|
HC VASCULITIS AB PANEL
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900983516
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Adventist Health Commercial |
$13.00
|
| Rate for Payer: Cash Price |
$35.75
|
| Rate for Payer: Central Health Plan Commercial |
$52.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.00
|
| Rate for Payer: EPIC Health Plan Senior |
$26.00
|
| Rate for Payer: Galaxy Health WC |
$55.25
|
| Rate for Payer: Global Benefits Group Commercial |
$39.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$58.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.00
|
| Rate for Payer: Multiplan Commercial |
$48.75
|
| Rate for Payer: Networks By Design Commercial |
$42.25
|
| Rate for Payer: Prime Health Services Commercial |
$55.25
|
|
|
HC VASCULITIS AB PANEL
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900983516
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.34 |
| Max. Negotiated Rate |
$170.20 |
| Rate for Payer: Adventist Health Commercial |
$13.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$11.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$39.47
|
| 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 |
$39.45
|
| Rate for Payer: Blue Shield of California EPN |
$25.80
|
| Rate for Payer: Cash Price |
$35.75
|
| Rate for Payer: Cash Price |
$35.75
|
| Rate for Payer: Central Health Plan Commercial |
$52.00
|
| Rate for Payer: Cigna of CA HMO |
$41.60
|
| Rate for Payer: Cigna of CA PPO |
$48.10
|
| 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 |
$55.25
|
| Rate for Payer: Global Benefits Group Commercial |
$39.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$58.50
|
| 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 |
$43.35
|
| 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 |
$13.00
|
| 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 |
$48.75
|
| Rate for Payer: Networks By Design Commercial |
$42.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11.53
|
| Rate for Payer: Prime Health Services Commercial |
$55.25
|
| 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 |
$39.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.00
|
| 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 VASCUTRAK PTA BALLOON
|
Facility
|
IP
|
$2,535.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909021725
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$507.00 |
| Max. Negotiated Rate |
$2,281.50 |
| Rate for Payer: Adventist Health Commercial |
$507.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,959.56
|
| Rate for Payer: Blue Shield of California EPN |
$1,277.64
|
| Rate for Payer: Cash Price |
$1,394.25
|
| Rate for Payer: Central Health Plan Commercial |
$2,028.00
|
| Rate for Payer: Cigna of CA HMO |
$1,774.50
|
| Rate for Payer: Cigna of CA PPO |
$1,774.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,014.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,014.00
|
| Rate for Payer: Galaxy Health WC |
$2,154.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,521.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,281.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,690.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$965.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,569.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$507.00
|
| Rate for Payer: Multiplan Commercial |
$1,901.25
|
| Rate for Payer: Networks By Design Commercial |
$1,267.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,154.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$951.39
|
| Rate for Payer: United Healthcare All Other HMO |
$926.04
|
| Rate for Payer: United Healthcare HMO Rider |
$906.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$830.21
|
|
|
HC VASCUTRAK PTA BALLOON
|
Facility
|
OP
|
$2,535.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909021725
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$507.00 |
| Max. Negotiated Rate |
$2,281.50 |
| Rate for Payer: Adventist Health Commercial |
$507.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,154.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,394.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,901.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,157.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,403.63
|
| Rate for Payer: Blue Shield of California Commercial |
$1,959.56
|
| Rate for Payer: Blue Shield of California EPN |
$1,277.64
|
| Rate for Payer: Cash Price |
$1,394.25
|
| Rate for Payer: Central Health Plan Commercial |
$2,028.00
|
| Rate for Payer: Cigna of CA HMO |
$1,774.50
|
| Rate for Payer: Cigna of CA PPO |
$1,774.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,154.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,154.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,154.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,014.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,014.00
|
| Rate for Payer: Galaxy Health WC |
$2,154.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,521.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,281.50
|
| Rate for Payer: InnovAge PACE Commercial |
$1,267.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,690.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$965.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,569.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$507.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,774.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,774.50
|
| Rate for Payer: Multiplan Commercial |
$1,901.25
|
| Rate for Payer: Networks By Design Commercial |
$1,267.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,154.75
|
| Rate for Payer: Riverside University Health System MISP |
$1,014.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,521.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,521.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$951.39
|
| Rate for Payer: United Healthcare All Other HMO |
$926.04
|
| Rate for Payer: United Healthcare HMO Rider |
$906.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$830.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,154.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,154.75
|
| Rate for Payer: Vantage Medical Group Senior |
$2,154.75
|
|
|
HC VASOPNEUMATIC DEVICE MCAL
|
Facility
|
IP
|
$204.00
|
|
|
Service Code
|
CPT 97016
|
| Hospital Charge Code |
901300043
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$183.60 |
| Rate for Payer: Adventist Health Commercial |
$40.80
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Central Health Plan Commercial |
$163.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.60
|
| Rate for Payer: EPIC Health Plan Senior |
$81.60
|
| Rate for Payer: Galaxy Health WC |
$173.40
|
| Rate for Payer: Global Benefits Group Commercial |
$122.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$183.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$136.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$126.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.80
|
| Rate for Payer: Multiplan Commercial |
$153.00
|
| Rate for Payer: Networks By Design Commercial |
$132.60
|
| Rate for Payer: Prime Health Services Commercial |
$173.40
|
|
|
HC VASOPNEUMATIC DEVICE MCAL
|
Facility
|
OP
|
$204.00
|
|
|
Service Code
|
CPT 97016
|
| Hospital Charge Code |
901300043
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$19.16 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$83.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$123.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$173.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$112.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$153.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Central Health Plan Commercial |
$163.20
|
| Rate for Payer: Cigna of CA HMO |
$130.56
|
| Rate for Payer: Cigna of CA PPO |
$150.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$173.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$173.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$173.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.60
|
| Rate for Payer: EPIC Health Plan Senior |
$81.60
|
| Rate for Payer: Galaxy Health WC |
$173.40
|
| Rate for Payer: Global Benefits Group Commercial |
$122.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$183.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.16
|
| Rate for Payer: InnovAge PACE Commercial |
$102.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$136.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$126.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$142.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$142.80
|
| Rate for Payer: Multiplan Commercial |
$153.00
|
| Rate for Payer: Networks By Design Commercial |
$132.60
|
| Rate for Payer: Prime Health Services Commercial |
$173.40
|
| Rate for Payer: Riverside University Health System MISP |
$81.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$122.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$122.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$173.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$173.40
|
| Rate for Payer: Vantage Medical Group Senior |
$173.40
|
|
|
HC VASOPNEUMATIC DEVICE MCARE COMM
|
Facility
|
IP
|
$204.00
|
|
|
Service Code
|
CPT 97016
|
| Hospital Charge Code |
900407041
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$183.60 |
| Rate for Payer: Adventist Health Commercial |
$40.80
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Central Health Plan Commercial |
$163.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.60
|
| Rate for Payer: EPIC Health Plan Senior |
$81.60
|
| Rate for Payer: Galaxy Health WC |
$173.40
|
| Rate for Payer: Global Benefits Group Commercial |
$122.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$183.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$136.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$126.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.80
|
| Rate for Payer: Multiplan Commercial |
$153.00
|
| Rate for Payer: Networks By Design Commercial |
$132.60
|
| Rate for Payer: Prime Health Services Commercial |
$173.40
|
|
|
HC VASOPNEUMATIC DEVICE MCARE COMM
|
Facility
|
OP
|
$204.00
|
|
|
Service Code
|
CPT 97016
|
| Hospital Charge Code |
900407041
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$19.16 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$83.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$123.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$173.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$112.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$153.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Central Health Plan Commercial |
$163.20
|
| Rate for Payer: Cigna of CA HMO |
$130.56
|
| Rate for Payer: Cigna of CA PPO |
$150.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$173.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$173.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$173.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.60
|
| Rate for Payer: EPIC Health Plan Senior |
$81.60
|
| Rate for Payer: Galaxy Health WC |
$173.40
|
| Rate for Payer: Global Benefits Group Commercial |
$122.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$183.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.16
|
| Rate for Payer: InnovAge PACE Commercial |
$102.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$136.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$126.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$142.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$142.80
|
| Rate for Payer: Multiplan Commercial |
$153.00
|
| Rate for Payer: Networks By Design Commercial |
$132.60
|
| Rate for Payer: Prime Health Services Commercial |
$173.40
|
| Rate for Payer: Riverside University Health System MISP |
$81.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$122.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$122.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$173.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$173.40
|
| Rate for Payer: Vantage Medical Group Senior |
$173.40
|
|
|
HC VASOPNEUMATIC DEVICE OT
|
Facility
|
OP
|
$204.00
|
|
|
Service Code
|
CPT 97016
|
| Hospital Charge Code |
905104107
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$19.16 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$83.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$123.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$173.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$112.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$153.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Central Health Plan Commercial |
$163.20
|
| Rate for Payer: Cigna of CA HMO |
$130.56
|
| Rate for Payer: Cigna of CA PPO |
$150.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$173.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$173.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$173.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.60
|
| Rate for Payer: EPIC Health Plan Senior |
$81.60
|
| Rate for Payer: Galaxy Health WC |
$173.40
|
| Rate for Payer: Global Benefits Group Commercial |
$122.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$183.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.16
|
| Rate for Payer: InnovAge PACE Commercial |
$102.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$136.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$126.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$142.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$142.80
|
| Rate for Payer: Multiplan Commercial |
$153.00
|
| Rate for Payer: Networks By Design Commercial |
$132.60
|
| Rate for Payer: Prime Health Services Commercial |
$173.40
|
| Rate for Payer: Riverside University Health System MISP |
$81.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$122.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$122.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$173.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$173.40
|
| Rate for Payer: Vantage Medical Group Senior |
$173.40
|
|
|
HC VASOPNEUMATIC DEVICE OT
|
Facility
|
IP
|
$204.00
|
|
|
Service Code
|
CPT 97016
|
| Hospital Charge Code |
905104107
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$183.60 |
| Rate for Payer: Adventist Health Commercial |
$40.80
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Central Health Plan Commercial |
$163.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.60
|
| Rate for Payer: EPIC Health Plan Senior |
$81.60
|
| Rate for Payer: Galaxy Health WC |
$173.40
|
| Rate for Payer: Global Benefits Group Commercial |
$122.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$183.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$136.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$126.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.80
|
| Rate for Payer: Multiplan Commercial |
$153.00
|
| Rate for Payer: Networks By Design Commercial |
$132.60
|
| Rate for Payer: Prime Health Services Commercial |
$173.40
|
|
|
HC VASOPNEUMATIC DEVICE OT
|
Facility
|
IP
|
$204.00
|
|
|
Service Code
|
CPT 97016
|
| Hospital Charge Code |
901307016
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$183.60 |
| Rate for Payer: Adventist Health Commercial |
$40.80
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Central Health Plan Commercial |
$163.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.60
|
| Rate for Payer: EPIC Health Plan Senior |
$81.60
|
| Rate for Payer: Galaxy Health WC |
$173.40
|
| Rate for Payer: Global Benefits Group Commercial |
$122.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$183.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$136.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$126.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.80
|
| Rate for Payer: Multiplan Commercial |
$153.00
|
| Rate for Payer: Networks By Design Commercial |
$132.60
|
| Rate for Payer: Prime Health Services Commercial |
$173.40
|
|
|
HC VASOPNEUMATIC DEVICE OT
|
Facility
|
OP
|
$204.00
|
|
|
Service Code
|
CPT 97016
|
| Hospital Charge Code |
901307016
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$19.16 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$83.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$123.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$173.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$112.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$153.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Central Health Plan Commercial |
$163.20
|
| Rate for Payer: Cigna of CA HMO |
$130.56
|
| Rate for Payer: Cigna of CA PPO |
$150.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$173.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$173.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$173.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.60
|
| Rate for Payer: EPIC Health Plan Senior |
$81.60
|
| Rate for Payer: Galaxy Health WC |
$173.40
|
| Rate for Payer: Global Benefits Group Commercial |
$122.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$183.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.16
|
| Rate for Payer: InnovAge PACE Commercial |
$102.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$136.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$126.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$142.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$142.80
|
| Rate for Payer: Multiplan Commercial |
$153.00
|
| Rate for Payer: Networks By Design Commercial |
$132.60
|
| Rate for Payer: Prime Health Services Commercial |
$173.40
|
| Rate for Payer: Riverside University Health System MISP |
$81.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$122.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$122.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$173.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$173.40
|
| Rate for Payer: Vantage Medical Group Senior |
$173.40
|
|
|
HC VASOPNEUMATIC DEVICE PT
|
Facility
|
OP
|
$204.00
|
|
|
Service Code
|
CPT 97016
|
| Hospital Charge Code |
900419065
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$19.16 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$83.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$123.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$173.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$112.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$153.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Central Health Plan Commercial |
$163.20
|
| Rate for Payer: Cigna of CA HMO |
$130.56
|
| Rate for Payer: Cigna of CA PPO |
$150.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$173.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$173.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$173.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.60
|
| Rate for Payer: EPIC Health Plan Senior |
$81.60
|
| Rate for Payer: Galaxy Health WC |
$173.40
|
| Rate for Payer: Global Benefits Group Commercial |
$122.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$183.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.16
|
| Rate for Payer: InnovAge PACE Commercial |
$102.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$136.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$126.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$142.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$142.80
|
| Rate for Payer: Multiplan Commercial |
$153.00
|
| Rate for Payer: Networks By Design Commercial |
$132.60
|
| Rate for Payer: Prime Health Services Commercial |
$173.40
|
| Rate for Payer: Riverside University Health System MISP |
$81.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$122.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$122.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$173.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$173.40
|
| Rate for Payer: Vantage Medical Group Senior |
$173.40
|
|
|
HC VASOPNEUMATIC DEVICE PT
|
Facility
|
IP
|
$204.00
|
|
|
Service Code
|
CPT 97016
|
| Hospital Charge Code |
900419065
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$183.60 |
| Rate for Payer: Adventist Health Commercial |
$40.80
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Central Health Plan Commercial |
$163.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.60
|
| Rate for Payer: EPIC Health Plan Senior |
$81.60
|
| Rate for Payer: Galaxy Health WC |
$173.40
|
| Rate for Payer: Global Benefits Group Commercial |
$122.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$183.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$136.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$126.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.80
|
| Rate for Payer: Multiplan Commercial |
$153.00
|
| Rate for Payer: Networks By Design Commercial |
$132.60
|
| Rate for Payer: Prime Health Services Commercial |
$173.40
|
|
|
HC VASOPNEUMATIC DEVICE PT
|
Facility
|
OP
|
$204.00
|
|
|
Service Code
|
CPT 97016
|
| Hospital Charge Code |
905103107
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$19.16 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$83.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$123.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$173.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$112.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$153.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Central Health Plan Commercial |
$163.20
|
| Rate for Payer: Cigna of CA HMO |
$130.56
|
| Rate for Payer: Cigna of CA PPO |
$150.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$173.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$173.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$173.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.60
|
| Rate for Payer: EPIC Health Plan Senior |
$81.60
|
| Rate for Payer: Galaxy Health WC |
$173.40
|
| Rate for Payer: Global Benefits Group Commercial |
$122.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$183.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.16
|
| Rate for Payer: InnovAge PACE Commercial |
$102.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$136.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$126.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$142.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$142.80
|
| Rate for Payer: Multiplan Commercial |
$153.00
|
| Rate for Payer: Networks By Design Commercial |
$132.60
|
| Rate for Payer: Prime Health Services Commercial |
$173.40
|
| Rate for Payer: Riverside University Health System MISP |
$81.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$122.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$122.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$173.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$173.40
|
| Rate for Payer: Vantage Medical Group Senior |
$173.40
|
|
|
HC VASOPNEUMATIC DEVICE PT
|
Facility
|
IP
|
$204.00
|
|
|
Service Code
|
CPT 97016
|
| Hospital Charge Code |
905103107
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$183.60 |
| Rate for Payer: Adventist Health Commercial |
$40.80
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Central Health Plan Commercial |
$163.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.60
|
| Rate for Payer: EPIC Health Plan Senior |
$81.60
|
| Rate for Payer: Galaxy Health WC |
$173.40
|
| Rate for Payer: Global Benefits Group Commercial |
$122.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$183.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$136.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$126.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.80
|
| Rate for Payer: Multiplan Commercial |
$153.00
|
| Rate for Payer: Networks By Design Commercial |
$132.60
|
| Rate for Payer: Prime Health Services Commercial |
$173.40
|
|
|
HC VAT PIV KIT
|
Facility
|
IP
|
$67.16
|
|
| Hospital Charge Code |
901698272
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.43 |
| Max. Negotiated Rate |
$60.44 |
| Rate for Payer: Adventist Health Commercial |
$13.43
|
| Rate for Payer: Cash Price |
$36.94
|
| Rate for Payer: Central Health Plan Commercial |
$53.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.86
|
| Rate for Payer: EPIC Health Plan Senior |
$26.86
|
| Rate for Payer: Galaxy Health WC |
$57.09
|
| Rate for Payer: Global Benefits Group Commercial |
$40.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$60.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.43
|
| Rate for Payer: Multiplan Commercial |
$50.37
|
| Rate for Payer: Networks By Design Commercial |
$43.65
|
| Rate for Payer: Prime Health Services Commercial |
$57.09
|
|
|
HC VAT PIV KIT
|
Facility
|
OP
|
$67.16
|
|
| Hospital Charge Code |
901698272
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.43 |
| Max. Negotiated Rate |
$60.44 |
| Rate for Payer: Adventist Health Commercial |
$13.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$40.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$57.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$36.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$50.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$32.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.44
|
| Rate for Payer: Blue Shield of California Commercial |
$41.03
|
| Rate for Payer: Blue Shield of California EPN |
$26.80
|
| Rate for Payer: Cash Price |
$36.94
|
| Rate for Payer: Central Health Plan Commercial |
$53.73
|
| Rate for Payer: Cigna of CA HMO |
$42.98
|
| Rate for Payer: Cigna of CA PPO |
$49.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$57.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$57.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$57.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.86
|
| Rate for Payer: EPIC Health Plan Senior |
$26.86
|
| Rate for Payer: Galaxy Health WC |
$57.09
|
| Rate for Payer: Global Benefits Group Commercial |
$40.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$60.44
|
| Rate for Payer: InnovAge PACE Commercial |
$33.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.01
|
| Rate for Payer: Multiplan Commercial |
$50.37
|
| Rate for Payer: Networks By Design Commercial |
$43.65
|
| Rate for Payer: Prime Health Services Commercial |
$57.09
|
| Rate for Payer: Riverside University Health System MISP |
$26.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$40.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$40.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.58
|
| Rate for Payer: United Healthcare All Other HMO |
$33.58
|
| Rate for Payer: United Healthcare HMO Rider |
$33.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$33.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$57.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$57.09
|
| Rate for Payer: Vantage Medical Group Senior |
$57.09
|
|
|
HC VEEG 21-12HR INTMT MNTRD
|
Facility
|
OP
|
$2,172.00
|
|
|
Service Code
|
CPT 95712
|
| Hospital Charge Code |
900605712
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$395.66 |
| Max. Negotiated Rate |
$3,209.17 |
| Rate for Payer: Adventist Health Commercial |
$434.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$395.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,319.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$395.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,209.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,275.62
|
| Rate for Payer: Blue Shield of California Commercial |
$1,318.40
|
| Rate for Payer: Blue Shield of California EPN |
$862.28
|
| Rate for Payer: Cash Price |
$1,194.60
|
| Rate for Payer: Cash Price |
$1,194.60
|
| Rate for Payer: Cash Price |
$1,194.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,737.60
|
| Rate for Payer: Cigna of CA HMO |
$1,390.08
|
| Rate for Payer: Cigna of CA PPO |
$1,607.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$593.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$435.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$395.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$534.14
|
| Rate for Payer: EPIC Health Plan Senior |
$395.66
|
| Rate for Payer: Galaxy Health WC |
$1,846.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,303.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,954.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$648.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$641.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$395.66
|
| Rate for Payer: InnovAge PACE Commercial |
$593.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,448.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$708.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$395.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$434.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$530.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$530.18
|
| Rate for Payer: Multiplan Commercial |
$1,629.00
|
| Rate for Payer: Networks By Design Commercial |
$1,411.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$395.66
|
| Rate for Payer: Prime Health Services Commercial |
$1,846.20
|
| Rate for Payer: Prime Health Services Medicare |
$419.40
|
| Rate for Payer: Riverside University Health System MISP |
$435.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,303.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,303.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,039.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,896.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,389.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,272.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$395.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Vantage Medical Group Senior |
$395.66
|
|
|
HC VEEG 21-12HR INTMT MNTRD
|
Facility
|
IP
|
$2,172.00
|
|
|
Service Code
|
CPT 95712
|
| Hospital Charge Code |
900605712
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$434.40 |
| Max. Negotiated Rate |
$1,954.80 |
| Rate for Payer: Adventist Health Commercial |
$434.40
|
| Rate for Payer: Cash Price |
$1,194.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,737.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$868.80
|
| Rate for Payer: EPIC Health Plan Senior |
$868.80
|
| Rate for Payer: Galaxy Health WC |
$1,846.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,303.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,954.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,448.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$827.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,344.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$434.40
|
| Rate for Payer: Multiplan Commercial |
$1,629.00
|
| Rate for Payer: Networks By Design Commercial |
$1,411.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,846.20
|
|
|
HC VEEG 21-12HR UNMNTRD
|
Facility
|
IP
|
$1,249.00
|
|
|
Service Code
|
CPT 95711
|
| Hospital Charge Code |
900605711
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$249.80 |
| Max. Negotiated Rate |
$1,124.10 |
| Rate for Payer: Adventist Health Commercial |
$249.80
|
| Rate for Payer: Cash Price |
$686.95
|
| Rate for Payer: Central Health Plan Commercial |
$999.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$499.60
|
| Rate for Payer: EPIC Health Plan Senior |
$499.60
|
| Rate for Payer: Galaxy Health WC |
$1,061.65
|
| Rate for Payer: Global Benefits Group Commercial |
$749.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,124.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$833.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$475.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$773.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$249.80
|
| Rate for Payer: Multiplan Commercial |
$936.75
|
| Rate for Payer: Networks By Design Commercial |
$811.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,061.65
|
|
|
HC VEEG 21-12HR UNMNTRD
|
Facility
|
OP
|
$1,249.00
|
|
|
Service Code
|
CPT 95711
|
| Hospital Charge Code |
900605711
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$249.80 |
| Max. Negotiated Rate |
$3,209.17 |
| Rate for Payer: Adventist Health Commercial |
$249.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$395.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$758.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$395.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,209.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$733.54
|
| Rate for Payer: Blue Shield of California Commercial |
$758.14
|
| Rate for Payer: Blue Shield of California EPN |
$495.85
|
| Rate for Payer: Cash Price |
$686.95
|
| Rate for Payer: Cash Price |
$686.95
|
| Rate for Payer: Cash Price |
$686.95
|
| Rate for Payer: Central Health Plan Commercial |
$999.20
|
| Rate for Payer: Cigna of CA HMO |
$799.36
|
| Rate for Payer: Cigna of CA PPO |
$924.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$593.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$435.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$395.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$534.14
|
| Rate for Payer: EPIC Health Plan Senior |
$395.66
|
| Rate for Payer: Galaxy Health WC |
$1,061.65
|
| Rate for Payer: Global Benefits Group Commercial |
$749.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,124.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$648.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$381.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$395.66
|
| Rate for Payer: InnovAge PACE Commercial |
$593.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$833.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$421.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$395.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$249.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$530.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$530.18
|
| Rate for Payer: Multiplan Commercial |
$936.75
|
| Rate for Payer: Networks By Design Commercial |
$811.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$395.66
|
| Rate for Payer: Prime Health Services Commercial |
$1,061.65
|
| Rate for Payer: Prime Health Services Medicare |
$419.40
|
| Rate for Payer: Riverside University Health System MISP |
$435.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$749.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$749.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,039.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,896.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,389.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,272.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$395.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Vantage Medical Group Senior |
$395.66
|
|
|
HC VEEG 2-12HR CONT MNTRD
|
Facility
|
IP
|
$4,168.00
|
|
|
Service Code
|
CPT 95713
|
| Hospital Charge Code |
900605713
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$833.60 |
| Max. Negotiated Rate |
$3,751.20 |
| Rate for Payer: Adventist Health Commercial |
$833.60
|
| Rate for Payer: Cash Price |
$2,292.40
|
| Rate for Payer: Central Health Plan Commercial |
$3,334.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,667.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,667.20
|
| Rate for Payer: Galaxy Health WC |
$3,542.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,500.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,751.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,780.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,588.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,579.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$833.60
|
| Rate for Payer: Multiplan Commercial |
$3,126.00
|
| Rate for Payer: Networks By Design Commercial |
$2,709.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,542.80
|
|
|
HC VEEG 2-12HR CONT MNTRD
|
Facility
|
OP
|
$4,168.00
|
|
|
Service Code
|
CPT 95713
|
| Hospital Charge Code |
900605713
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$674.18 |
| Max. Negotiated Rate |
$3,751.20 |
| Rate for Payer: Adventist Health Commercial |
$833.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$674.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,531.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$741.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$674.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,209.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,447.87
|
| Rate for Payer: Blue Shield of California Commercial |
$2,529.98
|
| Rate for Payer: Blue Shield of California EPN |
$1,654.70
|
| Rate for Payer: Cash Price |
$2,292.40
|
| Rate for Payer: Cash Price |
$2,292.40
|
| Rate for Payer: Cash Price |
$2,292.40
|
| Rate for Payer: Central Health Plan Commercial |
$3,334.40
|
| Rate for Payer: Cigna of CA HMO |
$2,667.52
|
| Rate for Payer: Cigna of CA PPO |
$3,084.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$741.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$674.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$910.14
|
| Rate for Payer: EPIC Health Plan Senior |
$674.18
|
| Rate for Payer: Galaxy Health WC |
$3,542.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,500.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,751.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,105.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,254.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$674.18
|
| Rate for Payer: InnovAge PACE Commercial |
$1,011.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,780.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,386.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$674.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$833.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$903.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$903.40
|
| Rate for Payer: Multiplan Commercial |
$3,126.00
|
| Rate for Payer: Networks By Design Commercial |
$2,709.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$674.18
|
| Rate for Payer: Prime Health Services Commercial |
$3,542.80
|
| Rate for Payer: Prime Health Services Medicare |
$714.63
|
| Rate for Payer: Riverside University Health System MISP |
$741.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,500.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,500.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,039.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,896.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,389.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,272.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$674.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$741.60
|
| Rate for Payer: Vantage Medical Group Senior |
$674.18
|
|
|
HC VEEG EA 12-26HR CONT MNTRD
|
Facility
|
IP
|
$4,485.00
|
|
|
Service Code
|
CPT 95716
|
| Hospital Charge Code |
900605716
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$897.00 |
| Max. Negotiated Rate |
$4,036.50 |
| Rate for Payer: Adventist Health Commercial |
$897.00
|
| Rate for Payer: Cash Price |
$2,466.75
|
| Rate for Payer: Central Health Plan Commercial |
$3,588.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,794.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,794.00
|
| Rate for Payer: Galaxy Health WC |
$3,812.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,691.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,036.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,991.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,708.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,776.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$897.00
|
| Rate for Payer: Multiplan Commercial |
$3,363.75
|
| Rate for Payer: Networks By Design Commercial |
$2,915.25
|
| Rate for Payer: Prime Health Services Commercial |
$3,812.25
|
|
