|
HC TUBE TRACH SHILEY PEDS 4.5MM
|
Facility
IP
|
$318.43
|
|
| Hospital Charge Code |
901698484
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.69 |
| Max. Negotiated Rate |
$286.59 |
| Rate for Payer: Cash Price |
$143.29
|
| Rate for Payer: Central Health Plan Commercial |
$254.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$127.37
|
| Rate for Payer: Galaxy Health WC |
$270.67
|
| Rate for Payer: Global Benefits Group Commercial |
$191.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$286.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$212.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.69
|
| Rate for Payer: Multiplan Commercial |
$238.82
|
| Rate for Payer: Networks By Design Commercial |
$206.98
|
| Rate for Payer: Prime Health Services Commercial |
$270.67
|
|
|
HC TUBE TRACH SHILEY PEDS 4.5MM
|
Facility
OP
|
$318.43
|
|
| Hospital Charge Code |
901698484
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.69 |
| Max. Negotiated Rate |
$286.59 |
| Rate for Payer: Aetna of CA HMO/PPO |
$193.38
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$270.67
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$175.14
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$175.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$154.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$188.13
|
| Rate for Payer: BCBS Transplant Transplant |
$191.06
|
| Rate for Payer: Blue Shield of California Commercial |
$200.29
|
| Rate for Payer: Blue Shield of California EPN |
$155.71
|
| Rate for Payer: Cash Price |
$143.29
|
| Rate for Payer: Central Health Plan Commercial |
$254.74
|
| Rate for Payer: Cigna of CA HMO |
$203.80
|
| Rate for Payer: Cigna of CA PPO |
$235.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$270.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$127.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$127.37
|
| Rate for Payer: Galaxy Health WC |
$270.67
|
| Rate for Payer: Global Benefits Group Commercial |
$191.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$286.59
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$238.82
|
| Rate for Payer: IEHP medi-cal |
$111.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$212.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.69
|
| Rate for Payer: Multiplan Commercial |
$238.82
|
| Rate for Payer: Networks By Design Commercial |
$206.98
|
| Rate for Payer: Prime Health Services Commercial |
$270.67
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$191.06
|
| Rate for Payer: Riverside University Health MISP |
$127.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$191.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$191.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$159.22
|
| Rate for Payer: United Healthcare All Other HMO |
$159.22
|
| Rate for Payer: United Healthcare HMO Rider |
$159.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$159.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$270.67
|
| Rate for Payer: Vantage Medical Group Senior |
$270.67
|
|
|
HC TUBE TRACH SHILEY PEDS 4MM
|
Facility
IP
|
$224.98
|
|
| Hospital Charge Code |
901601132
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$202.48 |
| Rate for Payer: Cash Price |
$101.24
|
| Rate for Payer: Central Health Plan Commercial |
$179.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.99
|
| Rate for Payer: Galaxy Health WC |
$191.23
|
| Rate for Payer: Global Benefits Group Commercial |
$134.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$202.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$150.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.00
|
| Rate for Payer: Multiplan Commercial |
$168.74
|
| Rate for Payer: Networks By Design Commercial |
$146.24
|
| Rate for Payer: Prime Health Services Commercial |
$191.23
|
|
|
HC TUBE TRACH SHILEY PEDS 4MM
|
Facility
OP
|
$224.98
|
|
| Hospital Charge Code |
901601132
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$202.48 |
| Rate for Payer: Aetna of CA HMO/PPO |
$136.63
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$191.23
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$123.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$123.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$108.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.92
|
| Rate for Payer: BCBS Transplant Transplant |
$134.99
|
| Rate for Payer: Blue Shield of California Commercial |
$141.51
|
| Rate for Payer: Blue Shield of California EPN |
$110.02
|
| Rate for Payer: Cash Price |
$101.24
|
| Rate for Payer: Central Health Plan Commercial |
$179.98
|
| Rate for Payer: Cigna of CA HMO |
$143.99
|
| Rate for Payer: Cigna of CA PPO |
$166.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$191.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.99
|
| Rate for Payer: EPIC Health Plan Transplant |
$89.99
|
| Rate for Payer: Galaxy Health WC |
$191.23
|
| Rate for Payer: Global Benefits Group Commercial |
$134.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$202.48
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$168.74
|
| Rate for Payer: IEHP medi-cal |
$78.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$150.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.00
|
| Rate for Payer: Multiplan Commercial |
$168.74
|
| Rate for Payer: Networks By Design Commercial |
$146.24
|
| Rate for Payer: Prime Health Services Commercial |
$191.23
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$134.99
|
| Rate for Payer: Riverside University Health MISP |
$89.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$134.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$134.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$112.49
|
| Rate for Payer: United Healthcare All Other HMO |
$112.49
|
| Rate for Payer: United Healthcare HMO Rider |
$112.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$112.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$191.23
|
| Rate for Payer: Vantage Medical Group Senior |
$191.23
|
|
|
HC TUBE TRACH SHILEY PEDS 5MM
|
Facility
IP
|
$224.98
|
|
| Hospital Charge Code |
901603786
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$202.48 |
| Rate for Payer: Cash Price |
$101.24
|
| Rate for Payer: Central Health Plan Commercial |
$179.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.99
|
| Rate for Payer: Galaxy Health WC |
$191.23
|
| Rate for Payer: Global Benefits Group Commercial |
$134.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$202.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$150.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.00
|
| Rate for Payer: Multiplan Commercial |
$168.74
|
| Rate for Payer: Networks By Design Commercial |
$146.24
|
| Rate for Payer: Prime Health Services Commercial |
$191.23
|
|
|
HC TUBE TRACH SHILEY PEDS 5MM
|
Facility
OP
|
$224.98
|
|
| Hospital Charge Code |
901603786
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$202.48 |
| Rate for Payer: Aetna of CA HMO/PPO |
$136.63
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$191.23
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$123.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$123.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$108.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.92
|
| Rate for Payer: BCBS Transplant Transplant |
$134.99
|
| Rate for Payer: Blue Shield of California Commercial |
$141.51
|
| Rate for Payer: Blue Shield of California EPN |
$110.02
|
| Rate for Payer: Cash Price |
$101.24
|
| Rate for Payer: Central Health Plan Commercial |
$179.98
|
| Rate for Payer: Cigna of CA HMO |
$143.99
|
| Rate for Payer: Cigna of CA PPO |
$166.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$191.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.99
|
| Rate for Payer: EPIC Health Plan Transplant |
$89.99
|
| Rate for Payer: Galaxy Health WC |
$191.23
|
| Rate for Payer: Global Benefits Group Commercial |
$134.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$202.48
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$168.74
|
| Rate for Payer: IEHP medi-cal |
$78.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$150.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.00
|
| Rate for Payer: Multiplan Commercial |
$168.74
|
| Rate for Payer: Networks By Design Commercial |
$146.24
|
| Rate for Payer: Prime Health Services Commercial |
$191.23
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$134.99
|
| Rate for Payer: Riverside University Health MISP |
$89.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$134.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$134.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$112.49
|
| Rate for Payer: United Healthcare All Other HMO |
$112.49
|
| Rate for Payer: United Healthcare HMO Rider |
$112.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$112.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$191.23
|
| Rate for Payer: Vantage Medical Group Senior |
$191.23
|
|
|
HC TUBE TRACH SHILEY SIZE 5.5
|
Facility
OP
|
$224.98
|
|
| Hospital Charge Code |
901601204
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$202.48 |
| Rate for Payer: Aetna of CA HMO/PPO |
$136.63
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$191.23
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$123.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$123.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$108.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.92
|
| Rate for Payer: BCBS Transplant Transplant |
$134.99
|
| Rate for Payer: Blue Shield of California Commercial |
$141.51
|
| Rate for Payer: Blue Shield of California EPN |
$110.02
|
| Rate for Payer: Cash Price |
$101.24
|
| Rate for Payer: Central Health Plan Commercial |
$179.98
|
| Rate for Payer: Cigna of CA HMO |
$143.99
|
| Rate for Payer: Cigna of CA PPO |
$166.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$191.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.99
|
| Rate for Payer: EPIC Health Plan Transplant |
$89.99
|
| Rate for Payer: Galaxy Health WC |
$191.23
|
| Rate for Payer: Global Benefits Group Commercial |
$134.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$202.48
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$168.74
|
| Rate for Payer: IEHP medi-cal |
$78.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$150.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.00
|
| Rate for Payer: Multiplan Commercial |
$168.74
|
| Rate for Payer: Networks By Design Commercial |
$146.24
|
| Rate for Payer: Prime Health Services Commercial |
$191.23
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$134.99
|
| Rate for Payer: Riverside University Health MISP |
$89.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$134.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$134.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$112.49
|
| Rate for Payer: United Healthcare All Other HMO |
$112.49
|
| Rate for Payer: United Healthcare HMO Rider |
$112.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$112.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$191.23
|
| Rate for Payer: Vantage Medical Group Senior |
$191.23
|
|
|
HC TUBE TRACH SHILEY SIZE 5.5
|
Facility
IP
|
$224.98
|
|
| Hospital Charge Code |
901601204
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$202.48 |
| Rate for Payer: Cash Price |
$101.24
|
| Rate for Payer: Central Health Plan Commercial |
$179.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.99
|
| Rate for Payer: Galaxy Health WC |
$191.23
|
| Rate for Payer: Global Benefits Group Commercial |
$134.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$202.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$150.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.00
|
| Rate for Payer: Multiplan Commercial |
$168.74
|
| Rate for Payer: Networks By Design Commercial |
$146.24
|
| Rate for Payer: Prime Health Services Commercial |
$191.23
|
|
|
HC TUBE TRANSFER CAPD REG 48"
|
Facility
IP
|
$91.73
|
|
| Hospital Charge Code |
901601947
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.35 |
| Max. Negotiated Rate |
$82.56 |
| Rate for Payer: Cash Price |
$41.28
|
| Rate for Payer: Central Health Plan Commercial |
$73.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.69
|
| Rate for Payer: Galaxy Health WC |
$77.97
|
| Rate for Payer: Global Benefits Group Commercial |
$55.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$82.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$61.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.35
|
| Rate for Payer: Multiplan Commercial |
$68.80
|
| Rate for Payer: Networks By Design Commercial |
$59.62
|
| Rate for Payer: Prime Health Services Commercial |
$77.97
|
|
|
HC TUBE TRANSFER CAPD REG 48"
|
Facility
OP
|
$91.73
|
|
| Hospital Charge Code |
901601947
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.35 |
| Max. Negotiated Rate |
$82.56 |
| Rate for Payer: Aetna of CA HMO/PPO |
$55.71
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$77.97
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$50.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$50.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$44.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.19
|
| Rate for Payer: BCBS Transplant Transplant |
$55.04
|
| Rate for Payer: Blue Shield of California Commercial |
$57.70
|
| Rate for Payer: Blue Shield of California EPN |
$44.86
|
| Rate for Payer: Cash Price |
$41.28
|
| Rate for Payer: Central Health Plan Commercial |
$73.38
|
| Rate for Payer: Cigna of CA HMO |
$58.71
|
| Rate for Payer: Cigna of CA PPO |
$67.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$77.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$36.69
|
| Rate for Payer: Galaxy Health WC |
$77.97
|
| Rate for Payer: Global Benefits Group Commercial |
$55.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$82.56
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$68.80
|
| Rate for Payer: IEHP medi-cal |
$32.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$61.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.35
|
| Rate for Payer: Multiplan Commercial |
$68.80
|
| Rate for Payer: Networks By Design Commercial |
$59.62
|
| Rate for Payer: Prime Health Services Commercial |
$77.97
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$55.04
|
| Rate for Payer: Riverside University Health MISP |
$36.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$55.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$55.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.86
|
| Rate for Payer: United Healthcare All Other HMO |
$45.86
|
| Rate for Payer: United Healthcare HMO Rider |
$45.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$45.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$77.97
|
| Rate for Payer: Vantage Medical Group Senior |
$77.97
|
|
|
HC TUBE VAC ULTA VERATRAC DUO SET
|
Facility
OP
|
$580.00
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901698620
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$62.09 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$62.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$319.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$280.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$342.66
|
| Rate for Payer: BCBS Transplant Transplant |
$348.00
|
| Rate for Payer: Blue Shield of California Commercial |
$364.82
|
| Rate for Payer: Blue Shield of California EPN |
$283.62
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Cigna of CA HMO |
$371.20
|
| Rate for Payer: Cigna of CA PPO |
$429.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$435.00
|
| Rate for Payer: IEHP medi-cal |
$203.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: Riverside University Health MISP |
$232.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$290.00
|
| Rate for Payer: United Healthcare All Other HMO |
$290.00
|
| Rate for Payer: United Healthcare HMO Rider |
$290.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC TUBE VAC ULTA VERATRAC DUO SET
|
Facility
IP
|
$580.00
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901698620
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
|
|
HC TUBE YANKAUER SUCTION REG
|
Facility
OP
|
$5.99
|
|
|
Service Code
|
CPT A4628
|
| Hospital Charge Code |
901698726
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$9.82 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.54
|
| Rate for Payer: BCBS Transplant Transplant |
$3.59
|
| Rate for Payer: Blue Shield of California Commercial |
$3.77
|
| Rate for Payer: Blue Shield of California EPN |
$2.93
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Central Health Plan Commercial |
$4.79
|
| Rate for Payer: Cigna of CA HMO |
$3.83
|
| Rate for Payer: Cigna of CA PPO |
$4.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.40
|
| Rate for Payer: Galaxy Health WC |
$5.09
|
| Rate for Payer: Global Benefits Group Commercial |
$3.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.39
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.49
|
| Rate for Payer: IEHP medi-cal |
$2.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.20
|
| Rate for Payer: Multiplan Commercial |
$4.49
|
| Rate for Payer: Networks By Design Commercial |
$3.89
|
| Rate for Payer: Prime Health Services Commercial |
$5.09
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.59
|
| Rate for Payer: Riverside University Health MISP |
$2.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.09
|
| Rate for Payer: Vantage Medical Group Senior |
$5.09
|
|
|
HC TUBE YANKAUER SUCTION REG
|
Facility
IP
|
$5.99
|
|
|
Service Code
|
CPT A4628
|
| Hospital Charge Code |
901698726
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$5.39 |
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Central Health Plan Commercial |
$4.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: Galaxy Health WC |
$5.09
|
| Rate for Payer: Global Benefits Group Commercial |
$3.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.20
|
| Rate for Payer: Multiplan Commercial |
$4.49
|
| Rate for Payer: Networks By Design Commercial |
$3.89
|
| Rate for Payer: Prime Health Services Commercial |
$5.09
|
|
|
HC TUMOR LOCAL I-111 ZEVALIN DIAGNOSTIC
|
Facility
OP
|
$3,961.00
|
|
|
Service Code
|
CPT 78804
|
| Hospital Charge Code |
909301340
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$792.20 |
| Max. Negotiated Rate |
$3,564.90 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,774.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,965.63
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,661.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,951.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,774.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$903.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,340.16
|
| Rate for Payer: BCBS Transplant Transplant |
$2,376.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,447.90
|
| Rate for Payer: Blue Shield of California EPN |
$1,925.05
|
| Rate for Payer: Caremore Medicare Advantage |
$1,774.15
|
| Rate for Payer: Cash Price |
$1,782.45
|
| Rate for Payer: Cash Price |
$1,782.45
|
| Rate for Payer: Central Health Plan Commercial |
$3,168.80
|
| Rate for Payer: Cigna of CA HMO |
$2,535.04
|
| Rate for Payer: Cigna of CA PPO |
$2,931.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,661.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,395.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,774.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,774.15
|
| Rate for Payer: Galaxy Health WC |
$3,366.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,376.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,564.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,970.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,909.61
|
| Rate for Payer: IEHP medi-cal |
$2,927.35
|
| Rate for Payer: IEHP Medicare Advantage |
$1,774.15
|
| Rate for Payer: Innovage PACE Commercial |
$2,661.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,641.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,774.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$792.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,377.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,377.36
|
| Rate for Payer: Multiplan Commercial |
$2,970.75
|
| Rate for Payer: Networks By Design Commercial |
$2,574.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,366.85
|
| Rate for Payer: Prime Health Services Medicare |
$1,880.60
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,376.60
|
| Rate for Payer: Riverside University Health MISP |
$1,951.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,376.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,376.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,519.84
|
| Rate for Payer: United Healthcare All Other HMO |
$2,519.84
|
| Rate for Payer: United Healthcare HMO Rider |
$2,519.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,519.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,661.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,951.56
|
| Rate for Payer: Vantage Medical Group Senior |
$1,774.15
|
|
|
HC TUMOR LOCAL I-111 ZEVALIN DIAGNOSTIC
|
Facility
IP
|
$3,961.00
|
|
|
Service Code
|
CPT 78804
|
| Hospital Charge Code |
909301340
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$792.20 |
| Max. Negotiated Rate |
$3,564.90 |
| Rate for Payer: Cash Price |
$1,782.45
|
| Rate for Payer: Central Health Plan Commercial |
$3,168.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,584.40
|
| Rate for Payer: Galaxy Health WC |
$3,366.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,376.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,564.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,641.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$792.20
|
| Rate for Payer: Multiplan Commercial |
$2,970.75
|
| Rate for Payer: Networks By Design Commercial |
$2,574.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,366.85
|
|
|
HC TUMOR LOCLIZATN SPECT SNGL DAY
|
Facility
IP
|
$4,872.00
|
|
|
Service Code
|
CPT 78803
|
| Hospital Charge Code |
909301254
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$974.40 |
| Max. Negotiated Rate |
$4,384.80 |
| Rate for Payer: Cash Price |
$2,192.40
|
| Rate for Payer: Central Health Plan Commercial |
$3,897.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,948.80
|
| Rate for Payer: Galaxy Health WC |
$4,141.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,923.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,384.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,249.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$974.40
|
| Rate for Payer: Multiplan Commercial |
$3,654.00
|
| Rate for Payer: Networks By Design Commercial |
$3,166.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,141.20
|
|
|
HC TUMOR LOCLIZATN SPECT SNGL DAY
|
Facility
OP
|
$4,872.00
|
|
|
Service Code
|
CPT 78803
|
| Hospital Charge Code |
909301254
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$974.40 |
| Max. Negotiated Rate |
$4,384.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,774.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,674.31
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,661.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,951.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,774.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,236.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,878.38
|
| Rate for Payer: BCBS Transplant Transplant |
$2,923.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,010.90
|
| Rate for Payer: Blue Shield of California EPN |
$2,367.79
|
| Rate for Payer: Caremore Medicare Advantage |
$1,774.15
|
| Rate for Payer: Cash Price |
$2,192.40
|
| Rate for Payer: Cash Price |
$2,192.40
|
| Rate for Payer: Central Health Plan Commercial |
$3,897.60
|
| Rate for Payer: Cigna of CA HMO |
$3,118.08
|
| Rate for Payer: Cigna of CA PPO |
$3,605.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,661.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,395.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,774.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,774.15
|
| Rate for Payer: Galaxy Health WC |
$4,141.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,923.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,384.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,654.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,909.61
|
| Rate for Payer: IEHP medi-cal |
$2,927.35
|
| Rate for Payer: IEHP Medicare Advantage |
$1,774.15
|
| Rate for Payer: Innovage PACE Commercial |
$2,661.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,249.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,774.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$974.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,377.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,377.36
|
| Rate for Payer: Multiplan Commercial |
$3,654.00
|
| Rate for Payer: Networks By Design Commercial |
$3,166.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,141.20
|
| Rate for Payer: Prime Health Services Medicare |
$1,880.60
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,923.20
|
| Rate for Payer: Riverside University Health MISP |
$1,951.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,923.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,923.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,260.70
|
| Rate for Payer: United Healthcare All Other HMO |
$1,260.70
|
| Rate for Payer: United Healthcare HMO Rider |
$1,260.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,260.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,661.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,951.56
|
| Rate for Payer: Vantage Medical Group Senior |
$1,774.15
|
|
|
HC TURBO TRACKER 2-TIP
|
Facility
IP
|
$1,170.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909081811
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$234.00 |
| Max. Negotiated Rate |
$1,053.00 |
| Rate for Payer: Cash Price |
$526.50
|
| Rate for Payer: Central Health Plan Commercial |
$936.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$468.00
|
| Rate for Payer: Galaxy Health WC |
$994.50
|
| Rate for Payer: Global Benefits Group Commercial |
$702.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,053.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$780.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.00
|
| Rate for Payer: Multiplan Commercial |
$877.50
|
| Rate for Payer: Networks By Design Commercial |
$760.50
|
| Rate for Payer: Prime Health Services Commercial |
$994.50
|
|
|
HC TURBO TRACKER 2-TIP
|
Facility
OP
|
$1,170.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909081811
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$188.37 |
| Max. Negotiated Rate |
$1,053.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$188.37
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$994.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$643.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$643.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$566.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$691.24
|
| Rate for Payer: BCBS Transplant Transplant |
$702.00
|
| Rate for Payer: Blue Shield of California Commercial |
$735.93
|
| Rate for Payer: Blue Shield of California EPN |
$572.13
|
| Rate for Payer: Cash Price |
$526.50
|
| Rate for Payer: Cash Price |
$526.50
|
| Rate for Payer: Central Health Plan Commercial |
$936.00
|
| Rate for Payer: Cigna of CA HMO |
$748.80
|
| Rate for Payer: Cigna of CA PPO |
$865.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$994.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$468.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$468.00
|
| Rate for Payer: Galaxy Health WC |
$994.50
|
| Rate for Payer: Global Benefits Group Commercial |
$702.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,053.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$877.50
|
| Rate for Payer: IEHP medi-cal |
$409.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$780.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.00
|
| Rate for Payer: Multiplan Commercial |
$877.50
|
| Rate for Payer: Networks By Design Commercial |
$760.50
|
| Rate for Payer: Prime Health Services Commercial |
$994.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$702.00
|
| Rate for Payer: Riverside University Health MISP |
$468.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$702.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$702.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$585.00
|
| Rate for Payer: United Healthcare All Other HMO |
$585.00
|
| Rate for Payer: United Healthcare HMO Rider |
$585.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$585.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$994.50
|
| Rate for Payer: Vantage Medical Group Senior |
$994.50
|
|
|
HC TVSWG VARIABLESTIFFNESS(TAD/II
|
Facility
IP
|
$93.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081230
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.60 |
| Max. Negotiated Rate |
$83.70 |
| Rate for Payer: Cash Price |
$41.85
|
| Rate for Payer: Central Health Plan Commercial |
$74.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.20
|
| Rate for Payer: Galaxy Health WC |
$79.05
|
| Rate for Payer: Global Benefits Group Commercial |
$55.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$83.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$62.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.60
|
| Rate for Payer: Multiplan Commercial |
$69.75
|
| Rate for Payer: Networks By Design Commercial |
$60.45
|
| Rate for Payer: Prime Health Services Commercial |
$79.05
|
|
|
HC TVSWG VARIABLESTIFFNESS(TAD/II
|
Facility
OP
|
$93.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081230
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.60 |
| Max. Negotiated Rate |
$396.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$396.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$79.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$51.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$51.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$45.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.94
|
| Rate for Payer: BCBS Transplant Transplant |
$55.80
|
| Rate for Payer: Blue Shield of California Commercial |
$58.50
|
| Rate for Payer: Blue Shield of California EPN |
$45.48
|
| Rate for Payer: Cash Price |
$41.85
|
| Rate for Payer: Cash Price |
$41.85
|
| Rate for Payer: Central Health Plan Commercial |
$74.40
|
| Rate for Payer: Cigna of CA HMO |
$59.52
|
| Rate for Payer: Cigna of CA PPO |
$68.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$79.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$37.20
|
| Rate for Payer: Galaxy Health WC |
$79.05
|
| Rate for Payer: Global Benefits Group Commercial |
$55.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$83.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$69.75
|
| Rate for Payer: IEHP medi-cal |
$32.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$62.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.60
|
| Rate for Payer: Multiplan Commercial |
$69.75
|
| Rate for Payer: Networks By Design Commercial |
$60.45
|
| Rate for Payer: Prime Health Services Commercial |
$79.05
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$55.80
|
| Rate for Payer: Riverside University Health MISP |
$37.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$55.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$55.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$46.50
|
| Rate for Payer: United Healthcare All Other HMO |
$46.50
|
| Rate for Payer: United Healthcare HMO Rider |
$46.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$46.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$79.05
|
| Rate for Payer: Vantage Medical Group Senior |
$79.05
|
|
|
HC T-WAVE ALTERNANS
|
Facility
IP
|
$1,831.00
|
|
|
Service Code
|
CPT 93025
|
| Hospital Charge Code |
900200153
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$366.20 |
| Max. Negotiated Rate |
$1,647.90 |
| Rate for Payer: Cash Price |
$823.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,464.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$732.40
|
| Rate for Payer: Galaxy Health WC |
$1,556.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,098.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,647.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,221.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$366.20
|
| Rate for Payer: Multiplan Commercial |
$1,373.25
|
| Rate for Payer: Networks By Design Commercial |
$1,190.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,556.35
|
|
|
HC T-WAVE ALTERNANS
|
Facility
OP
|
$1,831.00
|
|
|
Service Code
|
CPT 93025
|
| Hospital Charge Code |
900200153
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$195.17 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Adventist Health Medi-Cal |
$195.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$935.57
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$195.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,815.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,081.75
|
| Rate for Payer: BCBS Transplant Transplant |
$1,098.60
|
| 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: Caremore Medicare Advantage |
$195.17
|
| Rate for Payer: Cash Price |
$823.95
|
| Rate for Payer: Cash Price |
$823.95
|
| Rate for Payer: Cash Price |
$823.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,464.80
|
| Rate for Payer: Cigna of CA HMO |
$1,171.84
|
| Rate for Payer: Cigna of CA PPO |
$1,354.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$292.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$263.48
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$195.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$195.17
|
| Rate for Payer: Galaxy Health WC |
$1,556.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,098.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,647.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,373.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$320.08
|
| Rate for Payer: IEHP medi-cal |
$322.03
|
| Rate for Payer: IEHP Medicare Advantage |
$195.17
|
| Rate for Payer: Innovage PACE Commercial |
$292.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,221.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$195.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$366.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$261.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$261.53
|
| Rate for Payer: Multiplan Commercial |
$1,373.25
|
| Rate for Payer: Networks By Design Commercial |
$1,190.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,556.35
|
| Rate for Payer: Prime Health Services Medicare |
$206.88
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,098.60
|
| Rate for Payer: Riverside University Health MISP |
$214.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,098.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,098.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,078.00
|
| Rate for Payer: United Healthcare All Other HMO |
$827.00
|
| Rate for Payer: United Healthcare HMO Rider |
$702.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$643.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Vantage Medical Group Senior |
$195.17
|
|
|
HC U1RNP AUTO AB
|
Facility
IP
|
$162.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913524
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$145.80 |
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Central Health Plan Commercial |
$129.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.80
|
| Rate for Payer: Galaxy Health WC |
$137.70
|
| Rate for Payer: Global Benefits Group Commercial |
$97.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$145.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$108.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.40
|
| Rate for Payer: Multiplan Commercial |
$121.50
|
| Rate for Payer: Networks By Design Commercial |
$105.30
|
| Rate for Payer: Prime Health Services Commercial |
$137.70
|
|
