|
HC TTE W WO CONTR ECG
|
Facility
|
IP
|
$1,949.00
|
|
|
Service Code
|
CPT C8930
|
| Hospital Charge Code |
900200257
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$389.80 |
| Max. Negotiated Rate |
$1,754.10 |
| Rate for Payer: Adventist Health Commercial |
$389.80
|
| Rate for Payer: Cash Price |
$1,071.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,559.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$779.60
|
| Rate for Payer: EPIC Health Plan Senior |
$779.60
|
| Rate for Payer: Galaxy Health WC |
$1,656.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,169.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,754.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,299.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$742.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,206.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$389.80
|
| Rate for Payer: Multiplan Commercial |
$1,461.75
|
| Rate for Payer: Networks By Design Commercial |
$1,266.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,656.65
|
|
|
HC TTE W WO CONTR ECG
|
Facility
|
OP
|
$1,949.00
|
|
|
Service Code
|
CPT C8930
|
| Hospital Charge Code |
900200257
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$389.80 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$389.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,003.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,183.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,104.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,003.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,183.04
|
| Rate for Payer: Blue Shield of California EPN |
$773.75
|
| Rate for Payer: Cash Price |
$1,071.95
|
| Rate for Payer: Cash Price |
$1,071.95
|
| Rate for Payer: Cash Price |
$1,071.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,559.20
|
| Rate for Payer: Cigna of CA HMO |
$1,247.36
|
| Rate for Payer: Cigna of CA PPO |
$1,442.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,104.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,003.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,355.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,003.85
|
| Rate for Payer: Galaxy Health WC |
$1,656.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,169.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,754.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,646.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,003.85
|
| Rate for Payer: InnovAge PACE Commercial |
$1,505.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,299.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$742.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,003.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$389.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,345.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,345.16
|
| Rate for Payer: Multiplan Commercial |
$1,461.75
|
| Rate for Payer: Networks By Design Commercial |
$1,266.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,003.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,656.65
|
| Rate for Payer: Prime Health Services Medicare |
$1,064.08
|
| Rate for Payer: Riverside University Health System MISP |
$1,104.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,169.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,169.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$968.00
|
| Rate for Payer: United Healthcare All Other HMO |
$982.00
|
| Rate for Payer: United Healthcare HMO Rider |
$832.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$762.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,003.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,104.23
|
| Rate for Payer: Vantage Medical Group Senior |
$1,003.85
|
|
|
HC TTG IGA
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900913669
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.34 |
| Max. Negotiated Rate |
$170.20 |
| Rate for Payer: Adventist Health Commercial |
$9.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$11.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$29.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Alpha Care 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 |
$34.54
|
| Rate for Payer: Blue Shield of California Commercial |
$29.74
|
| Rate for Payer: Blue Shield of California EPN |
$19.45
|
| Rate for Payer: Cash Price |
$26.95
|
| Rate for Payer: Cash Price |
$26.95
|
| Rate for Payer: Central Health Plan Commercial |
$39.20
|
| Rate for Payer: Cigna of CA HMO |
$31.36
|
| Rate for Payer: Cigna of CA PPO |
$36.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.57
|
| Rate for Payer: EPIC Health Plan Senior |
$11.53
|
| Rate for Payer: Galaxy Health WC |
$41.65
|
| Rate for Payer: Global Benefits Group Commercial |
$29.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: InnovAge PACE Commercial |
$17.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.80
|
| 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 |
$36.75
|
| Rate for Payer: Networks By Design Commercial |
$31.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11.53
|
| Rate for Payer: Prime Health Services Commercial |
$41.65
|
| Rate for Payer: Prime Health Services Medicare |
$12.22
|
| Rate for Payer: Riverside University Health System MISP |
$12.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.40
|
| 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: Upland Medical Group Pediatric |
$11.53
|
| 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 IGA
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900913669
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$44.10 |
| Rate for Payer: Adventist Health Commercial |
$9.80
|
| Rate for Payer: Cash Price |
$26.95
|
| Rate for Payer: Central Health Plan Commercial |
$39.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.60
|
| Rate for Payer: EPIC Health Plan Senior |
$19.60
|
| Rate for Payer: Galaxy Health WC |
$41.65
|
| Rate for Payer: Global Benefits Group Commercial |
$29.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.80
|
| Rate for Payer: Multiplan Commercial |
$36.75
|
| Rate for Payer: Networks By Design Commercial |
$31.85
|
| Rate for Payer: Prime Health Services Commercial |
$41.65
|
|
|
HC TTG IGG
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900913670
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$44.10 |
| Rate for Payer: Adventist Health Commercial |
$9.80
|
| Rate for Payer: Cash Price |
$26.95
|
| Rate for Payer: Central Health Plan Commercial |
$39.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.60
|
| Rate for Payer: EPIC Health Plan Senior |
$19.60
|
| Rate for Payer: Galaxy Health WC |
$41.65
|
| Rate for Payer: Global Benefits Group Commercial |
$29.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.80
|
| Rate for Payer: Multiplan Commercial |
$36.75
|
| Rate for Payer: Networks By Design Commercial |
$31.85
|
| Rate for Payer: Prime Health Services Commercial |
$41.65
|
|
|
HC TTG IGG
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900913670
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.34 |
| Max. Negotiated Rate |
$170.20 |
| Rate for Payer: Adventist Health Commercial |
$9.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$11.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$29.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Alpha Care 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 |
$34.54
|
| Rate for Payer: Blue Shield of California Commercial |
$29.74
|
| Rate for Payer: Blue Shield of California EPN |
$19.45
|
| Rate for Payer: Cash Price |
$26.95
|
| Rate for Payer: Cash Price |
$26.95
|
| Rate for Payer: Central Health Plan Commercial |
$39.20
|
| Rate for Payer: Cigna of CA HMO |
$31.36
|
| Rate for Payer: Cigna of CA PPO |
$36.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.57
|
| Rate for Payer: EPIC Health Plan Senior |
$11.53
|
| Rate for Payer: Galaxy Health WC |
$41.65
|
| Rate for Payer: Global Benefits Group Commercial |
$29.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: InnovAge PACE Commercial |
$17.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.80
|
| 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 |
$36.75
|
| Rate for Payer: Networks By Design Commercial |
$31.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11.53
|
| Rate for Payer: Prime Health Services Commercial |
$41.65
|
| Rate for Payer: Prime Health Services Medicare |
$12.22
|
| Rate for Payer: Riverside University Health System MISP |
$12.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.40
|
| 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: Upland Medical Group Pediatric |
$11.53
|
| 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 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 |
$885.47 |
| Rate for Payer: Adventist Health Commercial |
$196.77
|
| Rate for Payer: Cash Price |
$541.12
|
| Rate for Payer: Central Health Plan Commercial |
$787.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$393.54
|
| Rate for Payer: EPIC Health Plan Senior |
$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 |
$885.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$656.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$374.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$609.00
|
| 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 3.0FR
|
Facility
|
OP
|
$983.85
|
|
| Hospital Charge Code |
900800901
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$196.77 |
| Max. Negotiated Rate |
$885.47 |
| Rate for Payer: Adventist Health Commercial |
$196.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$597.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$836.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$541.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$737.89
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$476.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$577.82
|
| Rate for Payer: Blue Shield of California Commercial |
$601.13
|
| Rate for Payer: Blue Shield of California EPN |
$392.56
|
| Rate for Payer: Cash Price |
$541.12
|
| 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: Dignity Health Medi-Cal |
$836.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$836.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$393.54
|
| Rate for Payer: EPIC Health Plan Senior |
$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 |
$885.47
|
| Rate for Payer: InnovAge PACE Commercial |
$491.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$656.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$374.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$609.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$688.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$688.70
|
| 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: Riverside University Health System 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 |
$491.93
|
| Rate for Payer: United Healthcare All Other HMO |
$491.93
|
| Rate for Payer: United Healthcare HMO Rider |
$491.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$491.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$836.27
|
| 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 3.5FR
|
Facility
|
OP
|
$983.85
|
|
| Hospital Charge Code |
900800902
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$196.77 |
| Max. Negotiated Rate |
$885.47 |
| Rate for Payer: Adventist Health Commercial |
$196.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$597.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$836.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$541.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$737.89
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$476.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$577.82
|
| Rate for Payer: Blue Shield of California Commercial |
$601.13
|
| Rate for Payer: Blue Shield of California EPN |
$392.56
|
| Rate for Payer: Cash Price |
$541.12
|
| 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: Dignity Health Medi-Cal |
$836.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$836.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$393.54
|
| Rate for Payer: EPIC Health Plan Senior |
$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 |
$885.47
|
| Rate for Payer: InnovAge PACE Commercial |
$491.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$656.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$374.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$609.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$688.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$688.70
|
| 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: Riverside University Health System 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 |
$491.93
|
| Rate for Payer: United Healthcare All Other HMO |
$491.93
|
| Rate for Payer: United Healthcare HMO Rider |
$491.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$491.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$836.27
|
| 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 3.5FR
|
Facility
|
IP
|
$983.85
|
|
| Hospital Charge Code |
900800902
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$196.77 |
| Max. Negotiated Rate |
$885.47 |
| Rate for Payer: Adventist Health Commercial |
$196.77
|
| Rate for Payer: Cash Price |
$541.12
|
| Rate for Payer: Central Health Plan Commercial |
$787.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$393.54
|
| Rate for Payer: EPIC Health Plan Senior |
$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 |
$885.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$656.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$374.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$609.00
|
| 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
|
IP
|
$983.85
|
|
| Hospital Charge Code |
900800903
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$196.77 |
| Max. Negotiated Rate |
$885.47 |
| Rate for Payer: Adventist Health Commercial |
$196.77
|
| Rate for Payer: Cash Price |
$541.12
|
| Rate for Payer: Central Health Plan Commercial |
$787.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$393.54
|
| Rate for Payer: EPIC Health Plan Senior |
$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 |
$885.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$656.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$374.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$609.00
|
| 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 |
$885.47 |
| Rate for Payer: Adventist Health Commercial |
$196.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$597.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$836.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$541.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$737.89
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$476.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$577.82
|
| Rate for Payer: Blue Shield of California Commercial |
$601.13
|
| Rate for Payer: Blue Shield of California EPN |
$392.56
|
| Rate for Payer: Cash Price |
$541.12
|
| 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: Dignity Health Medi-Cal |
$836.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$836.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$393.54
|
| Rate for Payer: EPIC Health Plan Senior |
$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 |
$885.47
|
| Rate for Payer: InnovAge PACE Commercial |
$491.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$656.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$374.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$609.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$688.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$688.70
|
| 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: Riverside University Health System 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 |
$491.93
|
| Rate for Payer: United Healthcare All Other HMO |
$491.93
|
| Rate for Payer: United Healthcare HMO Rider |
$491.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$491.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$836.27
|
| 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: Adventist Health Commercial |
$168.68
|
| Rate for Payer: Cash Price |
$463.88
|
| Rate for Payer: Central Health Plan Commercial |
$674.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.36
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medi-Cal |
$321.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$522.07
|
| 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: Adventist Health Commercial |
$168.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$512.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$716.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$463.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$632.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$408.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$495.33
|
| Rate for Payer: Blue Shield of California Commercial |
$515.32
|
| Rate for Payer: Blue Shield of California EPN |
$336.52
|
| Rate for Payer: Cash Price |
$463.88
|
| 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: Dignity Health Medi-Cal |
$716.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$716.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.36
|
| Rate for Payer: EPIC Health Plan Senior |
$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: InnovAge PACE Commercial |
$421.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$562.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$321.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$522.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$590.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$590.39
|
| 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: Riverside University Health System 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 Commercial/Exchange |
$716.90
|
| 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: Adventist Health Commercial |
$168.68
|
| Rate for Payer: Cash Price |
$463.88
|
| Rate for Payer: Central Health Plan Commercial |
$674.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.36
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medi-Cal |
$321.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$522.07
|
| 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 3.5MM
|
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: Adventist Health Commercial |
$168.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$512.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$716.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$463.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$632.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$408.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$495.33
|
| Rate for Payer: Blue Shield of California Commercial |
$515.32
|
| Rate for Payer: Blue Shield of California EPN |
$336.52
|
| Rate for Payer: Cash Price |
$463.88
|
| 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: Dignity Health Medi-Cal |
$716.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$716.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.36
|
| Rate for Payer: EPIC Health Plan Senior |
$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: InnovAge PACE Commercial |
$421.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$562.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$321.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$522.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$590.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$590.39
|
| 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: Riverside University Health System 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 Commercial/Exchange |
$716.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$716.90
|
| Rate for Payer: Vantage Medical Group Senior |
$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: Adventist Health Commercial |
$168.68
|
| Rate for Payer: Cash Price |
$463.88
|
| Rate for Payer: Central Health Plan Commercial |
$674.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.36
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medi-Cal |
$321.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$522.07
|
| 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: Adventist Health Commercial |
$168.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$512.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$716.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$463.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$632.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$408.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$495.33
|
| Rate for Payer: Blue Shield of California Commercial |
$515.32
|
| Rate for Payer: Blue Shield of California EPN |
$336.52
|
| Rate for Payer: Cash Price |
$463.88
|
| 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: Dignity Health Medi-Cal |
$716.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$716.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.36
|
| Rate for Payer: EPIC Health Plan Senior |
$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: InnovAge PACE Commercial |
$421.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$562.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$321.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$522.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$590.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$590.39
|
| 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: Riverside University Health System 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 Commercial/Exchange |
$716.90
|
| 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: Adventist Health Commercial |
$168.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$512.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$716.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$463.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$632.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$408.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$495.33
|
| Rate for Payer: Blue Shield of California Commercial |
$515.32
|
| Rate for Payer: Blue Shield of California EPN |
$336.52
|
| Rate for Payer: Cash Price |
$463.88
|
| 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: Dignity Health Medi-Cal |
$716.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$716.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.36
|
| Rate for Payer: EPIC Health Plan Senior |
$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: InnovAge PACE Commercial |
$421.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$562.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$321.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$522.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$590.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$590.39
|
| 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: Riverside University Health System 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 Commercial/Exchange |
$716.90
|
| 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: Adventist Health Commercial |
$168.68
|
| Rate for Payer: Cash Price |
$463.88
|
| Rate for Payer: Central Health Plan Commercial |
$674.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.36
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medi-Cal |
$321.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$522.07
|
| 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
|
IP
|
$843.41
|
|
| Hospital Charge Code |
900800905
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$168.68 |
| Max. Negotiated Rate |
$759.07 |
| Rate for Payer: Adventist Health Commercial |
$168.68
|
| Rate for Payer: Cash Price |
$463.88
|
| Rate for Payer: Central Health Plan Commercial |
$674.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.36
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medi-Cal |
$321.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$522.07
|
| 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: Adventist Health Commercial |
$168.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$512.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$716.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$463.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$632.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$408.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$495.33
|
| Rate for Payer: Blue Shield of California Commercial |
$515.32
|
| Rate for Payer: Blue Shield of California EPN |
$336.52
|
| Rate for Payer: Cash Price |
$463.88
|
| 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: Dignity Health Medi-Cal |
$716.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$716.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.36
|
| Rate for Payer: EPIC Health Plan Senior |
$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: InnovAge PACE Commercial |
$421.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$562.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$321.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$522.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$590.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$590.39
|
| 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: Riverside University Health System 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 Commercial/Exchange |
$716.90
|
| 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: Adventist Health Commercial |
$168.68
|
| Rate for Payer: Cash Price |
$463.88
|
| Rate for Payer: Central Health Plan Commercial |
$674.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.36
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medi-Cal |
$321.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$522.07
|
| 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: Adventist Health Commercial |
$168.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$512.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$716.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$463.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$632.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$408.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$495.33
|
| Rate for Payer: Blue Shield of California Commercial |
$515.32
|
| Rate for Payer: Blue Shield of California EPN |
$336.52
|
| Rate for Payer: Cash Price |
$463.88
|
| 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: Dignity Health Medi-Cal |
$716.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$716.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.36
|
| Rate for Payer: EPIC Health Plan Senior |
$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: InnovAge PACE Commercial |
$421.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$562.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$321.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$522.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$590.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$590.39
|
| 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: Riverside University Health System 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 Commercial/Exchange |
$716.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$716.90
|
| Rate for Payer: Vantage Medical Group Senior |
$716.90
|
|
|
HC T-TUBE CHOLANGIOGRAM INJ
|
Facility
|
OP
|
$2,860.00
|
|
|
Service Code
|
CPT 47531
|
| Hospital Charge Code |
909000191
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$572.00 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$572.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,484.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,726.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,932.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,484.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,764.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$7,144.49
|
| Rate for Payer: Blue Shield of California Commercial |
$4,851.77
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$1,573.00
|
| Rate for Payer: Cash Price |
$1,573.00
|
| Rate for Payer: Cash Price |
$1,573.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,288.00
|
| Rate for Payer: Cigna of CA HMO |
$1,830.40
|
| Rate for Payer: Cigna of CA PPO |
$2,116.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,726.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,932.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,484.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,053.43
|
| Rate for Payer: EPIC Health Plan Senior |
$4,484.02
|
| Rate for Payer: Galaxy Health WC |
$2,431.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,716.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,574.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,353.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$586.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,484.02
|
| Rate for Payer: InnovAge PACE Commercial |
$6,726.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,907.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$647.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,484.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$572.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,008.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,008.59
|
| Rate for Payer: Multiplan Commercial |
$2,145.00
|
| Rate for Payer: Multiplan WC |
$7,144.49
|
| Rate for Payer: Networks By Design Commercial |
$1,859.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,484.02
|
| Rate for Payer: Preferred Health Network WC |
$7,290.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,431.00
|
| Rate for Payer: Prime Health Services Medicare |
$4,753.06
|
| Rate for Payer: Prime Health Services WC |
$7,071.59
|
| Rate for Payer: Riverside University Health System MISP |
$4,932.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,716.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,484.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,726.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,932.42
|
| Rate for Payer: Vantage Medical Group Senior |
$4,484.02
|
|
