate for Payer: Multiplan Commercial |
$632.56
|
| Rate for Payer: Networks By Design Commercial |
$548.22
|
| Rate for Payer: Prime Health Services Commercial |
$716.90
|
|
|
HC TTS BIVONA PEDS CUFFED 4.5MM
|
Facility
OP
|
$843.41
|
|
| Hospital Charge Code |
900800904
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$168.68 |
| Max. Negotiated Rate |
$759.07 |
| Rate for Payer: Aetna of CA HMO/PPO |
$512.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$716.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$463.88
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$463.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$408.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$498.29
|
| Rate for Payer: BCBS Transplant Transplant |
$506.05
|
| Rate for Payer: Blue Shield of California Commercial |
$530.50
|
| Rate for Payer: Blue Shield of California EPN |
$412.43
|
| Rate for Payer: Cash Price |
$379.53
|
| Rate for Payer: Central Health Plan Commercial |
$674.73
|
| Rate for Payer: Cigna of CA HMO |
$539.78
|
| Rate for Payer: Cigna of CA PPO |
$624.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$716.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$337.36
|
| Rate for Payer: Galaxy Health WC |
$716.90
|
| Rate for Payer: Global Benefits Group Commercial |
$506.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$759.07
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$632.56
|
| Rate for Payer: IEHP medi-cal |
$295.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$562.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.68
|
| Rate for Payer: Multiplan Commercial |
$632.56
|
| Rate for Payer: Networks By Design Commercial |
$548.22
|
| Rate for Payer: Prime Health Services Commercial |
$716.90
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$506.05
|
| Rate for Payer: Riverside University Health MISP |
$337.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$506.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$506.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$421.70
|
| Rate for Payer: United Healthcare All Other HMO |
$421.70
|
| Rate for Payer: United Healthcare HMO Rider |
$421.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$421.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$716.90
|
| Rate for Payer: Vantage Medical Group Senior |
$716.90
|
|
|
HC TTS BIVONA PEDS CUFFED 4.5MM
|
Facility
IP
|
$843.41
|
|
| Hospital Charge Code |
900800904
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$168.68 |
| Max. Negotiated Rate |
$759.07 |
| Rate for Payer: Cash Price |
$379.53
|
| Rate for Payer: Central Health Plan Commercial |
$674.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.36
|
| Rate for Payer: Galaxy Health WC |
$716.90
|
| Rate for Payer: Global Benefits Group Commercial |
$506.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$759.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$562.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.68
|
| Rate for Payer: Multiplan Commercial |
$632.56
|
| Rate for Payer: Networks By Design Commercial |
$548.22
|
| Rate for Payer: Prime Health Services Commercial |
$716.90
|
|
|
HC T-TUBE CHOLANGIOGRAM INJ
|
Facility
OP
|
$2,926.00
|
|
|
Service Code
|
CPT 47531
|
| Hospital Charge Code |
909000191
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$585.20 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,322.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,483.93
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,754.88
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,322.62
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1,755.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$4,322.62
|
| Rate for Payer: Cash Price |
$1,316.70
|
| Rate for Payer: Cash Price |
$1,316.70
|
| Rate for Payer: Cash Price |
$1,316.70
|
| Rate for Payer: Central Health Plan Commercial |
$2,340.80
|
| Rate for Payer: Cigna of CA PPO |
$2,165.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,483.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,835.54
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,322.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,322.62
|
| Rate for Payer: Galaxy Health WC |
$2,487.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,755.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,633.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,194.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,089.10
|
| Rate for Payer: IEHP medi-cal |
$7,132.32
|
| Rate for Payer: IEHP Medicare Advantage |
$4,322.62
|
| Rate for Payer: Innovage PACE Commercial |
$6,483.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,951.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,322.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$585.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,792.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,792.31
|
| Rate for Payer: Multiplan Commercial |
$2,194.50
|
| Rate for Payer: Networks By Design Commercial |
$1,901.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,487.10
|
| Rate for Payer: Prime Health Services Medicare |
$4,581.98
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,755.60
|
| Rate for Payer: Riverside University Health MISP |
$4,754.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,755.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,754.88
|
| Rate for Payer: Vantage Medical Group Senior |
$4,322.62
|
|
|
HC T-TUBE CHOLANGIOGRAM INJ
|
Facility
IP
|
$2,926.00
|
|
|
Service Code
|
CPT 47531
|
| Hospital Charge Code |
909000191
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$585.20 |
| Max. Negotiated Rate |
$2,633.40 |
| Rate for Payer: Cash Price |
$1,316.70
|
| Rate for Payer: Central Health Plan Commercial |
$2,340.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,170.40
|
| Rate for Payer: Galaxy Health WC |
$2,487.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,755.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,633.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,951.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$585.20
|
| Rate for Payer: Multiplan Commercial |
$2,194.50
|
| Rate for Payer: Networks By Design Commercial |
$1,901.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,487.10
|
|
|
HC TUBE BIVONA AIR CUFF PEDS
|
Facility
IP
|
$738.00
|
|
| Hospital Charge Code |
900800708
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$147.60 |
| Max. Negotiated Rate |
$664.20 |
| Rate for Payer: Cash Price |
$332.10
|
| Rate for Payer: Central Health Plan Commercial |
$590.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$295.20
|
| Rate for Payer: Galaxy Health WC |
$627.30
|
| Rate for Payer: Global Benefits Group Commercial |
$442.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$664.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$492.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$147.60
|
| Rate for Payer: Multiplan Commercial |
$553.50
|
| Rate for Payer: Networks By Design Commercial |
$479.70
|
| Rate for Payer: Prime Health Services Commercial |
$627.30
|
|
|
HC TUBE BIVONA AIR CUFF PEDS
|
Facility
OP
|
$738.00
|
|
| Hospital Charge Code |
900800708
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$147.60 |
| Max. Negotiated Rate |
$664.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$448.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$627.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$405.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$405.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$357.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$436.01
|
| Rate for Payer: BCBS Transplant Transplant |
$442.80
|
| Rate for Payer: Blue Shield of California Commercial |
$464.20
|
| Rate for Payer: Blue Shield of California EPN |
$360.88
|
| Rate for Payer: Cash Price |
$332.10
|
| Rate for Payer: Central Health Plan Commercial |
$590.40
|
| Rate for Payer: Cigna of CA HMO |
$472.32
|
| Rate for Payer: Cigna of CA PPO |
$546.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$627.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$295.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$295.20
|
| Rate for Payer: Galaxy Health WC |
$627.30
|
| Rate for Payer: Global Benefits Group Commercial |
$442.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$664.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$553.50
|
| Rate for Payer: IEHP medi-cal |
$258.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$492.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$147.60
|
| Rate for Payer: Multiplan Commercial |
$553.50
|
| Rate for Payer: Networks By Design Commercial |
$479.70
|
| Rate for Payer: Prime Health Services Commercial |
$627.30
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$442.80
|
| Rate for Payer: Riverside University Health MISP |
$295.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$442.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$442.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$369.00
|
| Rate for Payer: United Healthcare All Other HMO |
$369.00
|
| Rate for Payer: United Healthcare HMO Rider |
$369.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$369.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$627.30
|
| Rate for Payer: Vantage Medical Group Senior |
$627.30
|
|
|
HC TUBE CHECK (ABSCESS/CYST)
|
Facility
OP
|
$381.00
|
|
|
Service Code
|
CPT 49424
|
| Hospital Charge Code |
909000212
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$76.20 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$323.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$209.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$209.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: BCBS Transplant Transplant |
$228.60
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$171.45
|
| Rate for Payer: Cash Price |
$171.45
|
| Rate for Payer: Cash Price |
$171.45
|
| Rate for Payer: Central Health Plan Commercial |
$304.80
|
| Rate for Payer: Cigna of CA PPO |
$281.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$323.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$152.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$152.40
|
| Rate for Payer: Galaxy Health WC |
$323.85
|
| Rate for Payer: Global Benefits Group Commercial |
$228.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$342.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$285.75
|
| Rate for Payer: IEHP medi-cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$254.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.20
|
| Rate for Payer: Multiplan Commercial |
$285.75
|
| Rate for Payer: Networks By Design Commercial |
$247.65
|
| Rate for Payer: Prime Health Services Commercial |
$323.85
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$228.60
|
| Rate for Payer: Riverside University Health MISP |
$152.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$228.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$323.85
|
| Rate for Payer: Vantage Medical Group Senior |
$323.85
|
|
