|
HC DUP SCAN EXTRACRANIAL ART COMPLEX
|
Facility
|
OP
|
$1,964.00
|
|
|
Service Code
|
CPT 93880
|
| Hospital Charge Code |
908100102
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$220.00 |
| Max. Negotiated Rate |
$1,767.60 |
| Rate for Payer: Adventist Health Commercial |
$392.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$306.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$996.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$994.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,142.46
|
| Rate for Payer: Blue Shield of California Commercial |
$1,237.32
|
| Rate for Payer: Blue Shield of California EPN |
$779.71
|
| Rate for Payer: Cash Price |
$883.80
|
| Rate for Payer: Cash Price |
$883.80
|
| Rate for Payer: Cash Price |
$883.80
|
| Rate for Payer: Center for Health Promotion Commercial |
$220.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,571.20
|
| Rate for Payer: Cigna of CA HMO |
$1,256.96
|
| Rate for Payer: Cigna of CA PPO |
$1,453.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,374.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.35
|
| Rate for Payer: EPIC Health Plan Senior |
$337.57
|
| Rate for Payer: Galaxy Health WC |
$1,669.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,178.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,767.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$269.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,247.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$297.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$392.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$411.22
|
| Rate for Payer: Multiplan Commercial |
$1,473.00
|
| Rate for Payer: Networks By Design Commercial |
$1,276.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$306.88
|
| Rate for Payer: Prime Health Services Commercial |
$1,669.40
|
| Rate for Payer: Prime Health Services Medicare |
$325.29
|
| Rate for Payer: Riverside University Health System MISP |
$337.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,178.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,178.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,588.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,289.00
|
| Rate for Payer: United Healthcare HMO Rider |
$978.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$895.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$306.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
|
|
HC DUP SCAN EXTRACRANIAL ART LIMITED
|
Facility
|
OP
|
$955.00
|
|
|
Service Code
|
CPT 93882
|
| Hospital Charge Code |
908100116
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$131.13 |
| Max. Negotiated Rate |
$1,588.00 |
| Rate for Payer: Adventist Health Commercial |
$191.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$134.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$994.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$660.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$555.52
|
| Rate for Payer: Blue Shield of California Commercial |
$601.65
|
| Rate for Payer: Blue Shield of California EPN |
$379.13
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Central Health Plan Commercial |
$764.00
|
| Rate for Payer: Cigna of CA HMO |
$611.20
|
| Rate for Payer: Cigna of CA PPO |
$706.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$668.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$811.75
|
| Rate for Payer: Global Benefits Group Commercial |
$573.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$859.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$131.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$606.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$144.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$191.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$716.25
|
| Rate for Payer: Networks By Design Commercial |
$620.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$134.46
|
| Rate for Payer: Prime Health Services Commercial |
$811.75
|
| Rate for Payer: Prime Health Services Medicare |
$142.53
|
| Rate for Payer: Riverside University Health System MISP |
$147.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$573.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$573.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,588.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,289.00
|
| Rate for Payer: United Healthcare HMO Rider |
$978.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$895.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC DUP SCAN EXTRACRANIAL ART LIMITED
|
Facility
|
IP
|
$955.00
|
|
|
Service Code
|
CPT 93882
|
| Hospital Charge Code |
908100116
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$191.00 |
| Max. Negotiated Rate |
$859.50 |
| Rate for Payer: Adventist Health Commercial |
$191.00
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Central Health Plan Commercial |
$764.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$668.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$382.00
|
| Rate for Payer: EPIC Health Plan Senior |
$382.00
|
| Rate for Payer: Galaxy Health WC |
$811.75
|
| Rate for Payer: Global Benefits Group Commercial |
$573.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$859.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$606.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$563.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$191.00
|
| Rate for Payer: Multiplan Commercial |
$716.25
|
| Rate for Payer: Networks By Design Commercial |
$620.75
|
| Rate for Payer: Prime Health Services Commercial |
$811.75
|
|
|
HC DVC BERLIN HEART DRIVING UNIT
|
Facility
|
IP
|
$16,170.00
|
|
| Hospital Charge Code |
901692008
|
|
Hospital Revenue Code
|
291
|
| Min. Negotiated Rate |
$3,234.00 |
| Max. Negotiated Rate |
$14,553.00 |
| Rate for Payer: Adventist Health Commercial |
$3,234.00
|
| Rate for Payer: Cash Price |
$7,276.50
|
| Rate for Payer: Central Health Plan Commercial |
$12,936.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11,319.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,468.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6,468.00
|
| Rate for Payer: Galaxy Health WC |
$13,744.50
|
| Rate for Payer: Global Benefits Group Commercial |
$9,702.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,553.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,267.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,540.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,234.00
|
| Rate for Payer: Multiplan Commercial |
$12,127.50
|
| Rate for Payer: Networks By Design Commercial |
$10,510.50
|
| Rate for Payer: Prime Health Services Commercial |
$13,744.50
|
|
|
HC DVC BERLIN HEART DRIVING UNIT
|
Facility
|
OP
|
$16,170.00
|
|
| Hospital Charge Code |
901692008
|
|
Hospital Revenue Code
|
291
|
| Min. Negotiated Rate |
$3,234.00 |
| Max. Negotiated Rate |
$14,553.00 |
| Rate for Payer: Adventist Health Commercial |
$3,234.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,820.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,744.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,893.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12,127.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7,829.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,406.09
|
| Rate for Payer: Blue Shield of California Commercial |
$10,251.78
|
| Rate for Payer: Blue Shield of California EPN |
$6,451.83
|
| Rate for Payer: Cash Price |
$7,276.50
|
| Rate for Payer: Central Health Plan Commercial |
$12,936.00
|
| Rate for Payer: Cigna of CA HMO |
$10,348.80
|
| Rate for Payer: Cigna of CA PPO |
$11,965.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,744.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,744.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,744.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11,319.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,468.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6,468.00
|
| Rate for Payer: Galaxy Health WC |
$13,744.50
|
| Rate for Payer: Global Benefits Group Commercial |
$9,702.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,553.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,267.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,869.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,540.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,234.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11,319.00
|
| Rate for Payer: Multiplan Commercial |
$12,127.50
|
| Rate for Payer: Networks By Design Commercial |
$10,510.50
|
| Rate for Payer: Prime Health Services Commercial |
$13,744.50
|
| Rate for Payer: Riverside University Health System MISP |
$6,468.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,702.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,702.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,744.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,744.50
|
| Rate for Payer: Vantage Medical Group Senior |
$13,744.50
|
|
|
HC DVC FEEDING TUBE 5-18FR
|
Facility
|
OP
|
$15.91
|
|
|
Service Code
|
CPT B9998
|
| Hospital Charge Code |
901698340
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.18 |
| Max. Negotiated Rate |
$14.32 |
| Rate for Payer: Adventist Health Commercial |
$3.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.25
|
| Rate for Payer: Blue Shield of California Commercial |
$10.09
|
| Rate for Payer: Blue Shield of California EPN |
$6.35
|
| Rate for Payer: Cash Price |
$7.16
|
| Rate for Payer: Central Health Plan Commercial |
$12.73
|
| Rate for Payer: Cigna of CA HMO |
$10.18
|
| Rate for Payer: Cigna of CA PPO |
$11.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.36
|
| Rate for Payer: EPIC Health Plan Senior |
$6.36
|
| Rate for Payer: Galaxy Health WC |
$13.52
|
| Rate for Payer: Global Benefits Group Commercial |
$9.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11.14
|
| Rate for Payer: Multiplan Commercial |
$11.93
|
| Rate for Payer: Networks By Design Commercial |
$10.34
|
| Rate for Payer: Prime Health Services Commercial |
$13.52
|
| Rate for Payer: Riverside University Health System MISP |
$6.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.96
|
| Rate for Payer: United Healthcare All Other HMO |
$7.96
|
| Rate for Payer: United Healthcare HMO Rider |
$7.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.52
|
| Rate for Payer: Vantage Medical Group Senior |
$13.52
|
|
|
HC DVC FEEDING TUBE 5-18FR
|
Facility
|
IP
|
$15.91
|
|
|
Service Code
|
CPT B9998
|
| Hospital Charge Code |
901698340
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.18 |
| Max. Negotiated Rate |
$14.32 |
| Rate for Payer: Adventist Health Commercial |
$3.18
|
| Rate for Payer: Cash Price |
$7.16
|
| Rate for Payer: Central Health Plan Commercial |
$12.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.36
|
| Rate for Payer: EPIC Health Plan Senior |
$6.36
|
| Rate for Payer: Galaxy Health WC |
$13.52
|
| Rate for Payer: Global Benefits Group Commercial |
$9.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.18
|
| Rate for Payer: Multiplan Commercial |
$11.93
|
| Rate for Payer: Networks By Design Commercial |
$10.34
|
| Rate for Payer: Prime Health Services Commercial |
$13.52
|
|
|
HC DVC NASAL SUCTION
|
Facility
|
IP
|
$20.58
|
|
| Hospital Charge Code |
901604906
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.12 |
| Max. Negotiated Rate |
$18.52 |
| Rate for Payer: Adventist Health Commercial |
$4.12
|
| Rate for Payer: Cash Price |
$9.26
|
| Rate for Payer: Central Health Plan Commercial |
$16.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.23
|
| Rate for Payer: EPIC Health Plan Senior |
$8.23
|
| Rate for Payer: Galaxy Health WC |
$17.49
|
| Rate for Payer: Global Benefits Group Commercial |
$12.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.12
|
| Rate for Payer: Multiplan Commercial |
$15.44
|
| Rate for Payer: Networks By Design Commercial |
$13.38
|
| Rate for Payer: Prime Health Services Commercial |
$17.49
|
|
|
HC DVC NASAL SUCTION
|
Facility
|
OP
|
$20.58
|
|
| Hospital Charge Code |
901604906
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.12 |
| Max. Negotiated Rate |
$18.52 |
| Rate for Payer: Adventist Health Commercial |
$4.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.97
|
| Rate for Payer: Blue Shield of California Commercial |
$13.05
|
| Rate for Payer: Blue Shield of California EPN |
$8.21
|
| Rate for Payer: Cash Price |
$9.26
|
| Rate for Payer: Central Health Plan Commercial |
$16.46
|
| Rate for Payer: Cigna of CA HMO |
$13.17
|
| Rate for Payer: Cigna of CA PPO |
$15.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.23
|
| Rate for Payer: EPIC Health Plan Senior |
$8.23
|
| Rate for Payer: Galaxy Health WC |
$17.49
|
| Rate for Payer: Global Benefits Group Commercial |
$12.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14.41
|
| Rate for Payer: Multiplan Commercial |
$15.44
|
| Rate for Payer: Networks By Design Commercial |
$13.38
|
| Rate for Payer: Prime Health Services Commercial |
$17.49
|
| Rate for Payer: Riverside University Health System MISP |
$8.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.29
|
| Rate for Payer: United Healthcare All Other HMO |
$10.29
|
| Rate for Payer: United Healthcare HMO Rider |
$10.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.49
|
| Rate for Payer: Vantage Medical Group Senior |
$17.49
|
|
|
HC DVC NASAL SUCTION PREEMIE
|
Facility
|
OP
|
$19.02
|
|
| Hospital Charge Code |
901605138
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$17.12 |
| Rate for Payer: Adventist Health Commercial |
$3.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.06
|
| Rate for Payer: Blue Shield of California Commercial |
$12.06
|
| Rate for Payer: Blue Shield of California EPN |
$7.59
|
| Rate for Payer: Cash Price |
$8.56
|
| Rate for Payer: Central Health Plan Commercial |
$15.22
|
| Rate for Payer: Cigna of CA HMO |
$12.17
|
| Rate for Payer: Cigna of CA PPO |
$14.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.61
|
| Rate for Payer: EPIC Health Plan Senior |
$7.61
|
| Rate for Payer: Galaxy Health WC |
$16.17
|
| Rate for Payer: Global Benefits Group Commercial |
$11.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13.31
|
| Rate for Payer: Multiplan Commercial |
$14.27
|
| Rate for Payer: Networks By Design Commercial |
$12.36
|
| Rate for Payer: Prime Health Services Commercial |
$16.17
|
| Rate for Payer: Riverside University Health System MISP |
$7.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.51
|
| Rate for Payer: United Healthcare All Other HMO |
$9.51
|
| Rate for Payer: United Healthcare HMO Rider |
$9.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.17
|
| Rate for Payer: Vantage Medical Group Senior |
$16.17
|
|
|
HC DVC NASAL SUCTION PREEMIE
|
Facility
|
IP
|
$19.02
|
|
| Hospital Charge Code |
901605138
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$17.12 |
| Rate for Payer: Adventist Health Commercial |
$3.80
|
| Rate for Payer: Cash Price |
$8.56
|
| Rate for Payer: Central Health Plan Commercial |
$15.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.61
|
| Rate for Payer: EPIC Health Plan Senior |
$7.61
|
| Rate for Payer: Galaxy Health WC |
$16.17
|
| Rate for Payer: Global Benefits Group Commercial |
$11.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.80
|
| Rate for Payer: Multiplan Commercial |
$14.27
|
| Rate for Payer: Networks By Design Commercial |
$12.36
|
| Rate for Payer: Prime Health Services Commercial |
$16.17
|
|
|
HC DVC NASAL SUCTION STD W/COVER
|
Facility
|
IP
|
$25.34
|
|
| Hospital Charge Code |
901698481
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$22.81 |
| Rate for Payer: Adventist Health Commercial |
$5.07
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Central Health Plan Commercial |
$20.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.14
|
| Rate for Payer: EPIC Health Plan Senior |
$10.14
|
| Rate for Payer: Galaxy Health WC |
$21.54
|
| Rate for Payer: Global Benefits Group Commercial |
$15.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.07
|
| Rate for Payer: Multiplan Commercial |
$19.00
|
| Rate for Payer: Networks By Design Commercial |
$16.47
|
| Rate for Payer: Prime Health Services Commercial |
$21.54
|
|
|
HC DVC NASAL SUCTION STD W/COVER
|
Facility
|
OP
|
$25.34
|
|
| Hospital Charge Code |
901698481
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$22.81 |
| Rate for Payer: Adventist Health Commercial |
$5.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.74
|
| Rate for Payer: Blue Shield of California Commercial |
$16.07
|
| Rate for Payer: Blue Shield of California EPN |
$10.11
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Central Health Plan Commercial |
$20.27
|
| Rate for Payer: Cigna of CA HMO |
$16.22
|
| Rate for Payer: Cigna of CA PPO |
$18.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.54
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.14
|
| Rate for Payer: EPIC Health Plan Senior |
$10.14
|
| Rate for Payer: Galaxy Health WC |
$21.54
|
| Rate for Payer: Global Benefits Group Commercial |
$15.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.74
|
| Rate for Payer: Multiplan Commercial |
$19.00
|
| Rate for Payer: Networks By Design Commercial |
$16.47
|
| Rate for Payer: Prime Health Services Commercial |
$21.54
|
| Rate for Payer: Riverside University Health System MISP |
$10.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.67
|
| Rate for Payer: United Healthcare All Other HMO |
$12.67
|
| Rate for Payer: United Healthcare HMO Rider |
$12.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.54
|
| Rate for Payer: Vantage Medical Group Senior |
$21.54
|
|
|
HC DVC NASAL SUCTION STNDR
|
Facility
|
OP
|
$19.84
|
|
| Hospital Charge Code |
901605137
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.97 |
| Max. Negotiated Rate |
$17.86 |
| Rate for Payer: Adventist Health Commercial |
$3.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.54
|
| Rate for Payer: Blue Shield of California Commercial |
$12.58
|
| Rate for Payer: Blue Shield of California EPN |
$7.92
|
| Rate for Payer: Cash Price |
$8.93
|
| Rate for Payer: Central Health Plan Commercial |
$15.87
|
| Rate for Payer: Cigna of CA HMO |
$12.70
|
| Rate for Payer: Cigna of CA PPO |
$14.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.86
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.94
|
| Rate for Payer: EPIC Health Plan Senior |
$7.94
|
| Rate for Payer: Galaxy Health WC |
$16.86
|
| Rate for Payer: Global Benefits Group Commercial |
$11.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13.89
|
| Rate for Payer: Multiplan Commercial |
$14.88
|
| Rate for Payer: Networks By Design Commercial |
$12.90
|
| Rate for Payer: Prime Health Services Commercial |
$16.86
|
| Rate for Payer: Riverside University Health System MISP |
$7.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.92
|
| Rate for Payer: United Healthcare All Other HMO |
$9.92
|
| Rate for Payer: United Healthcare HMO Rider |
$9.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.86
|
| Rate for Payer: Vantage Medical Group Senior |
$16.86
|
|
|
HC DVC NASAL SUCTION STNDR
|
Facility
|
IP
|
$19.84
|
|
| Hospital Charge Code |
901605137
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.97 |
| Max. Negotiated Rate |
$17.86 |
| Rate for Payer: Adventist Health Commercial |
$3.97
|
| Rate for Payer: Cash Price |
$8.93
|
| Rate for Payer: Central Health Plan Commercial |
$15.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.94
|
| Rate for Payer: EPIC Health Plan Senior |
$7.94
|
| Rate for Payer: Galaxy Health WC |
$16.86
|
| Rate for Payer: Global Benefits Group Commercial |
$11.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.97
|
| Rate for Payer: Multiplan Commercial |
$14.88
|
| Rate for Payer: Networks By Design Commercial |
$12.90
|
| Rate for Payer: Prime Health Services Commercial |
$16.86
|
|
|
HC DVC NASAL SUCTN PREEMIE W/CVR
|
Facility
|
OP
|
$25.34
|
|
| Hospital Charge Code |
901698482
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$22.81 |
| Rate for Payer: Adventist Health Commercial |
$5.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.74
|
| Rate for Payer: Blue Shield of California Commercial |
$16.07
|
| Rate for Payer: Blue Shield of California EPN |
$10.11
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Central Health Plan Commercial |
$20.27
|
| Rate for Payer: Cigna of CA HMO |
$16.22
|
| Rate for Payer: Cigna of CA PPO |
$18.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.54
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.14
|
| Rate for Payer: EPIC Health Plan Senior |
$10.14
|
| Rate for Payer: Galaxy Health WC |
$21.54
|
| Rate for Payer: Global Benefits Group Commercial |
$15.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.74
|
| Rate for Payer: Multiplan Commercial |
$19.00
|
| Rate for Payer: Networks By Design Commercial |
$16.47
|
| Rate for Payer: Prime Health Services Commercial |
$21.54
|
| Rate for Payer: Riverside University Health System MISP |
$10.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.67
|
| Rate for Payer: United Healthcare All Other HMO |
$12.67
|
| Rate for Payer: United Healthcare HMO Rider |
$12.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.54
|
| Rate for Payer: Vantage Medical Group Senior |
$21.54
|
|
|
HC DVC NASAL SUCTN PREEMIE W/CVR
|
Facility
|
IP
|
$25.34
|
|
| Hospital Charge Code |
901698482
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$22.81 |
| Rate for Payer: Adventist Health Commercial |
$5.07
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Central Health Plan Commercial |
$20.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.14
|
| Rate for Payer: EPIC Health Plan Senior |
$10.14
|
| Rate for Payer: Galaxy Health WC |
$21.54
|
| Rate for Payer: Global Benefits Group Commercial |
$15.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.07
|
| Rate for Payer: Multiplan Commercial |
$19.00
|
| Rate for Payer: Networks By Design Commercial |
$16.47
|
| Rate for Payer: Prime Health Services Commercial |
$21.54
|
|
|
HC DVC PELVIC ORTHOTIC TPOD
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT E0944 NU
|
| Hospital Charge Code |
901605152
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$406.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$368.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$342.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
|
|
HC DVC PELVIC ORTHOTIC TPOD
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT E0944 NU
|
| Hospital Charge Code |
901605152
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$53.66 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$120.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$280.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$337.39
|
| Rate for Payer: Blue Shield of California Commercial |
$367.72
|
| Rate for Payer: Blue Shield of California EPN |
$231.42
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Cigna of CA HMO |
$371.20
|
| Rate for Payer: Cigna of CA PPO |
$429.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$493.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$406.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$53.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$368.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$59.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$342.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Riverside University Health System MISP |
$232.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC DVC RESQPOD RESUSCITATOR
|
Facility
|
OP
|
$580.00
|
|
| Hospital Charge Code |
901605270
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$352.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$280.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$337.39
|
| Rate for Payer: Blue Shield of California Commercial |
$367.72
|
| Rate for Payer: Blue Shield of California EPN |
$231.42
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Cigna of CA HMO |
$371.20
|
| Rate for Payer: Cigna of CA PPO |
$429.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$493.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$406.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$368.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$210.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$342.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Riverside University Health System MISP |
$232.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$290.00
|
| Rate for Payer: United Healthcare All Other HMO |
$290.00
|
| Rate for Payer: United Healthcare HMO Rider |
$290.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC DVC RESQPOD RESUSCITATOR
|
Facility
|
IP
|
$580.00
|
|
| Hospital Charge Code |
901605270
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$406.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$368.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$342.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
|
|
HC DVC THORACENTESIS 8FR
|
Facility
|
OP
|
$295.40
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
901600672
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$59.08 |
| Max. Negotiated Rate |
$265.86 |
| Rate for Payer: Adventist Health Commercial |
$59.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$251.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$162.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$221.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$134.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$162.00
|
| Rate for Payer: Blue Shield of California Commercial |
$236.91
|
| Rate for Payer: Blue Shield of California EPN |
$148.88
|
| Rate for Payer: Cash Price |
$132.93
|
| Rate for Payer: Central Health Plan Commercial |
$236.32
|
| Rate for Payer: Cigna of CA HMO |
$206.78
|
| Rate for Payer: Cigna of CA PPO |
$206.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$251.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$251.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$251.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$206.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.16
|
| Rate for Payer: EPIC Health Plan Senior |
$118.16
|
| Rate for Payer: Galaxy Health WC |
$251.09
|
| Rate for Payer: Global Benefits Group Commercial |
$177.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$265.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$187.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$107.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$174.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$206.78
|
| Rate for Payer: Multiplan Commercial |
$221.55
|
| Rate for Payer: Networks By Design Commercial |
$147.70
|
| Rate for Payer: Prime Health Services Commercial |
$251.09
|
| Rate for Payer: Riverside University Health System MISP |
$118.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$177.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$177.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$110.86
|
| Rate for Payer: United Healthcare All Other HMO |
$107.91
|
| Rate for Payer: United Healthcare HMO Rider |
$105.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$96.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$251.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$251.09
|
| Rate for Payer: Vantage Medical Group Senior |
$251.09
|
|
|
HC DVC THORACENTESIS 8FR
|
Facility
|
IP
|
$295.40
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
901600672
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$59.08 |
| Max. Negotiated Rate |
$265.86 |
| Rate for Payer: Adventist Health Commercial |
$59.08
|
| Rate for Payer: Blue Shield of California Commercial |
$236.91
|
| Rate for Payer: Blue Shield of California EPN |
$148.88
|
| Rate for Payer: Cash Price |
$132.93
|
| Rate for Payer: Central Health Plan Commercial |
$236.32
|
| Rate for Payer: Cigna of CA HMO |
$206.78
|
| Rate for Payer: Cigna of CA PPO |
$206.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$206.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.16
|
| Rate for Payer: EPIC Health Plan Senior |
$118.16
|
| Rate for Payer: Galaxy Health WC |
$251.09
|
| Rate for Payer: Global Benefits Group Commercial |
$177.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$265.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$187.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$174.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.08
|
| Rate for Payer: Multiplan Commercial |
$221.55
|
| Rate for Payer: Networks By Design Commercial |
$147.70
|
| Rate for Payer: Prime Health Services Commercial |
$251.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$110.86
|
| Rate for Payer: United Healthcare All Other HMO |
$107.91
|
| Rate for Payer: United Healthcare HMO Rider |
$105.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$96.74
|
|
|
HC DVLP COG SKILL 15 MIN OT MCARE
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT G0515
|
| Hospital Charge Code |
905104369
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$45.01 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$50.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$75.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$105.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$93.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| 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 |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Central Health Plan Commercial |
$99.20
|
| Rate for Payer: Cigna of CA HMO |
$79.36
|
| Rate for Payer: Cigna of CA PPO |
$91.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$105.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$105.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$105.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$86.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.60
|
| Rate for Payer: EPIC Health Plan Senior |
$49.60
|
| Rate for Payer: Galaxy Health WC |
$105.40
|
| Rate for Payer: Global Benefits Group Commercial |
$74.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$111.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$78.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$45.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$73.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$86.80
|
| Rate for Payer: Multiplan Commercial |
$93.00
|
| Rate for Payer: Networks By Design Commercial |
$80.60
|
| Rate for Payer: Prime Health Services Commercial |
$105.40
|
| Rate for Payer: Riverside University Health System MISP |
$49.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$74.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$74.40
|
| 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 |
$105.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$105.40
|
| Rate for Payer: Vantage Medical Group Senior |
$105.40
|
|
|
HC DVLP COG SKILL 15 MIN OT MCARE
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
CPT G0515
|
| Hospital Charge Code |
905104369
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$24.80 |
| Max. Negotiated Rate |
$111.60 |
| Rate for Payer: Adventist Health Commercial |
$24.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Central Health Plan Commercial |
$99.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$86.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.60
|
| Rate for Payer: EPIC Health Plan Senior |
$49.60
|
| Rate for Payer: Galaxy Health WC |
$105.40
|
| Rate for Payer: Global Benefits Group Commercial |
$74.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$111.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$78.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$73.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.80
|
| Rate for Payer: Multiplan Commercial |
$93.00
|
| Rate for Payer: Networks By Design Commercial |
$80.60
|
| Rate for Payer: Prime Health Services Commercial |
$105.40
|
|
