|
HC CNTRL VNS CATH KIT MAC DL 9FR
|
Facility
|
IP
|
$880.90
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698533
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$176.18 |
| Max. Negotiated Rate |
$792.81 |
| Rate for Payer: Blue Shield of California EPN |
$470.40
|
| Rate for Payer: Cash Price |
$396.41
|
| Rate for Payer: Central Health Plan Commercial |
$704.72
|
| Rate for Payer: Cigna of CA HMO |
$616.63
|
| Rate for Payer: Cigna of CA PPO |
$616.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$352.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$352.36
|
| Rate for Payer: Galaxy Health WC |
$748.76
|
| Rate for Payer: Global Benefits Group Commercial |
$528.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$792.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$587.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$335.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.18
|
| Rate for Payer: Multiplan Commercial |
$660.68
|
| Rate for Payer: Prime Health Services Commercial |
$748.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$332.63
|
| Rate for Payer: United Healthcare All Other HMO |
$324.88
|
| Rate for Payer: United Healthcare HMO Rider |
$317.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.70
|
|
|
HC CNTRL VNS CATH KIT QL 8.5FR
|
Facility
|
IP
|
$791.29
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698536
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$158.26 |
| Max. Negotiated Rate |
$712.16 |
| Rate for Payer: Blue Shield of California EPN |
$422.55
|
| Rate for Payer: Cash Price |
$356.08
|
| Rate for Payer: Central Health Plan Commercial |
$633.03
|
| Rate for Payer: Cigna of CA HMO |
$553.90
|
| Rate for Payer: Cigna of CA PPO |
$553.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$316.52
|
| Rate for Payer: EPIC Health Plan Transplant |
$316.52
|
| Rate for Payer: Galaxy Health WC |
$672.60
|
| Rate for Payer: Global Benefits Group Commercial |
$474.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$712.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$527.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$301.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.26
|
| Rate for Payer: Multiplan Commercial |
$593.47
|
| Rate for Payer: Prime Health Services Commercial |
$672.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$298.79
|
| Rate for Payer: United Healthcare All Other HMO |
$291.83
|
| Rate for Payer: United Healthcare HMO Rider |
$285.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$261.13
|
|
|
HC CNTRL VNS CATH KIT QL 8.5FR
|
Facility
|
OP
|
$791.29
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698536
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$158.26 |
| Max. Negotiated Rate |
$712.16 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$672.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$435.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$361.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$440.75
|
| Rate for Payer: Blue Distinction Transplant |
$474.77
|
| Rate for Payer: Blue Shield of California Commercial |
$593.47
|
| Rate for Payer: Blue Shield of California EPN |
$430.46
|
| Rate for Payer: Cash Price |
$356.08
|
| Rate for Payer: Central Health Plan Commercial |
$633.03
|
| Rate for Payer: Cigna of CA HMO |
$553.90
|
| Rate for Payer: Cigna of CA PPO |
$553.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$672.60
|
| Rate for Payer: Dignity Health Media |
$672.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$672.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$316.52
|
| Rate for Payer: EPIC Health Plan Transplant |
$316.52
|
| Rate for Payer: Galaxy Health WC |
$672.60
|
| Rate for Payer: Global Benefits Group Commercial |
$474.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$712.16
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$593.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$276.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$527.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$301.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.26
|
| Rate for Payer: Multiplan Commercial |
$593.47
|
| Rate for Payer: Networks By Design Commercial |
$395.64
|
| Rate for Payer: Prime Health Services Commercial |
$672.60
|
| Rate for Payer: Riverside University Health System MISP |
$316.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$474.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$474.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$395.64
|
| Rate for Payer: United Healthcare All Other HMO |
$395.64
|
| Rate for Payer: United Healthcare HMO Rider |
$395.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$395.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$672.60
|
| Rate for Payer: Vantage Medical Group Senior |
$672.60
|
|
|
HC CNTRL VNS CATH KIT TL 7FR 16CM
|
Facility
|
IP
|
$702.79
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698537
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$140.56 |
| Max. Negotiated Rate |
$632.51 |
| Rate for Payer: Cash Price |
$316.26
|
| Rate for Payer: Central Health Plan Commercial |
$562.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$281.12
|
| Rate for Payer: Galaxy Health WC |
$597.37
|
| Rate for Payer: Global Benefits Group Commercial |
$421.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$632.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$468.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$267.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.56
|
| Rate for Payer: Multiplan Commercial |
$527.09
|
| Rate for Payer: Networks By Design Commercial |
$456.81
|
| Rate for Payer: Prime Health Services Commercial |
$597.37
|
|
|
HC CNTRL VNS CATH KIT TL 7FR 16CM
|
Facility
|
OP
|
$702.79
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698537
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$140.56 |
| Max. Negotiated Rate |
$1,019.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,019.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$597.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$386.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$386.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$340.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$415.21
|
| Rate for Payer: Blue Distinction Transplant |
$421.67
|
| Rate for Payer: Blue Shield of California Commercial |
$442.05
|
| Rate for Payer: Blue Shield of California EPN |
$343.66
|
| Rate for Payer: Cash Price |
$316.26
|
| Rate for Payer: Cash Price |
$316.26
|
| Rate for Payer: Central Health Plan Commercial |
$562.23
|
| Rate for Payer: Cigna of CA HMO |
$449.79
|
| Rate for Payer: Cigna of CA PPO |
$520.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$597.37
|
| Rate for Payer: Dignity Health Media |
$597.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$597.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$281.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$281.12
|
| Rate for Payer: Galaxy Health WC |
$597.37
|
| Rate for Payer: Global Benefits Group Commercial |
$421.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$632.51
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$527.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$245.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$468.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$267.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.56
|
| Rate for Payer: Multiplan Commercial |
$527.09
|
| Rate for Payer: Networks By Design Commercial |
$456.81
|
| Rate for Payer: Prime Health Services Commercial |
$597.37
|
| Rate for Payer: Riverside University Health System MISP |
$281.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$421.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$421.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$351.40
|
| Rate for Payer: United Healthcare All Other HMO |
$351.40
|
| Rate for Payer: United Healthcare HMO Rider |
$351.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$351.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$597.37
|
| Rate for Payer: Vantage Medical Group Senior |
$597.37
|
|
|
HC CNTRL VNS CATH KIT TL 7FR 20CM
|
Facility
|
OP
|
$702.79
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698538
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$140.56 |
| Max. Negotiated Rate |
$1,019.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,019.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$597.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$386.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$386.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$340.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$415.21
|
| Rate for Payer: Blue Distinction Transplant |
$421.67
|
| Rate for Payer: Blue Shield of California Commercial |
$442.05
|
| Rate for Payer: Blue Shield of California EPN |
$343.66
|
| Rate for Payer: Cash Price |
$316.26
|
| Rate for Payer: Cash Price |
$316.26
|
| Rate for Payer: Central Health Plan Commercial |
$562.23
|
| Rate for Payer: Cigna of CA HMO |
$449.79
|
| Rate for Payer: Cigna of CA PPO |
$520.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$597.37
|
| Rate for Payer: Dignity Health Media |
$597.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$597.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$281.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$281.12
|
| Rate for Payer: Galaxy Health WC |
$597.37
|
| Rate for Payer: Global Benefits Group Commercial |
$421.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$632.51
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$527.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$245.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$468.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$267.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.56
|
| Rate for Payer: Multiplan Commercial |
$527.09
|
| Rate for Payer: Networks By Design Commercial |
$456.81
|
| Rate for Payer: Prime Health Services Commercial |
$597.37
|
| Rate for Payer: Riverside University Health System MISP |
$281.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$421.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$421.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$351.40
|
| Rate for Payer: United Healthcare All Other HMO |
$351.40
|
| Rate for Payer: United Healthcare HMO Rider |
$351.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$351.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$597.37
|
| Rate for Payer: Vantage Medical Group Senior |
$597.37
|
|
|
HC CNTRL VNS CATH KIT TL 7FR 20CM
|
Facility
|
IP
|
$702.79
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698538
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$140.56 |
| Max. Negotiated Rate |
$632.51 |
| Rate for Payer: Cash Price |
$316.26
|
| Rate for Payer: Central Health Plan Commercial |
$562.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$281.12
|
| Rate for Payer: Galaxy Health WC |
$597.37
|
| Rate for Payer: Global Benefits Group Commercial |
$421.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$632.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$468.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$267.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.56
|
| Rate for Payer: Multiplan Commercial |
$527.09
|
| Rate for Payer: Networks By Design Commercial |
$456.81
|
| Rate for Payer: Prime Health Services Commercial |
$597.37
|
|
|
HC CNTR VISIPAQUE 320 50ML PER ML
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
CPT Q9967
|
| Hospital Charge Code |
906812679
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$5.40 |
| Rate for Payer: Blue Shield of California Commercial |
$4.50
|
| Rate for Payer: Blue Shield of California EPN |
$3.20
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Central Health Plan Commercial |
$4.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: Galaxy Health WC |
$5.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.20
|
| Rate for Payer: Multiplan Commercial |
$4.50
|
| Rate for Payer: Networks By Design Commercial |
$3.90
|
| Rate for Payer: Prime Health Services Commercial |
$5.10
|
|
|
HC CNTR VISIPAQUE 320 50ML PER ML
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
CPT Q9967
|
| Hospital Charge Code |
906812679
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$5.40 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.84
|
| Rate for Payer: Blue Distinction Transplant |
$3.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3.77
|
| Rate for Payer: Blue Shield of California EPN |
$2.93
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Central Health Plan Commercial |
$4.80
|
| Rate for Payer: Cigna of CA HMO |
$3.84
|
| Rate for Payer: Cigna of CA PPO |
$4.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.10
|
| Rate for Payer: Dignity Health Media |
$5.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.40
|
| Rate for Payer: Galaxy Health WC |
$5.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.20
|
| Rate for Payer: Multiplan Commercial |
$4.50
|
| Rate for Payer: Networks By Design Commercial |
$3.90
|
| Rate for Payer: Prime Health Services Commercial |
$5.10
|
| Rate for Payer: Riverside University Health System MISP |
$2.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.10
|
| Rate for Payer: Vantage Medical Group Senior |
$5.10
|
|
|
HC CNVRT NEHPU TO NEPH CATH PERCU
|
Facility
|
IP
|
$1,028.00
|
|
|
Service Code
|
CPT 50434
|
| Hospital Charge Code |
909050434
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$205.60 |
| Max. Negotiated Rate |
$925.20 |
| Rate for Payer: Cash Price |
$462.60
|
| Rate for Payer: Central Health Plan Commercial |
$822.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$411.20
|
| Rate for Payer: Galaxy Health WC |
$873.80
|
| Rate for Payer: Global Benefits Group Commercial |
$616.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$925.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$685.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$391.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$205.60
|
| Rate for Payer: Multiplan Commercial |
$771.00
|
| Rate for Payer: Networks By Design Commercial |
$668.20
|
| Rate for Payer: Prime Health Services Commercial |
$873.80
|
|
|
HC CNVRT NEHPU TO NEPH CATH PERCU
|
Facility
|
OP
|
$1,028.00
|
|
|
Service Code
|
CPT 50434
|
| Hospital Charge Code |
909050434
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$205.60 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,544.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,544.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$616.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$2,544.87
|
| Rate for Payer: Cash Price |
$462.60
|
| Rate for Payer: Cash Price |
$462.60
|
| Rate for Payer: Central Health Plan Commercial |
$822.40
|
| Rate for Payer: Cigna of CA PPO |
$760.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Dignity Health Media |
$2,544.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,799.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,435.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,544.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,544.87
|
| Rate for Payer: Galaxy Health WC |
$873.80
|
| Rate for Payer: Global Benefits Group Commercial |
$616.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$925.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$771.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,173.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,199.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,544.87
|
| Rate for Payer: InnovAge PACE Commercial |
$3,817.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$685.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,569.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,544.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$205.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,410.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,410.13
|
| Rate for Payer: Multiplan Commercial |
$771.00
|
| Rate for Payer: Networks By Design Commercial |
$668.20
|
| Rate for Payer: Prime Health Services Commercial |
$873.80
|
| Rate for Payer: Prime Health Services Medicare |
$2,697.56
|
| Rate for Payer: Riverside University Health System MISP |
$2,799.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$616.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: Vantage Medical Group Senior |
$2,544.87
|
|
|
HC CO2
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
CPT 82374
|
| Hospital Charge Code |
900910258
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.80 |
| Max. Negotiated Rate |
$80.10 |
| Rate for Payer: Cash Price |
$40.05
|
| Rate for Payer: Central Health Plan Commercial |
$71.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.60
|
| Rate for Payer: Galaxy Health WC |
$75.65
|
| Rate for Payer: Global Benefits Group Commercial |
$53.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$80.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$59.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.80
|
| Rate for Payer: Multiplan Commercial |
$66.75
|
| Rate for Payer: Networks By Design Commercial |
$57.85
|
| Rate for Payer: Prime Health Services Commercial |
$75.65
|
|
|
HC CO2
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 82374
|
| Hospital Charge Code |
900910258
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.58 |
| Max. Negotiated Rate |
$42.12 |
| Rate for Payer: Adventist Health Medi-Cal |
$4.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$35.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.12
|
| Rate for Payer: Blue Distinction Transplant |
$9.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9.27
|
| Rate for Payer: Blue Shield of California EPN |
$7.29
|
| Rate for Payer: Caremore Medicare Advantage |
$4.88
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Central Health Plan Commercial |
$12.00
|
| Rate for Payer: Cigna of CA HMO |
$9.60
|
| Rate for Payer: Cigna of CA PPO |
$11.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.32
|
| Rate for Payer: Dignity Health Media |
$4.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.59
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.88
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.88
|
| Rate for Payer: InnovAge PACE Commercial |
$7.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.54
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
| Rate for Payer: Prime Health Services Medicare |
$5.17
|
| Rate for Payer: Riverside University Health System MISP |
$5.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.95
|
| Rate for Payer: United Healthcare All Other HMO |
$3.95
|
| Rate for Payer: United Healthcare HMO Rider |
$3.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.37
|
| Rate for Payer: Vantage Medical Group Senior |
$4.88
|
|
|
HC CO57 CYANOCOBALAMIN UP TO 1MCI
|
Facility
|
IP
|
$395.00
|
|
|
Service Code
|
CPT A9559
|
| Hospital Charge Code |
909301530
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$79.00 |
| Max. Negotiated Rate |
$355.50 |
| Rate for Payer: Blue Shield of California Commercial |
$296.25
|
| Rate for Payer: Blue Shield of California EPN |
$210.93
|
| Rate for Payer: Cash Price |
$177.75
|
| Rate for Payer: Central Health Plan Commercial |
$316.00
|
| Rate for Payer: Cigna of CA HMO |
$276.50
|
| Rate for Payer: Cigna of CA PPO |
$276.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$158.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$158.00
|
| Rate for Payer: Galaxy Health WC |
$335.75
|
| Rate for Payer: Global Benefits Group Commercial |
$237.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$355.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$263.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$150.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.00
|
| Rate for Payer: Multiplan Commercial |
$296.25
|
| Rate for Payer: Networks By Design Commercial |
$197.50
|
| Rate for Payer: Prime Health Services Commercial |
$335.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$149.15
|
| Rate for Payer: United Healthcare All Other HMO |
$145.68
|
| Rate for Payer: United Healthcare HMO Rider |
$142.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$130.35
|
|
|
HC CO57 CYANOCOBALAMIN UP TO 1MCI
|
Facility
|
OP
|
$395.00
|
|
|
Service Code
|
CPT A9559
|
| Hospital Charge Code |
909301530
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$79.00 |
| Max. Negotiated Rate |
$355.50 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$335.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$217.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.25
|
| Rate for Payer: Blue Distinction Transplant |
$237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$248.46
|
| Rate for Payer: Blue Shield of California EPN |
$193.16
|
| Rate for Payer: Cash Price |
$177.75
|
| Rate for Payer: Cash Price |
$177.75
|
| Rate for Payer: Central Health Plan Commercial |
$316.00
|
| Rate for Payer: Cigna of CA HMO |
$276.50
|
| Rate for Payer: Cigna of CA PPO |
$276.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$335.75
|
| Rate for Payer: Dignity Health Media |
$335.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$158.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$158.00
|
| Rate for Payer: Galaxy Health WC |
$335.75
|
| Rate for Payer: Global Benefits Group Commercial |
$237.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$355.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$296.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$138.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$263.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$246.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.00
|
| Rate for Payer: Multiplan Commercial |
$296.25
|
| Rate for Payer: Networks By Design Commercial |
$197.50
|
| Rate for Payer: Prime Health Services Commercial |
$335.75
|
| Rate for Payer: Riverside University Health System MISP |
$158.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$237.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$237.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$197.50
|
| Rate for Payer: United Healthcare All Other HMO |
$197.50
|
| Rate for Payer: United Healthcare HMO Rider |
$197.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$197.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.75
|
| Rate for Payer: Vantage Medical Group Senior |
$335.75
|
|
|
HC COAG FVIII INHIB EVAL BTHSDA U
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
900913970
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.42 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$93.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.22
|
| Rate for Payer: Blue Distinction Transplant |
$84.00
|
| Rate for Payer: Blue Shield of California Commercial |
$86.52
|
| Rate for Payer: Blue Shield of California EPN |
$68.04
|
| Rate for Payer: Caremore Medicare Advantage |
$12.87
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Central Health Plan Commercial |
$112.00
|
| Rate for Payer: Cigna of CA HMO |
$89.60
|
| Rate for Payer: Cigna of CA PPO |
$103.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.30
|
| Rate for Payer: Dignity Health Media |
$12.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.37
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.87
|
| Rate for Payer: Galaxy Health WC |
$119.00
|
| Rate for Payer: Global Benefits Group Commercial |
$84.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$126.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$105.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.87
|
| Rate for Payer: InnovAge PACE Commercial |
$19.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$93.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.25
|
| Rate for Payer: Multiplan Commercial |
$105.00
|
| Rate for Payer: Networks By Design Commercial |
$91.00
|
| Rate for Payer: Prime Health Services Commercial |
$119.00
|
| Rate for Payer: Prime Health Services Medicare |
$13.64
|
| Rate for Payer: Riverside University Health System MISP |
$14.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$84.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$84.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.42
|
| Rate for Payer: United Healthcare All Other HMO |
$10.42
|
| Rate for Payer: United Healthcare HMO Rider |
$10.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Vantage Medical Group Senior |
$12.87
|
|
|
HC COAG FVIII INHIB EVAL BTHSDA U
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
900913970
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Central Health Plan Commercial |
$112.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.00
|
| Rate for Payer: Galaxy Health WC |
$119.00
|
| Rate for Payer: Global Benefits Group Commercial |
$84.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$126.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$93.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.00
|
| Rate for Payer: Multiplan Commercial |
$105.00
|
| Rate for Payer: Networks By Design Commercial |
$91.00
|
| Rate for Payer: Prime Health Services Commercial |
$119.00
|
|
|
HC COAG TIME ACTIVATED
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
CPT 85347
|
| Hospital Charge Code |
900910011
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$37.76 |
| Rate for Payer: Adventist Health Medi-Cal |
$4.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.28
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$30.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.76
|
| Rate for Payer: Blue Distinction Transplant |
$15.60
|
| Rate for Payer: Blue Shield of California Commercial |
$16.07
|
| Rate for Payer: Blue Shield of California EPN |
$12.64
|
| Rate for Payer: Caremore Medicare Advantage |
$4.28
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Central Health Plan Commercial |
$20.80
|
| Rate for Payer: Cigna of CA HMO |
$16.64
|
| Rate for Payer: Cigna of CA PPO |
$19.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.42
|
| Rate for Payer: Dignity Health Media |
$4.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.78
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.28
|
| Rate for Payer: Galaxy Health WC |
$22.10
|
| Rate for Payer: Global Benefits Group Commercial |
$15.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$19.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.28
|
| Rate for Payer: InnovAge PACE Commercial |
$6.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.74
|
| Rate for Payer: Multiplan Commercial |
$19.50
|
| Rate for Payer: Networks By Design Commercial |
$16.90
|
| Rate for Payer: Prime Health Services Commercial |
$22.10
|
| Rate for Payer: Prime Health Services Medicare |
$4.54
|
| Rate for Payer: Riverside University Health System MISP |
$4.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.46
|
| Rate for Payer: United Healthcare All Other HMO |
$3.46
|
| Rate for Payer: United Healthcare HMO Rider |
$3.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.71
|
| Rate for Payer: Vantage Medical Group Senior |
$4.28
|
|
|
HC COAG TIME ACTIVATED
|
Facility
|
IP
|
$299.00
|
|
|
Service Code
|
CPT 85347
|
| Hospital Charge Code |
900910011
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$59.80 |
| Max. Negotiated Rate |
$269.10 |
| Rate for Payer: Cash Price |
$134.55
|
| Rate for Payer: Central Health Plan Commercial |
$239.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$119.60
|
| Rate for Payer: Galaxy Health WC |
$254.15
|
| Rate for Payer: Global Benefits Group Commercial |
$179.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$269.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$199.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.80
|
| Rate for Payer: Multiplan Commercial |
$224.25
|
| Rate for Payer: Networks By Design Commercial |
$194.35
|
| Rate for Payer: Prime Health Services Commercial |
$254.15
|
|
|
HC COCAINE METABOLITE CONF
|
Facility
|
IP
|
$271.00
|
|
|
Service Code
|
CPT 80353
|
| Hospital Charge Code |
900910518
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$54.20 |
| Max. Negotiated Rate |
$243.90 |
| Rate for Payer: Cash Price |
$121.95
|
| Rate for Payer: Central Health Plan Commercial |
$216.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.40
|
| Rate for Payer: Galaxy Health WC |
$230.35
|
| Rate for Payer: Global Benefits Group Commercial |
$162.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$243.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$180.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$103.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.20
|
| Rate for Payer: Multiplan Commercial |
$203.25
|
| Rate for Payer: Networks By Design Commercial |
$176.15
|
| Rate for Payer: Prime Health Services Commercial |
$230.35
|
|
|
HC COCAINE METABOLITE CONF
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
CPT 80353
|
| Hospital Charge Code |
900910518
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$191.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$123.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$105.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$129.04
|
| Rate for Payer: Blue Distinction Transplant |
$135.00
|
| Rate for Payer: Blue Shield of California Commercial |
$139.05
|
| Rate for Payer: Blue Shield of California EPN |
$109.35
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Central Health Plan Commercial |
$180.00
|
| Rate for Payer: Cigna of CA HMO |
$144.00
|
| Rate for Payer: Cigna of CA PPO |
$166.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$191.25
|
| Rate for Payer: Dignity Health Media |
$191.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$191.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$90.00
|
| Rate for Payer: Galaxy Health WC |
$191.25
|
| Rate for Payer: Global Benefits Group Commercial |
$135.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$202.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$168.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$78.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$150.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.00
|
| Rate for Payer: Multiplan Commercial |
$168.75
|
| Rate for Payer: Networks By Design Commercial |
$146.25
|
| Rate for Payer: Prime Health Services Commercial |
$191.25
|
| Rate for Payer: Riverside University Health System MISP |
$90.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$135.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$135.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$112.50
|
| Rate for Payer: United Healthcare All Other HMO |
$112.50
|
| Rate for Payer: United Healthcare HMO Rider |
$112.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$112.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$191.25
|
| Rate for Payer: Vantage Medical Group Senior |
$191.25
|
|
|
HC CO DIFFUSION CAPACITY
|
Facility
|
IP
|
$608.00
|
|
|
Service Code
|
CPT 94729
|
| Hospital Charge Code |
900801004
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$121.60 |
| Max. Negotiated Rate |
$547.20 |
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Central Health Plan Commercial |
$486.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$243.20
|
| Rate for Payer: Galaxy Health WC |
$516.80
|
| Rate for Payer: Global Benefits Group Commercial |
$364.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$547.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$405.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$231.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.60
|
| Rate for Payer: Multiplan Commercial |
$456.00
|
| Rate for Payer: Networks By Design Commercial |
$395.20
|
| Rate for Payer: Prime Health Services Commercial |
$516.80
|
|
|
HC CO DIFFUSION CAPACITY
|
Facility
|
OP
|
$608.00
|
|
|
Service Code
|
CPT 94729
|
| Hospital Charge Code |
900801004
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$725.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$276.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$516.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$334.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$334.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$234.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$359.21
|
| Rate for Payer: Blue Distinction Transplant |
$364.80
|
| Rate for Payer: Blue Shield of California Commercial |
$375.74
|
| Rate for Payer: Blue Shield of California EPN |
$295.49
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Central Health Plan Commercial |
$486.40
|
| Rate for Payer: Cigna of CA HMO |
$389.12
|
| Rate for Payer: Cigna of CA PPO |
$449.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$516.80
|
| Rate for Payer: Dignity Health Media |
$516.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$516.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$243.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$243.20
|
| Rate for Payer: Galaxy Health WC |
$516.80
|
| Rate for Payer: Global Benefits Group Commercial |
$364.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$547.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$456.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$212.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$405.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$91.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.60
|
| Rate for Payer: Multiplan Commercial |
$456.00
|
| Rate for Payer: Networks By Design Commercial |
$395.20
|
| Rate for Payer: Prime Health Services Commercial |
$516.80
|
| Rate for Payer: Riverside University Health System MISP |
$243.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$364.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$364.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$725.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$696.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$636.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$516.80
|
| Rate for Payer: Vantage Medical Group Senior |
$516.80
|
|
|
HC COIL AXIUM
|
Facility
|
OP
|
$3,375.00
|
|
| Hospital Charge Code |
909020035
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$675.00 |
| Max. Negotiated Rate |
$3,037.50 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,868.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,856.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,856.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,541.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,879.88
|
| Rate for Payer: Blue Distinction Transplant |
$2,025.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,531.25
|
| Rate for Payer: Blue Shield of California EPN |
$1,836.00
|
| Rate for Payer: Cash Price |
$1,518.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,700.00
|
| Rate for Payer: Cigna of CA HMO |
$2,362.50
|
| Rate for Payer: Cigna of CA PPO |
$2,362.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,868.75
|
| Rate for Payer: Dignity Health Media |
$2,868.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,868.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,350.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,350.00
|
| Rate for Payer: Galaxy Health WC |
$2,868.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,025.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,037.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,531.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,181.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,251.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,285.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$675.00
|
| Rate for Payer: Multiplan Commercial |
$2,531.25
|
| Rate for Payer: Networks By Design Commercial |
$1,687.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,868.75
|
| Rate for Payer: Riverside University Health System MISP |
$1,350.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,025.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,025.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,687.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,687.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,687.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,687.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,868.75
|
| Rate for Payer: Vantage Medical Group Senior |
$2,868.75
|
|
|
HC COIL AXIUM
|
Facility
|
IP
|
$3,375.00
|
|
| Hospital Charge Code |
909020035
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$675.00 |
| Max. Negotiated Rate |
$3,037.50 |
| Rate for Payer: Blue Shield of California EPN |
$1,802.25
|
| Rate for Payer: Cash Price |
$1,518.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,700.00
|
| Rate for Payer: Cigna of CA HMO |
$2,362.50
|
| Rate for Payer: Cigna of CA PPO |
$2,362.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,350.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,350.00
|
| Rate for Payer: Galaxy Health WC |
$2,868.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,025.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,037.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,251.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,285.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$675.00
|
| Rate for Payer: Multiplan Commercial |
$2,531.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,868.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,274.40
|
| Rate for Payer: United Healthcare All Other HMO |
$1,244.70
|
| Rate for Payer: United Healthcare HMO Rider |
$1,217.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,113.75
|
|
