|
HC DECLOT VAD CATH THROMBOLYTIC AGENT
|
Facility
|
IP
|
$2,126.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
945100110
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$425.20 |
| Max. Negotiated Rate |
$1,913.40 |
| Rate for Payer: Adventist Health Commercial |
$425.20
|
| Rate for Payer: Cash Price |
$956.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,700.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,488.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$850.40
|
| Rate for Payer: EPIC Health Plan Senior |
$850.40
|
| Rate for Payer: Galaxy Health WC |
$1,807.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,275.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,913.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,350.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,254.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$425.20
|
| Rate for Payer: Multiplan Commercial |
$1,594.50
|
| Rate for Payer: Networks By Design Commercial |
$1,381.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,807.10
|
|
|
HC DECLOT VAD CATH THROMBOLYTIC AGENT
|
Facility
|
IP
|
$2,126.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
910100004
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$425.20 |
| Max. Negotiated Rate |
$1,913.40 |
| Rate for Payer: Adventist Health Commercial |
$425.20
|
| Rate for Payer: Cash Price |
$956.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,700.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,488.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$850.40
|
| Rate for Payer: EPIC Health Plan Senior |
$850.40
|
| Rate for Payer: Galaxy Health WC |
$1,807.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,275.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,913.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,350.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,254.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$425.20
|
| Rate for Payer: Multiplan Commercial |
$1,594.50
|
| Rate for Payer: Networks By Design Commercial |
$1,381.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,807.10
|
|
|
HC DECLOT VAD CATH THROMBOLYTIC AGENT
|
Facility
|
OP
|
$2,126.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
947200110
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$57.64 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$425.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$424.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$637.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$467.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$424.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$671.50
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$956.70
|
| Rate for Payer: Cash Price |
$956.70
|
| Rate for Payer: Cash Price |
$956.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,700.80
|
| Rate for Payer: Cigna of CA HMO |
$1,360.64
|
| Rate for Payer: Cigna of CA PPO |
$1,573.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$637.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$467.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$424.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,488.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$700.97
|
| Rate for Payer: EPIC Health Plan Senior |
$467.31
|
| Rate for Payer: Galaxy Health WC |
$1,807.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,275.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,913.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$696.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$57.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$424.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,350.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$63.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$594.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$425.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$569.27
|
| Rate for Payer: Multiplan Commercial |
$1,594.50
|
| Rate for Payer: Multiplan WC |
$671.50
|
| Rate for Payer: Networks By Design Commercial |
$1,381.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$424.83
|
| Rate for Payer: Preferred Health Network WC |
$685.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,807.10
|
| Rate for Payer: Prime Health Services Medicare |
$450.32
|
| Rate for Payer: Prime Health Services WC |
$664.64
|
| Rate for Payer: Riverside University Health System MISP |
$467.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,275.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,063.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$424.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$637.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$467.31
|
| Rate for Payer: Vantage Medical Group Senior |
$424.83
|
|
|
HC DECLOT VAD CATH THROMBOLYTIC AGENT
|
Facility
|
IP
|
$2,126.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
901200077
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$425.20 |
| Max. Negotiated Rate |
$1,913.40 |
| Rate for Payer: Adventist Health Commercial |
$425.20
|
| Rate for Payer: Cash Price |
$956.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,700.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,488.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$850.40
|
| Rate for Payer: EPIC Health Plan Senior |
$850.40
|
| Rate for Payer: Galaxy Health WC |
$1,807.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,275.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,913.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,350.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,254.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$425.20
|
| Rate for Payer: Multiplan Commercial |
$1,594.50
|
| Rate for Payer: Networks By Design Commercial |
$1,381.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,807.10
|
|
|
HC DECLOT VAD CATH THROMBOLYTIC AGENT
|
Facility
|
IP
|
$2,126.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
948100110
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$425.20 |
| Max. Negotiated Rate |
$1,913.40 |
| Rate for Payer: Adventist Health Commercial |
$425.20
|
| Rate for Payer: Cash Price |
$956.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,700.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,488.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$850.40
|
| Rate for Payer: EPIC Health Plan Senior |
$850.40
|
| Rate for Payer: Galaxy Health WC |
$1,807.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,275.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,913.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,350.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,254.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$425.20
|
| Rate for Payer: Multiplan Commercial |
$1,594.50
|
| Rate for Payer: Networks By Design Commercial |
$1,381.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,807.10
|
|
|
HC DECLOT VAD CATH THROMBOLYTIC AGENT
|
Facility
|
IP
|
$2,126.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
946000110
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$425.20 |
| Max. Negotiated Rate |
$1,913.40 |
| Rate for Payer: Adventist Health Commercial |
$425.20
|
| Rate for Payer: Cash Price |
$956.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,700.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,488.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$850.40
|
| Rate for Payer: EPIC Health Plan Senior |
$850.40
|
| Rate for Payer: Galaxy Health WC |
$1,807.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,275.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,913.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,350.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,254.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$425.20
|
| Rate for Payer: Multiplan Commercial |
$1,594.50
|
| Rate for Payer: Networks By Design Commercial |
$1,381.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,807.10
|
|
|
HC DECLOT VAD CATH THROMBOLYTIC AGENT
|
Facility
|
IP
|
$2,126.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
940100110
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$425.20 |
| Max. Negotiated Rate |
$1,913.40 |
| Rate for Payer: Adventist Health Commercial |
$425.20
|
| Rate for Payer: Cash Price |
$956.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,700.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,488.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$850.40
|
| Rate for Payer: EPIC Health Plan Senior |
$850.40
|
| Rate for Payer: Galaxy Health WC |
$1,807.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,275.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,913.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,350.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,254.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$425.20
|
| Rate for Payer: Multiplan Commercial |
$1,594.50
|
| Rate for Payer: Networks By Design Commercial |
$1,381.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,807.10
|
|
|
HC DECLOT VAD CATH THROMBOLYTIC AGENT
|
Facility
|
IP
|
$2,126.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
949000302
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$425.20 |
| Max. Negotiated Rate |
$1,913.40 |
| Rate for Payer: Adventist Health Commercial |
$425.20
|
| Rate for Payer: Cash Price |
$956.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,700.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,488.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$850.40
|
| Rate for Payer: EPIC Health Plan Senior |
$850.40
|
| Rate for Payer: Galaxy Health WC |
$1,807.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,275.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,913.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,350.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,254.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$425.20
|
| Rate for Payer: Multiplan Commercial |
$1,594.50
|
| Rate for Payer: Networks By Design Commercial |
$1,381.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,807.10
|
|
|
HC DECLOT VAD CATH THROMBOLYTIC AGENT
|
Facility
|
IP
|
$2,126.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
945000110
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$425.20 |
| Max. Negotiated Rate |
$1,913.40 |
| Rate for Payer: Adventist Health Commercial |
$425.20
|
| Rate for Payer: Cash Price |
$956.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,700.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,488.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$850.40
|
| Rate for Payer: EPIC Health Plan Senior |
$850.40
|
| Rate for Payer: Galaxy Health WC |
$1,807.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,275.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,913.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,350.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,254.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$425.20
|
| Rate for Payer: Multiplan Commercial |
$1,594.50
|
| Rate for Payer: Networks By Design Commercial |
$1,381.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,807.10
|
|
|
HC DECLOT VAD CATH THROMBOLYTIC AGENT
|
Facility
|
OP
|
$2,126.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
949000302
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$57.64 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$425.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$424.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$637.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$467.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$424.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$671.50
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$956.70
|
| Rate for Payer: Cash Price |
$956.70
|
| Rate for Payer: Cash Price |
$956.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,700.80
|
| Rate for Payer: Cigna of CA HMO |
$1,360.64
|
| Rate for Payer: Cigna of CA PPO |
$1,573.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$637.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$467.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$424.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,488.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$700.97
|
| Rate for Payer: EPIC Health Plan Senior |
$467.31
|
| Rate for Payer: Galaxy Health WC |
$1,807.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,275.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,913.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$696.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$57.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$424.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,350.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$63.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$594.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$425.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$569.27
|
| Rate for Payer: Multiplan Commercial |
$1,594.50
|
| Rate for Payer: Multiplan WC |
$671.50
|
| Rate for Payer: Networks By Design Commercial |
$1,381.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$424.83
|
| Rate for Payer: Preferred Health Network WC |
$685.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,807.10
|
| Rate for Payer: Prime Health Services Medicare |
$450.32
|
| Rate for Payer: Prime Health Services WC |
$664.64
|
| Rate for Payer: Riverside University Health System MISP |
$467.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,275.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,063.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$424.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$637.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$467.31
|
| Rate for Payer: Vantage Medical Group Senior |
$424.83
|
|
|
HC DECLOT VAD CATH THROMBOLYTIC AGENT
|
Facility
|
OP
|
$2,126.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
946100110
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$57.64 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Dignity Health Medi-Cal |
$467.31
|
| Rate for Payer: Adventist Health Commercial |
$425.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$424.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$637.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$467.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$424.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$671.50
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$956.70
|
| Rate for Payer: Cash Price |
$956.70
|
| Rate for Payer: Cash Price |
$956.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,700.80
|
| Rate for Payer: Cigna of CA HMO |
$1,360.64
|
| Rate for Payer: Cigna of CA PPO |
$1,573.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$637.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$424.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,488.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$700.97
|
| Rate for Payer: EPIC Health Plan Senior |
$467.31
|
| Rate for Payer: Galaxy Health WC |
$1,807.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,275.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,913.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$696.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$57.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$424.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,350.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$63.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$594.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$425.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$569.27
|
| Rate for Payer: Multiplan Commercial |
$1,594.50
|
| Rate for Payer: Multiplan WC |
$671.50
|
| Rate for Payer: Networks By Design Commercial |
$1,381.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$424.83
|
| Rate for Payer: Preferred Health Network WC |
$685.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,807.10
|
| Rate for Payer: Prime Health Services Medicare |
$450.32
|
| Rate for Payer: Prime Health Services WC |
$664.64
|
| Rate for Payer: Riverside University Health System MISP |
$467.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,275.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,063.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$424.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$637.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$467.31
|
| Rate for Payer: Vantage Medical Group Senior |
$424.83
|
|
|
HC DECLOT VAD CATH THROMBOLYTIC AGENT
|
Facility
|
OP
|
$2,126.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
948100110
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$57.64 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$425.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$424.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$637.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$467.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$424.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$671.50
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$956.70
|
| Rate for Payer: Cash Price |
$956.70
|
| Rate for Payer: Cash Price |
$956.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,700.80
|
| Rate for Payer: Cigna of CA HMO |
$1,360.64
|
| Rate for Payer: Cigna of CA PPO |
$1,573.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$637.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$467.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$424.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,488.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$700.97
|
| Rate for Payer: EPIC Health Plan Senior |
$467.31
|
| Rate for Payer: Galaxy Health WC |
$1,807.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,275.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,913.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$696.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$57.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$424.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,350.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$63.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$594.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$425.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$569.27
|
| Rate for Payer: Multiplan Commercial |
$1,594.50
|
| Rate for Payer: Multiplan WC |
$671.50
|
| Rate for Payer: Networks By Design Commercial |
$1,381.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$424.83
|
| Rate for Payer: Preferred Health Network WC |
$685.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,807.10
|
| Rate for Payer: Prime Health Services Medicare |
$450.32
|
| Rate for Payer: Prime Health Services WC |
$664.64
|
| Rate for Payer: Riverside University Health System MISP |
$467.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,275.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,063.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$424.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$637.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$467.31
|
| Rate for Payer: Vantage Medical Group Senior |
$424.83
|
|
|
HC DECOMPRESSION LOWER LEG
|
Facility
|
IP
|
$7,128.00
|
|
|
Service Code
|
CPT 27600
|
| Hospital Charge Code |
900501510
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,425.60 |
| Max. Negotiated Rate |
$6,415.20 |
| Rate for Payer: Adventist Health Commercial |
$1,425.60
|
| Rate for Payer: Cash Price |
$3,207.60
|
| Rate for Payer: Central Health Plan Commercial |
$5,702.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,989.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,851.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,851.20
|
| Rate for Payer: Galaxy Health WC |
$6,058.80
|
| Rate for Payer: Global Benefits Group Commercial |
$4,276.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,415.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,526.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,205.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,425.60
|
| Rate for Payer: Multiplan Commercial |
$5,346.00
|
| Rate for Payer: Networks By Design Commercial |
$4,633.20
|
| Rate for Payer: Prime Health Services Commercial |
$6,058.80
|
|
|
HC DECOMPRESSION LOWER LEG
|
Facility
|
OP
|
$7,128.00
|
|
|
Service Code
|
CPT 27600
|
| Hospital Charge Code |
900501510
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$6,943.76 |
| Rate for Payer: Adventist Health Commercial |
$1,425.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,568.63
|
| Rate for Payer: Cash Price |
$3,207.60
|
| Rate for Payer: Cash Price |
$3,207.60
|
| Rate for Payer: Cash Price |
$3,207.60
|
| Rate for Payer: Cash Price |
$3,207.60
|
| Rate for Payer: Central Health Plan Commercial |
$5,702.40
|
| Rate for Payer: Cigna of CA HMO |
$4,561.92
|
| Rate for Payer: Cigna of CA PPO |
$5,274.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,989.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,943.76
|
| Rate for Payer: EPIC Health Plan Senior |
$4,629.17
|
| Rate for Payer: Galaxy Health WC |
$6,058.80
|
| Rate for Payer: Global Benefits Group Commercial |
$4,276.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,415.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,901.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,526.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$439.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,523.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,425.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,639.18
|
| Rate for Payer: Multiplan Commercial |
$5,346.00
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$4,633.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Preferred Health Network WC |
$6,702.68
|
| Rate for Payer: Prime Health Services Commercial |
$6,058.80
|
| Rate for Payer: Prime Health Services Medicare |
$4,460.84
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Riverside University Health System MISP |
$4,629.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,276.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,564.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,564.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,564.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,564.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,208.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
HC DEEP MUSCLE BIOPSY
|
Facility
|
OP
|
$8,074.00
|
|
|
Service Code
|
CPT 20205
|
| Hospital Charge Code |
904000001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$187.62 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,614.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$3,735.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,603.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,109.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,735.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$5,794.14
|
| Rate for Payer: Blue Shield of California Commercial |
$5,036.70
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$3,633.30
|
| Rate for Payer: Cash Price |
$3,633.30
|
| Rate for Payer: Cash Price |
$3,633.30
|
| Rate for Payer: Central Health Plan Commercial |
$6,459.20
|
| Rate for Payer: Cigna of CA HMO |
$5,167.36
|
| Rate for Payer: Cigna of CA PPO |
$5,974.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,603.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,109.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,735.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,651.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,164.32
|
| Rate for Payer: EPIC Health Plan Senior |
$4,109.55
|
| Rate for Payer: Galaxy Health WC |
$6,862.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,844.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,266.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,126.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$187.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,735.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,126.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$207.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,230.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,614.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,006.17
|
| Rate for Payer: Multiplan Commercial |
$6,055.50
|
| Rate for Payer: Multiplan WC |
$5,794.14
|
| Rate for Payer: Networks By Design Commercial |
$5,248.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,735.95
|
| Rate for Payer: Preferred Health Network WC |
$5,912.39
|
| Rate for Payer: Prime Health Services Commercial |
$6,862.90
|
| Rate for Payer: Prime Health Services Medicare |
$3,960.11
|
| Rate for Payer: Prime Health Services WC |
$5,735.02
|
| Rate for Payer: Riverside University Health System MISP |
$4,109.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,844.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,037.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,735.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,603.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,109.55
|
| Rate for Payer: Vantage Medical Group Senior |
$3,735.95
|
|
|
HC DEEP MUSCLE BIOPSY
|
Facility
|
IP
|
$8,074.00
|
|
|
Service Code
|
CPT 20205
|
| Hospital Charge Code |
904000001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,614.80 |
| Max. Negotiated Rate |
$7,266.60 |
| Rate for Payer: Adventist Health Commercial |
$1,614.80
|
| Rate for Payer: Cash Price |
$3,633.30
|
| Rate for Payer: Central Health Plan Commercial |
$6,459.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,651.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,229.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,229.60
|
| Rate for Payer: Galaxy Health WC |
$6,862.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,844.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,266.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,126.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,763.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,614.80
|
| Rate for Payer: Multiplan Commercial |
$6,055.50
|
| Rate for Payer: Networks By Design Commercial |
$5,248.10
|
| Rate for Payer: Prime Health Services Commercial |
$6,862.90
|
|
|
HC DELIVERY OF PLACENTA
|
Facility
|
IP
|
$11,471.00
|
|
|
Service Code
|
CPT 59414
|
| Hospital Charge Code |
902400375
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$2,294.20 |
| Max. Negotiated Rate |
$10,323.90 |
| Rate for Payer: Adventist Health Commercial |
$2,294.20
|
| Rate for Payer: Cash Price |
$5,161.95
|
| Rate for Payer: Central Health Plan Commercial |
$9,176.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,029.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,588.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,588.40
|
| Rate for Payer: Galaxy Health WC |
$9,750.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6,882.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,323.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,284.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,767.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,294.20
|
| Rate for Payer: Multiplan Commercial |
$8,603.25
|
| Rate for Payer: Networks By Design Commercial |
$7,456.15
|
| Rate for Payer: Prime Health Services Commercial |
$9,750.35
|
|
|
HC DELIVERY OF PLACENTA
|
Facility
|
OP
|
$11,471.00
|
|
|
Service Code
|
CPT 59414
|
| Hospital Charge Code |
902400375
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$168.93 |
| Max. Negotiated Rate |
$10,323.90 |
| Rate for Payer: Adventist Health Commercial |
$2,294.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,163.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,436.87
|
| Rate for Payer: Cash Price |
$5,161.95
|
| Rate for Payer: Cash Price |
$5,161.95
|
| Rate for Payer: Cash Price |
$5,161.95
|
| Rate for Payer: Cash Price |
$5,161.95
|
| Rate for Payer: Central Health Plan Commercial |
$9,176.80
|
| Rate for Payer: Cigna of CA HMO |
$7,341.44
|
| Rate for Payer: Cigna of CA PPO |
$8,488.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,579.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,163.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,029.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,869.74
|
| Rate for Payer: EPIC Health Plan Senior |
$4,579.83
|
| Rate for Payer: Galaxy Health WC |
$9,750.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6,882.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,323.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,828.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,163.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,284.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$168.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,475.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,294.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,579.06
|
| Rate for Payer: Multiplan Commercial |
$8,603.25
|
| Rate for Payer: Multiplan WC |
$6,436.87
|
| Rate for Payer: Networks By Design Commercial |
$7,456.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,163.48
|
| Rate for Payer: Preferred Health Network WC |
$6,568.23
|
| Rate for Payer: Prime Health Services Commercial |
$9,750.35
|
| Rate for Payer: Prime Health Services Medicare |
$4,413.29
|
| Rate for Payer: Prime Health Services WC |
$6,371.18
|
| Rate for Payer: Riverside University Health System MISP |
$4,579.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,882.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,735.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5,735.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5,735.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,735.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,163.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Vantage Medical Group Senior |
$4,163.48
|
|
|
HC DELIVERY OF PLACENTA
|
Facility
|
IP
|
$11,471.00
|
|
|
Service Code
|
CPT 59414
|
| Hospital Charge Code |
902400375
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,294.20 |
| Max. Negotiated Rate |
$10,323.90 |
| Rate for Payer: Adventist Health Commercial |
$2,294.20
|
| Rate for Payer: Cash Price |
$5,161.95
|
| Rate for Payer: Central Health Plan Commercial |
$9,176.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,029.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,588.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,588.40
|
| Rate for Payer: Galaxy Health WC |
$9,750.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6,882.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,323.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,284.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,767.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,294.20
|
| Rate for Payer: Multiplan Commercial |
$8,603.25
|
| Rate for Payer: Networks By Design Commercial |
$7,456.15
|
| Rate for Payer: Prime Health Services Commercial |
$9,750.35
|
|
|
HC DELIVERY OF PLACENTA
|
Facility
|
OP
|
$11,471.00
|
|
|
Service Code
|
CPT 59414
|
| Hospital Charge Code |
902400375
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$152.93 |
| Max. Negotiated Rate |
$10,323.90 |
| Rate for Payer: Adventist Health Commercial |
$2,294.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,163.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$501.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,163.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,272.61
|
| Rate for Payer: Blue Shield of California EPN |
$4,576.93
|
| Rate for Payer: Cash Price |
$5,161.95
|
| Rate for Payer: Cash Price |
$5,161.95
|
| Rate for Payer: Cash Price |
$5,161.95
|
| Rate for Payer: Cash Price |
$5,161.95
|
| Rate for Payer: Central Health Plan Commercial |
$9,176.80
|
| Rate for Payer: Cigna of CA HMO |
$7,341.44
|
| Rate for Payer: Cigna of CA PPO |
$8,488.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,579.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,163.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,029.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,869.74
|
| Rate for Payer: EPIC Health Plan Senior |
$4,579.83
|
| Rate for Payer: Galaxy Health WC |
$9,750.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6,882.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,323.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,828.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$152.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,163.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,284.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$168.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,828.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,294.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,579.06
|
| Rate for Payer: Multiplan Commercial |
$8,603.25
|
| Rate for Payer: Networks By Design Commercial |
$7,456.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,163.48
|
| Rate for Payer: Prime Health Services Commercial |
$9,750.35
|
| Rate for Payer: Prime Health Services Medicare |
$4,413.29
|
| Rate for Payer: Riverside University Health System MISP |
$4,579.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,882.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,882.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,091.00
|
| Rate for Payer: United Healthcare All Other HMO |
$839.00
|
| Rate for Payer: United Healthcare HMO Rider |
$635.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$581.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,163.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Vantage Medical Group Senior |
$4,163.48
|
|
|
HC DEMO/EVAL PT UTILIZATN INHALER
|
Facility
|
IP
|
$513.00
|
|
|
Service Code
|
CPT 94664
|
| Hospital Charge Code |
900800112
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$102.60 |
| Max. Negotiated Rate |
$461.70 |
| Rate for Payer: Adventist Health Commercial |
$102.60
|
| Rate for Payer: Cash Price |
$230.85
|
| Rate for Payer: Central Health Plan Commercial |
$410.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$359.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$205.20
|
| Rate for Payer: EPIC Health Plan Senior |
$205.20
|
| Rate for Payer: Galaxy Health WC |
$436.05
|
| Rate for Payer: Global Benefits Group Commercial |
$307.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$461.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$325.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$302.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.60
|
| Rate for Payer: Multiplan Commercial |
$384.75
|
| Rate for Payer: Networks By Design Commercial |
$333.45
|
| Rate for Payer: Prime Health Services Commercial |
$436.05
|
|
|
HC DEMO/EVAL PT UTILIZATN INHALER
|
Facility
|
OP
|
$513.00
|
|
|
Service Code
|
CPT 94664
|
| Hospital Charge Code |
900800112
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$14.79 |
| Max. Negotiated Rate |
$536.00 |
| Rate for Payer: Adventist Health Commercial |
$102.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$281.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$103.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$422.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$309.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$281.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$134.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$230.85
|
| Rate for Payer: Cash Price |
$230.85
|
| Rate for Payer: Cash Price |
$230.85
|
| Rate for Payer: Central Health Plan Commercial |
$410.40
|
| Rate for Payer: Cigna of CA HMO |
$328.32
|
| Rate for Payer: Cigna of CA PPO |
$379.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$422.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$309.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$281.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$359.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$464.71
|
| Rate for Payer: EPIC Health Plan Senior |
$309.80
|
| Rate for Payer: Galaxy Health WC |
$436.05
|
| Rate for Payer: Global Benefits Group Commercial |
$307.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$461.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$461.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$281.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$325.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$394.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$377.40
|
| Rate for Payer: Multiplan Commercial |
$384.75
|
| Rate for Payer: Networks By Design Commercial |
$333.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$281.64
|
| Rate for Payer: Prime Health Services Commercial |
$436.05
|
| Rate for Payer: Prime Health Services Medicare |
$298.54
|
| Rate for Payer: Riverside University Health System MISP |
$309.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$307.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$307.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$281.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$422.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$309.80
|
| Rate for Payer: Vantage Medical Group Senior |
$281.64
|
|
|
HC DENNIS BROWNE CLAMPED
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT L3150
|
| Hospital Charge Code |
915353150
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.60 |
| Max. Negotiated Rate |
$160.20 |
| Rate for Payer: Adventist Health Commercial |
$35.60
|
| Rate for Payer: Blue Shield of California Commercial |
$142.76
|
| Rate for Payer: Blue Shield of California EPN |
$89.71
|
| Rate for Payer: Cash Price |
$80.10
|
| Rate for Payer: Central Health Plan Commercial |
$142.40
|
| Rate for Payer: Cigna of CA HMO |
$124.60
|
| Rate for Payer: Cigna of CA PPO |
$124.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$124.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.20
|
| Rate for Payer: EPIC Health Plan Senior |
$71.20
|
| Rate for Payer: Galaxy Health WC |
$151.30
|
| Rate for Payer: Global Benefits Group Commercial |
$106.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$160.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$113.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$105.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.60
|
| Rate for Payer: Multiplan Commercial |
$133.50
|
| Rate for Payer: Networks By Design Commercial |
$115.70
|
| Rate for Payer: Prime Health Services Commercial |
$151.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$66.80
|
| Rate for Payer: United Healthcare All Other HMO |
$65.02
|
| Rate for Payer: United Healthcare HMO Rider |
$63.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$58.30
|
|
|
HC DENNIS BROWNE CLAMPED
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT L3150
|
| Hospital Charge Code |
905353150
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$58.30 |
| Max. Negotiated Rate |
$160.20 |
| Rate for Payer: Adventist Health Commercial |
$72.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$151.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$97.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$133.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$103.54
|
| Rate for Payer: Blue Shield of California Commercial |
$142.76
|
| Rate for Payer: Blue Shield of California EPN |
$89.71
|
| Rate for Payer: Cash Price |
$80.10
|
| Rate for Payer: Cash Price |
$80.10
|
| Rate for Payer: Central Health Plan Commercial |
$142.40
|
| Rate for Payer: Cigna of CA HMO |
$124.60
|
| Rate for Payer: Cigna of CA PPO |
$124.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$151.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$151.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$124.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.20
|
| Rate for Payer: EPIC Health Plan Senior |
$71.20
|
| Rate for Payer: Galaxy Health WC |
$151.30
|
| Rate for Payer: Global Benefits Group Commercial |
$106.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$160.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$88.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$113.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$97.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$105.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$124.60
|
| Rate for Payer: Multiplan Commercial |
$133.50
|
| Rate for Payer: Networks By Design Commercial |
$89.00
|
| Rate for Payer: Prime Health Services Commercial |
$151.30
|
| Rate for Payer: Riverside University Health System MISP |
$71.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$106.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$106.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$66.80
|
| Rate for Payer: United Healthcare All Other HMO |
$65.02
|
| Rate for Payer: United Healthcare HMO Rider |
$63.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$58.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$151.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.30
|
| Rate for Payer: Vantage Medical Group Senior |
$151.30
|
|
|
HC DENNIS BROWNE CLAMPED
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT L3150
|
| Hospital Charge Code |
905353150
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.60 |
| Max. Negotiated Rate |
$160.20 |
| Rate for Payer: Adventist Health Commercial |
$35.60
|
| Rate for Payer: Blue Shield of California Commercial |
$142.76
|
| Rate for Payer: Blue Shield of California EPN |
$89.71
|
| Rate for Payer: Cash Price |
$80.10
|
| Rate for Payer: Central Health Plan Commercial |
$142.40
|
| Rate for Payer: Cigna of CA HMO |
$124.60
|
| Rate for Payer: Cigna of CA PPO |
$124.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$124.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.20
|
| Rate for Payer: EPIC Health Plan Senior |
$71.20
|
| Rate for Payer: Galaxy Health WC |
$151.30
|
| Rate for Payer: Global Benefits Group Commercial |
$106.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$160.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$113.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$105.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.60
|
| Rate for Payer: Multiplan Commercial |
$133.50
|
| Rate for Payer: Networks By Design Commercial |
$115.70
|
| Rate for Payer: Prime Health Services Commercial |
$151.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$66.80
|
| Rate for Payer: United Healthcare All Other HMO |
$65.02
|
| Rate for Payer: United Healthcare HMO Rider |
$63.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$58.30
|
|
