|
HC VENT ASSIST & MGT SUB DAILY
|
Facility
IP
|
$7,641.00
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
900800101
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$1,528.20 |
| Max. Negotiated Rate |
$6,876.90 |
| Rate for Payer: Cash Price |
$3,438.45
|
| Rate for Payer: Central Health Plan Commercial |
$6,112.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,056.40
|
| Rate for Payer: Galaxy Health WC |
$6,494.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,584.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,876.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,096.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,528.20
|
| Rate for Payer: Multiplan Commercial |
$5,730.75
|
| Rate for Payer: Networks By Design Commercial |
$4,966.65
|
| Rate for Payer: Prime Health Services Commercial |
$6,494.85
|
|
|
HC VENT ASSIST & MGT SUB DAILY
|
Facility
OP
|
$7,641.00
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
900800101
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$287.00 |
| Max. Negotiated Rate |
$6,876.90 |
| Rate for Payer: Adventist Health Medi-Cal |
$782.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$370.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,174.46
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$861.27
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$782.97
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: BCBS Transplant Transplant |
$4,584.60
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Caremore Medicare Advantage |
$782.97
|
| Rate for Payer: Cash Price |
$3,438.45
|
| Rate for Payer: Cash Price |
$3,438.45
|
| Rate for Payer: Cash Price |
$3,438.45
|
| Rate for Payer: Cash Price |
$3,438.45
|
| Rate for Payer: Central Health Plan Commercial |
$6,112.80
|
| Rate for Payer: Cigna of CA HMO |
$4,890.24
|
| Rate for Payer: Cigna of CA PPO |
$5,654.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,174.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,057.01
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$782.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$782.97
|
| Rate for Payer: Galaxy Health WC |
$6,494.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,584.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,876.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5,730.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,284.07
|
| Rate for Payer: IEHP medi-cal |
$1,291.90
|
| Rate for Payer: IEHP Medicare Advantage |
$782.97
|
| Rate for Payer: Innovage PACE Commercial |
$1,174.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,096.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$782.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,528.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,049.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,049.18
|
| Rate for Payer: Multiplan Commercial |
$5,730.75
|
| Rate for Payer: Networks By Design Commercial |
$4,966.65
|
| Rate for Payer: Prime Health Services Commercial |
$6,494.85
|
| Rate for Payer: Prime Health Services Medicare |
$829.95
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4,584.60
|
| Rate for Payer: Riverside University Health MISP |
$861.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,584.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,584.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$509.00
|
| Rate for Payer: United Healthcare All Other HMO |
$478.00
|
| Rate for Payer: United Healthcare HMO Rider |
$428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$391.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,174.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$861.27
|
| Rate for Payer: Vantage Medical Group Senior |
$782.97
|
|
|
HC VENT PUNC THR PREV BURR HOLE
|
Facility
IP
|
$2,754.00
|
|
|
Service Code
|
CPT 61020
|
| Hospital Charge Code |
900501253
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$550.80 |
| Max. Negotiated Rate |
$2,478.60 |
| Rate for Payer: Cash Price |
$1,239.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,203.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,101.60
|
| Rate for Payer: Galaxy Health WC |
$2,340.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,652.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,478.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,836.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$550.80
|
| Rate for Payer: Multiplan Commercial |
$2,065.50
|
| Rate for Payer: Networks By Design Commercial |
$1,790.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,340.90
|
|
|
HC VENT PUNC THR PREV BURR HOLE
|
Facility
IP
|
$2,754.00
|
|
|
Service Code
|
CPT 61020
|
| Hospital Charge Code |
900501253
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$550.80 |
| Max. Negotiated Rate |
$2,478.60 |
| Rate for Payer: Cash Price |
$1,239.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,203.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,101.60
|
| Rate for Payer: Galaxy Health WC |
$2,340.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,652.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,478.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,836.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$550.80
|
| Rate for Payer: Multiplan Commercial |
$2,065.50
|
| Rate for Payer: Networks By Design Commercial |
$1,790.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,340.90
|
|
|
HC VENT PUNC THR PREV BURR HOLE
|
Facility
OP
|
$2,754.00
|
|
|
Service Code
|
CPT 61020
|
| Hospital Charge Code |
900501253
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,138.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1,652.40
|
| Rate for Payer: Caremore Medicare Advantage |
$1,138.83
|
| Rate for Payer: Cash Price |
$1,239.30
|
| Rate for Payer: Cash Price |
$1,239.30
|
| Rate for Payer: Cash Price |
$1,239.30
|
| Rate for Payer: Cash Price |
$1,239.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,203.20
|
| Rate for Payer: Cigna of CA PPO |
$2,037.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,708.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,537.42
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,138.83
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,138.83
|
| Rate for Payer: Galaxy Health WC |
$2,340.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,652.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,478.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,065.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,867.68
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$1,138.83
|
| Rate for Payer: Innovage PACE Commercial |
$1,708.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,836.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,138.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$550.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,526.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,526.03
|
| Rate for Payer: Multiplan Commercial |
$2,065.50
|
| Rate for Payer: Networks By Design Commercial |
$1,790.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,340.90
|
| Rate for Payer: Prime Health Services Medicare |
$1,207.16
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,652.40
|
| Rate for Payer: Riverside University Health MISP |
$1,252.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,652.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,377.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,377.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,377.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,377.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: Vantage Medical Group Senior |
$1,138.83
|
|
|
HC VENT PUNC THR PREV BURR HOLE
|
Facility
OP
|
$2,754.00
|
|
|
Service Code
|
CPT 61020
|
| Hospital Charge Code |
900501253
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$550.80 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,138.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,138.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1,652.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,732.27
|
| Rate for Payer: Blue Shield of California EPN |
$1,346.71
|
| Rate for Payer: Caremore Medicare Advantage |
$1,138.83
|
| Rate for Payer: Cash Price |
$1,239.30
|
| Rate for Payer: Cash Price |
$1,239.30
|
| Rate for Payer: Cash Price |
$1,239.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,203.20
|
| Rate for Payer: Cigna of CA HMO |
$1,762.56
|
| Rate for Payer: Cigna of CA PPO |
$2,037.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,708.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,537.42
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,138.83
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,138.83
|
| Rate for Payer: Galaxy Health WC |
$2,340.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,652.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,478.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,065.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,867.68
|
| Rate for Payer: IEHP medi-cal |
$1,879.07
|
| Rate for Payer: IEHP Medicare Advantage |
$1,138.83
|
| Rate for Payer: Innovage PACE Commercial |
$1,708.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,836.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,138.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$550.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,526.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,526.03
|
| Rate for Payer: Multiplan Commercial |
$2,065.50
|
| Rate for Payer: Networks By Design Commercial |
$1,790.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,340.90
|
| Rate for Payer: Prime Health Services Medicare |
$1,207.16
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,652.40
|
| Rate for Payer: Riverside University Health MISP |
$1,252.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,652.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,652.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,377.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,377.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,377.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,377.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: Vantage Medical Group Senior |
$1,138.83
|
|
|
HC VENT TUBE
|
Facility
OP
|
$300.00
|
|
| Hospital Charge Code |
909081809
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$182.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$255.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$165.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$165.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$145.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$177.24
|
| Rate for Payer: BCBS Transplant Transplant |
$180.00
|
| Rate for Payer: Blue Shield of California Commercial |
$188.70
|
| Rate for Payer: Blue Shield of California EPN |
$146.70
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Central Health Plan Commercial |
$240.00
|
| Rate for Payer: Cigna of CA HMO |
$192.00
|
| Rate for Payer: Cigna of CA PPO |
$222.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$255.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$120.00
|
| Rate for Payer: Galaxy Health WC |
$255.00
|
| Rate for Payer: Global Benefits Group Commercial |
$180.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$270.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$225.00
|
| Rate for Payer: IEHP medi-cal |
$105.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$200.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Multiplan Commercial |
$225.00
|
| Rate for Payer: Networks By Design Commercial |
$195.00
|
| Rate for Payer: Prime Health Services Commercial |
$255.00
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$180.00
|
| Rate for Payer: Riverside University Health MISP |
$120.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$180.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$180.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$150.00
|
| Rate for Payer: United Healthcare All Other HMO |
$150.00
|
| Rate for Payer: United Healthcare HMO Rider |
$150.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$150.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$255.00
|
| Rate for Payer: Vantage Medical Group Senior |
$255.00
|
|
|
HC VENT TUBE
|
Facility
IP
|
$300.00
|
|
| Hospital Charge Code |
909081809
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Central Health Plan Commercial |
$240.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.00
|
| Rate for Payer: Galaxy Health WC |
$255.00
|
| Rate for Payer: Global Benefits Group Commercial |
$180.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$270.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$200.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Multiplan Commercial |
$225.00
|
| Rate for Payer: Networks By Design Commercial |
$195.00
|
| Rate for Payer: Prime Health Services Commercial |
$255.00
|
|
|
HC VEP, CHECKERBOARD/FLASH
|
Facility
OP
|
$1,782.00
|
|
|
Service Code
|
CPT 95930
|
| Hospital Charge Code |
900600218
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$108.39 |
| Max. Negotiated Rate |
$1,603.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$392.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$701.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$108.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,052.81
|
| Rate for Payer: BCBS Transplant Transplant |
$1,069.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,101.28
|
| Rate for Payer: Blue Shield of California EPN |
$866.05
|
| Rate for Payer: Caremore Medicare Advantage |
$392.17
|
| Rate for Payer: Cash Price |
$801.90
|
| Rate for Payer: Cash Price |
$801.90
|
| Rate for Payer: Cash Price |
$801.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,425.60
|
| Rate for Payer: Cigna of CA HMO |
$1,140.48
|
| Rate for Payer: Cigna of CA PPO |
$1,318.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$588.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$529.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$392.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$392.17
|
| Rate for Payer: Galaxy Health WC |
$1,514.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,069.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,603.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,336.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$643.16
|
| Rate for Payer: IEHP medi-cal |
$647.08
|
| Rate for Payer: IEHP Medicare Advantage |
$392.17
|
| Rate for Payer: Innovage PACE Commercial |
$588.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,188.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$392.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$356.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$525.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$525.51
|
| Rate for Payer: Multiplan Commercial |
$1,336.50
|
| Rate for Payer: Networks By Design Commercial |
$1,158.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,514.70
|
| Rate for Payer: Prime Health Services Medicare |
$415.70
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,069.20
|
| Rate for Payer: Riverside University Health MISP |
$431.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,069.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,069.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,231.00
|
| Rate for Payer: United Healthcare All Other HMO |
$975.00
|
| Rate for Payer: United Healthcare HMO Rider |
$739.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Vantage Medical Group Senior |
$392.17
|
|
|
HC VEP, CHECKERBOARD/FLASH
|
Facility
IP
|
$1,782.00
|
|
|
Service Code
|
CPT 95930
|
| Hospital Charge Code |
900600218
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$356.40 |
| Max. Negotiated Rate |
$1,603.80 |
| Rate for Payer: Cash Price |
$801.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,425.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$712.80
|
| Rate for Payer: Galaxy Health WC |
$1,514.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,069.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,603.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,188.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$356.40
|
| Rate for Payer: Multiplan Commercial |
$1,336.50
|
| Rate for Payer: Networks By Design Commercial |
$1,158.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,514.70
|
|
|
HC VERTEBRAL UNI
|
Facility
IP
|
$17,995.00
|
|
|
Service Code
|
CPT 36226
|
| Hospital Charge Code |
909020149
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,599.00 |
| Max. Negotiated Rate |
$16,195.50 |
| Rate for Payer: Cash Price |
$8,097.75
|
| Rate for Payer: Central Health Plan Commercial |
$14,396.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,198.00
|
| Rate for Payer: Galaxy Health WC |
$15,295.75
|
| Rate for Payer: Global Benefits Group Commercial |
$10,797.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,195.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,002.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,599.00
|
| Rate for Payer: Multiplan Commercial |
$13,496.25
|
| Rate for Payer: Networks By Design Commercial |
$11,696.75
|
| Rate for Payer: Prime Health Services Commercial |
$15,295.75
|
|
|
HC VERTEBRAL UNI
|
Facility
OP
|
$17,995.00
|
|
|
Service Code
|
CPT 36226
|
| Hospital Charge Code |
909020149
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,212.08 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,866.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6,866.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: BCBS Transplant Transplant |
$10,797.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$6,866.07
|
| Rate for Payer: Cash Price |
$8,097.75
|
| Rate for Payer: Cash Price |
$8,097.75
|
| Rate for Payer: Central Health Plan Commercial |
$14,396.00
|
| Rate for Payer: Cigna of CA PPO |
$13,316.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,299.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,269.19
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6,866.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,866.07
|
| Rate for Payer: Galaxy Health WC |
$15,295.75
|
| Rate for Payer: Global Benefits Group Commercial |
$10,797.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,195.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$13,496.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,260.35
|
| Rate for Payer: IEHP medi-cal |
$11,329.02
|
| Rate for Payer: IEHP Medicare Advantage |
$6,866.07
|
| Rate for Payer: Innovage PACE Commercial |
$10,299.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,002.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,866.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,599.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,200.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,200.53
|
| Rate for Payer: Multiplan Commercial |
$13,496.25
|
| Rate for Payer: Networks By Design Commercial |
$11,696.75
|
| Rate for Payer: Prime Health Services Commercial |
$15,295.75
|
| Rate for Payer: Prime Health Services Medicare |
$7,278.03
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$10,797.00
|
| Rate for Payer: Riverside University Health MISP |
$7,552.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,797.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Vantage Medical Group Senior |
$6,866.07
|
|
|
HC VERTEBRAL UNI
|
Facility
IP
|
$17,995.00
|
|
|
Service Code
|
CPT 36226
|
| Hospital Charge Code |
906820224
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,599.00 |
| Max. Negotiated Rate |
$16,195.50 |
| Rate for Payer: Cash Price |
$8,097.75
|
| Rate for Payer: Central Health Plan Commercial |
$14,396.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,198.00
|
| Rate for Payer: Galaxy Health WC |
$15,295.75
|
| Rate for Payer: Global Benefits Group Commercial |
$10,797.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,195.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,002.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,599.00
|
| Rate for Payer: Multiplan Commercial |
$13,496.25
|
| Rate for Payer: Networks By Design Commercial |
$11,696.75
|
| Rate for Payer: Prime Health Services Commercial |
$15,295.75
|
|
|
HC VERTEBRAL UNI
|
Facility
OP
|
$17,995.00
|
|
|
Service Code
|
CPT 36226
|
| Hospital Charge Code |
906820224
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,212.08 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,866.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6,866.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: BCBS Transplant Transplant |
$10,797.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$6,866.07
|
| Rate for Payer: Cash Price |
$8,097.75
|
| Rate for Payer: Cash Price |
$8,097.75
|
| Rate for Payer: Central Health Plan Commercial |
$14,396.00
|
| Rate for Payer: Cigna of CA PPO |
$13,316.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,299.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,269.19
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6,866.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,866.07
|
| Rate for Payer: Galaxy Health WC |
$15,295.75
|
| Rate for Payer: Global Benefits Group Commercial |
$10,797.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,195.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$13,496.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,260.35
|
| Rate for Payer: IEHP medi-cal |
$11,329.02
|
| Rate for Payer: IEHP Medicare Advantage |
$6,866.07
|
| Rate for Payer: Innovage PACE Commercial |
$10,299.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,002.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,866.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,599.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,200.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,200.53
|
| Rate for Payer: Multiplan Commercial |
$13,496.25
|
| Rate for Payer: Networks By Design Commercial |
$11,696.75
|
| Rate for Payer: Prime Health Services Commercial |
$15,295.75
|
| Rate for Payer: Prime Health Services Medicare |
$7,278.03
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$10,797.00
|
| Rate for Payer: Riverside University Health MISP |
$7,552.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,797.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Vantage Medical Group Senior |
$6,866.07
|
|
|
HC VERTEBROPLASTY ADDL INJECT
|
Facility
OP
|
$10,378.00
|
|
|
Service Code
|
CPT 22512
|
| Hospital Charge Code |
909022512
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$951.00 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8,821.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,707.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5,707.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: BCBS Transplant Transplant |
$6,226.80
|
| Rate for Payer: Blue Shield of California Commercial |
$9,194.24
|
| Rate for Payer: Blue Shield of California EPN |
$6,603.71
|
| Rate for Payer: Cash Price |
$4,670.10
|
| Rate for Payer: Cash Price |
$4,670.10
|
| Rate for Payer: Cash Price |
$4,670.10
|
| Rate for Payer: Central Health Plan Commercial |
$8,302.40
|
| Rate for Payer: Cigna of CA PPO |
$7,679.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,821.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,151.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,151.20
|
| Rate for Payer: Galaxy Health WC |
$8,821.30
|
| Rate for Payer: Global Benefits Group Commercial |
$6,226.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,340.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7,783.50
|
| Rate for Payer: IEHP medi-cal |
$3,632.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,922.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,075.60
|
| Rate for Payer: Multiplan Commercial |
$7,783.50
|
| Rate for Payer: Networks By Design Commercial |
$6,745.70
|
| Rate for Payer: Prime Health Services Commercial |
$8,821.30
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$6,226.80
|
| Rate for Payer: Riverside University Health MISP |
$4,151.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,226.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,821.30
|
| Rate for Payer: Vantage Medical Group Senior |
$8,821.30
|
|
|
HC VERTEBROPLASTY ADDL INJECT
|
Facility
IP
|
$10,378.00
|
|
|
Service Code
|
CPT 22512
|
| Hospital Charge Code |
909022512
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,075.60 |
| Max. Negotiated Rate |
$9,340.20 |
| Rate for Payer: Cash Price |
$4,670.10
|
| Rate for Payer: Central Health Plan Commercial |
$8,302.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,151.20
|
| Rate for Payer: Galaxy Health WC |
$8,821.30
|
| Rate for Payer: Global Benefits Group Commercial |
$6,226.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,340.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,922.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,075.60
|
| Rate for Payer: Multiplan Commercial |
$7,783.50
|
| Rate for Payer: Networks By Design Commercial |
$6,745.70
|
| Rate for Payer: Prime Health Services Commercial |
$8,821.30
|
|
|
HC VESTIBULE OF MOUTH
|
Facility
OP
|
$1,324.00
|
|
|
Service Code
|
CPT 40808
|
| Hospital Charge Code |
900501785
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$264.80 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,031.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$687.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: BCBS Transplant Transplant |
$794.40
|
| Rate for Payer: Caremore Medicare Advantage |
$687.44
|
| Rate for Payer: Cash Price |
$595.80
|
| Rate for Payer: Cash Price |
$595.80
|
| Rate for Payer: Cash Price |
$595.80
|
| Rate for Payer: Cash Price |
$595.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,059.20
|
| Rate for Payer: Cigna of CA PPO |
$979.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,031.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$928.04
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$687.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$687.44
|
| Rate for Payer: Galaxy Health WC |
$1,125.40
|
| Rate for Payer: Global Benefits Group Commercial |
$794.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,191.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$993.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,127.40
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$687.44
|
| Rate for Payer: Innovage PACE Commercial |
$1,031.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$883.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$687.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$921.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$921.17
|
| Rate for Payer: Multiplan Commercial |
$993.00
|
| Rate for Payer: Networks By Design Commercial |
$860.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,125.40
|
| Rate for Payer: Prime Health Services Medicare |
$728.69
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$794.40
|
| Rate for Payer: Riverside University Health MISP |
$756.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$794.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$662.00
|
| Rate for Payer: United Healthcare All Other HMO |
$662.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$662.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: Vantage Medical Group Senior |
$687.44
|
|
|
HC VESTIBULE OF MOUTH
|
Facility
IP
|
$1,324.00
|
|
|
Service Code
|
CPT 40808
|
| Hospital Charge Code |
900501785
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$264.80 |
| Max. Negotiated Rate |
$1,191.60 |
| Rate for Payer: Cash Price |
$595.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,059.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$529.60
|
| Rate for Payer: Galaxy Health WC |
$1,125.40
|
| Rate for Payer: Global Benefits Group Commercial |
$794.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,191.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$883.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.80
|
| Rate for Payer: Multiplan Commercial |
$993.00
|
| Rate for Payer: Networks By Design Commercial |
$860.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,125.40
|
|
|
HC VISCOELASTIC TEST
|
Facility
OP
|
$101.00
|
|
|
Service Code
|
CPT 85396
|
| Hospital Charge Code |
900912037
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$15.98 |
| Max. Negotiated Rate |
$142.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$100.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$85.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$55.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$55.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$116.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$142.30
|
| Rate for Payer: BCBS Transplant Transplant |
$60.60
|
| Rate for Payer: Blue Shield of California Commercial |
$62.42
|
| Rate for Payer: Blue Shield of California EPN |
$49.09
|
| Rate for Payer: Cash Price |
$45.45
|
| Rate for Payer: Cash Price |
$45.45
|
| Rate for Payer: Central Health Plan Commercial |
$80.80
|
| Rate for Payer: Cigna of CA HMO |
$64.64
|
| Rate for Payer: Cigna of CA PPO |
$74.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$85.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$40.40
|
| Rate for Payer: Galaxy Health WC |
$85.85
|
| Rate for Payer: Global Benefits Group Commercial |
$60.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$75.75
|
| Rate for Payer: IEHP medi-cal |
$35.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$67.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.20
|
| Rate for Payer: Multiplan Commercial |
$75.75
|
| Rate for Payer: Networks By Design Commercial |
$65.65
|
| Rate for Payer: Prime Health Services Commercial |
$85.85
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$60.60
|
| Rate for Payer: Riverside University Health MISP |
$40.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.98
|
| Rate for Payer: United Healthcare All Other HMO |
$15.98
|
| Rate for Payer: United Healthcare HMO Rider |
$15.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$85.85
|
| Rate for Payer: Vantage Medical Group Senior |
$85.85
|
|
|
HC VISCOELASTIC TEST
|
Facility
IP
|
$141.00
|
|
|
Service Code
|
CPT 85396
|
| Hospital Charge Code |
900912037
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$28.20 |
| Max. Negotiated Rate |
$126.90 |
| Rate for Payer: Cash Price |
$63.45
|
| Rate for Payer: Central Health Plan Commercial |
$112.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.40
|
| Rate for Payer: Galaxy Health WC |
$119.85
|
| Rate for Payer: Global Benefits Group Commercial |
$84.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$126.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$94.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.20
|
| Rate for Payer: Multiplan Commercial |
$105.75
|
| Rate for Payer: Networks By Design Commercial |
$91.65
|
| Rate for Payer: Prime Health Services Commercial |
$119.85
|
|
|
HC VITAL CAPACITY TOTAL
|
Facility
OP
|
$562.00
|
|
|
Service Code
|
CPT 94150
|
| Hospital Charge Code |
900800430
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$112.40 |
| Max. Negotiated Rate |
$2,356.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$195.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$123.02
|
| 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 |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: BCBS Transplant Transplant |
$337.20
|
| Rate for Payer: Blue Shield of California Commercial |
$353.50
|
| Rate for Payer: Blue Shield of California EPN |
$274.82
|
| Rate for Payer: Caremore Medicare Advantage |
$195.17
|
| Rate for Payer: Cash Price |
$252.90
|
| Rate for Payer: Cash Price |
$252.90
|
| Rate for Payer: Cash Price |
$252.90
|
| Rate for Payer: Central Health Plan Commercial |
$449.60
|
| Rate for Payer: Cigna of CA HMO |
$359.68
|
| Rate for Payer: Cigna of CA PPO |
$415.88
|
| 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 |
$477.70
|
| Rate for Payer: Global Benefits Group Commercial |
$337.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$505.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$421.50
|
| 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 |
$374.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$195.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.40
|
| 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 |
$421.50
|
| Rate for Payer: Networks By Design Commercial |
$365.30
|
| Rate for Payer: Prime Health Services Commercial |
$477.70
|
| Rate for Payer: Prime Health Services Medicare |
$206.88
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$337.20
|
| Rate for Payer: Riverside University Health MISP |
$214.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$337.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$337.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$281.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$281.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$281.00
|
| 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 VITAL CAPACITY TOTAL
|
Facility
OP
|
$562.00
|
|
|
Service Code
|
CPT 94150
|
| Hospital Charge Code |
900800430
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$22.73 |
| Max. Negotiated Rate |
$725.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$195.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$123.02
|
| 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 |
$22.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$332.03
|
| Rate for Payer: BCBS Transplant Transplant |
$337.20
|
| Rate for Payer: Blue Shield of California Commercial |
$347.32
|
| Rate for Payer: Blue Shield of California EPN |
$273.13
|
| Rate for Payer: Caremore Medicare Advantage |
$195.17
|
| Rate for Payer: Cash Price |
$252.90
|
| Rate for Payer: Cash Price |
$252.90
|
| Rate for Payer: Cash Price |
$252.90
|
| Rate for Payer: Central Health Plan Commercial |
$449.60
|
| Rate for Payer: Cigna of CA HMO |
$359.68
|
| Rate for Payer: Cigna of CA PPO |
$415.88
|
| 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 |
$477.70
|
| Rate for Payer: Global Benefits Group Commercial |
$337.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$505.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$421.50
|
| 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 |
$374.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$195.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.40
|
| 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 |
$421.50
|
| Rate for Payer: Networks By Design Commercial |
$365.30
|
| Rate for Payer: Prime Health Services Commercial |
$477.70
|
| Rate for Payer: Prime Health Services Medicare |
$206.88
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$337.20
|
| Rate for Payer: Riverside University Health MISP |
$214.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$337.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$337.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$725.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$696.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$636.00
|
| 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 VITAL CAPACITY TOTAL
|
Facility
IP
|
$562.00
|
|
|
Service Code
|
CPT 94150
|
| Hospital Charge Code |
900800430
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$112.40 |
| Max. Negotiated Rate |
$505.80 |
| Rate for Payer: Cash Price |
$252.90
|
| Rate for Payer: Central Health Plan Commercial |
$449.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$224.80
|
| Rate for Payer: Galaxy Health WC |
$477.70
|
| Rate for Payer: Global Benefits Group Commercial |
$337.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$505.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$374.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.40
|
| Rate for Payer: Multiplan Commercial |
$421.50
|
| Rate for Payer: Networks By Design Commercial |
$365.30
|
| Rate for Payer: Prime Health Services Commercial |
$477.70
|
|
|
HC VITAL CAPACITY TOTAL
|
Facility
IP
|
$562.00
|
|
|
Service Code
|
CPT 94150
|
| Hospital Charge Code |
900800430
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$112.40 |
| Max. Negotiated Rate |
$505.80 |
| Rate for Payer: Cash Price |
$252.90
|
| Rate for Payer: Central Health Plan Commercial |
$449.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$224.80
|
| Rate for Payer: Galaxy Health WC |
$477.70
|
| Rate for Payer: Global Benefits Group Commercial |
$337.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$505.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$374.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.40
|
| Rate for Payer: Multiplan Commercial |
$421.50
|
| Rate for Payer: Networks By Design Commercial |
$365.30
|
| Rate for Payer: Prime Health Services Commercial |
$477.70
|
|
|
HC VITAMIN B12
|
Facility
OP
|
$30.00
|
|
|
Service Code
|
CPT 82607
|
| Hospital Charge Code |
900910830
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$133.76 |
| Rate for Payer: Adventist Health Medi-Cal |
$15.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$110.63
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$22.62
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$16.59
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$15.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$109.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.76
|
| Rate for Payer: BCBS Transplant Transplant |
$18.00
|
| Rate for Payer: Blue Shield of California Commercial |
$18.54
|
| Rate for Payer: Blue Shield of California EPN |
$14.58
|
| Rate for Payer: Caremore Medicare Advantage |
$15.08
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Central Health Plan Commercial |
$24.00
|
| Rate for Payer: Cigna of CA HMO |
$19.20
|
| Rate for Payer: Cigna of CA PPO |
$22.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$15.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.08
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$22.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24.73
|
| Rate for Payer: IEHP medi-cal |
$24.88
|
| Rate for Payer: IEHP Medicare Advantage |
$15.08
|
| Rate for Payer: Innovage PACE Commercial |
$22.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.21
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
| Rate for Payer: Prime Health Services Medicare |
$15.98
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$18.00
|
| Rate for Payer: Riverside University Health MISP |
$16.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.21
|
| Rate for Payer: United Healthcare All Other HMO |
$12.21
|
| Rate for Payer: United Healthcare HMO Rider |
$12.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.59
|
| Rate for Payer: Vantage Medical Group Senior |
$15.08
|
|
