|
HC INDR BIO/WEB PREFACE
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
CPT C1893
|
| Hospital Charge Code |
906812264
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$105.80 |
| Max. Negotiated Rate |
$476.10 |
| Rate for Payer: Adventist Health Commercial |
$105.80
|
| Rate for Payer: Cash Price |
$238.05
|
| Rate for Payer: Central Health Plan Commercial |
$423.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$370.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$211.60
|
| Rate for Payer: EPIC Health Plan Senior |
$211.60
|
| Rate for Payer: Galaxy Health WC |
$449.65
|
| Rate for Payer: Global Benefits Group Commercial |
$317.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$476.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$335.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$312.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.80
|
| Rate for Payer: Multiplan Commercial |
$396.75
|
| Rate for Payer: Networks By Design Commercial |
$343.85
|
| Rate for Payer: Prime Health Services Commercial |
$449.65
|
|
|
HC INDR COOK MULLINS 48CM
|
Facility
|
IP
|
$369.75
|
|
|
Service Code
|
CPT C1893
|
| Hospital Charge Code |
906811765
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$73.95 |
| Max. Negotiated Rate |
$332.77 |
| Rate for Payer: Adventist Health Commercial |
$73.95
|
| Rate for Payer: Cash Price |
$166.39
|
| Rate for Payer: Central Health Plan Commercial |
$295.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$258.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$147.90
|
| Rate for Payer: EPIC Health Plan Senior |
$147.90
|
| Rate for Payer: Galaxy Health WC |
$314.29
|
| Rate for Payer: Global Benefits Group Commercial |
$221.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$332.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$234.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$218.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.95
|
| Rate for Payer: Multiplan Commercial |
$277.31
|
| Rate for Payer: Networks By Design Commercial |
$240.34
|
| Rate for Payer: Prime Health Services Commercial |
$314.29
|
|
|
HC INDR COOK MULLINS 48CM
|
Facility
|
OP
|
$369.75
|
|
|
Service Code
|
CPT C1893
|
| Hospital Charge Code |
906811765
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$73.95 |
| Max. Negotiated Rate |
$364.83 |
| Rate for Payer: Adventist Health Commercial |
$73.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$364.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$314.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$203.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$277.31
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$179.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$215.08
|
| Rate for Payer: Blue Shield of California Commercial |
$234.42
|
| Rate for Payer: Blue Shield of California EPN |
$147.53
|
| Rate for Payer: Cash Price |
$166.39
|
| Rate for Payer: Cash Price |
$166.39
|
| Rate for Payer: Central Health Plan Commercial |
$295.80
|
| Rate for Payer: Cigna of CA HMO |
$236.64
|
| Rate for Payer: Cigna of CA PPO |
$273.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$314.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$314.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$314.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$258.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$147.90
|
| Rate for Payer: EPIC Health Plan Senior |
$147.90
|
| Rate for Payer: Galaxy Health WC |
$314.29
|
| Rate for Payer: Global Benefits Group Commercial |
$221.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$332.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$234.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$134.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$218.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$258.82
|
| Rate for Payer: Multiplan Commercial |
$277.31
|
| Rate for Payer: Networks By Design Commercial |
$240.34
|
| Rate for Payer: Prime Health Services Commercial |
$314.29
|
| Rate for Payer: Riverside University Health System MISP |
$147.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$221.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$221.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$184.88
|
| Rate for Payer: United Healthcare All Other HMO |
$184.88
|
| Rate for Payer: United Healthcare HMO Rider |
$184.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$184.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$314.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$314.29
|
| Rate for Payer: Vantage Medical Group Senior |
$314.29
|
|
|
HC INDR CORDIS AVANTI 035/038
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906811762
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$235.49 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$235.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$39.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.70
|
| Rate for Payer: Blue Shield of California Commercial |
$51.99
|
| Rate for Payer: Blue Shield of California EPN |
$32.72
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$69.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$57.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$52.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$48.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$57.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Riverside University Health System MISP |
$32.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.00
|
| Rate for Payer: United Healthcare All Other HMO |
$41.00
|
| Rate for Payer: United Healthcare HMO Rider |
$41.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.70
|
| Rate for Payer: Vantage Medical Group Senior |
$69.70
|
|
|
HC INDR CORDIS AVANTI 035/038
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906811762
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$57.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$52.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$48.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
|
|
HC INDR MICROPUNCTURE NEEDLE
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
909081252
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$235.49 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$235.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$102.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$58.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69.80
|
| Rate for Payer: Blue Shield of California Commercial |
$76.08
|
| Rate for Payer: Blue Shield of California EPN |
$47.88
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Central Health Plan Commercial |
$96.00
|
| Rate for Payer: Cigna of CA HMO |
$76.80
|
| Rate for Payer: Cigna of CA PPO |
$88.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$102.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$102.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$84.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Senior |
$48.00
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$76.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$43.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$70.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Networks By Design Commercial |
$78.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: Riverside University Health System MISP |
$48.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.00
|
| Rate for Payer: United Healthcare All Other HMO |
$60.00
|
| Rate for Payer: United Healthcare HMO Rider |
$60.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$60.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$102.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$102.00
|
| Rate for Payer: Vantage Medical Group Senior |
$102.00
|
|
|
HC INDR MICROPUNCTURE NEEDLE
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
909081252
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Central Health Plan Commercial |
$96.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$84.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Senior |
$48.00
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$76.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$70.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Networks By Design Commercial |
$78.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
|
|
HC INDR SHTH STJ FASTCATH EP
|
Facility
|
OP
|
$648.00
|
|
|
Service Code
|
CPT C1893
|
| Hospital Charge Code |
906812277
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$129.60 |
| Max. Negotiated Rate |
$583.20 |
| Rate for Payer: Adventist Health Commercial |
$129.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$364.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$550.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$356.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$486.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$313.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$376.94
|
| Rate for Payer: Blue Shield of California Commercial |
$410.83
|
| Rate for Payer: Blue Shield of California EPN |
$258.55
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Central Health Plan Commercial |
$518.40
|
| Rate for Payer: Cigna of CA HMO |
$414.72
|
| Rate for Payer: Cigna of CA PPO |
$479.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$550.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$550.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$550.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$453.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$259.20
|
| Rate for Payer: EPIC Health Plan Senior |
$259.20
|
| Rate for Payer: Galaxy Health WC |
$550.80
|
| Rate for Payer: Global Benefits Group Commercial |
$388.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$583.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$411.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$235.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$382.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$453.60
|
| Rate for Payer: Multiplan Commercial |
$486.00
|
| Rate for Payer: Networks By Design Commercial |
$421.20
|
| Rate for Payer: Prime Health Services Commercial |
$550.80
|
| Rate for Payer: Riverside University Health System MISP |
$259.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$388.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$388.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$324.00
|
| Rate for Payer: United Healthcare All Other HMO |
$324.00
|
| Rate for Payer: United Healthcare HMO Rider |
$324.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$324.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$550.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$550.80
|
| Rate for Payer: Vantage Medical Group Senior |
$550.80
|
|
|
HC INDR SHTH STJ FASTCATH EP
|
Facility
|
IP
|
$648.00
|
|
|
Service Code
|
CPT C1893
|
| Hospital Charge Code |
906812277
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$129.60 |
| Max. Negotiated Rate |
$583.20 |
| Rate for Payer: Adventist Health Commercial |
$129.60
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Central Health Plan Commercial |
$518.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$453.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$259.20
|
| Rate for Payer: EPIC Health Plan Senior |
$259.20
|
| Rate for Payer: Galaxy Health WC |
$550.80
|
| Rate for Payer: Global Benefits Group Commercial |
$388.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$583.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$411.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$382.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.60
|
| Rate for Payer: Multiplan Commercial |
$486.00
|
| Rate for Payer: Networks By Design Commercial |
$421.20
|
| Rate for Payer: Prime Health Services Commercial |
$550.80
|
|
|
HC INDR STJ APEEL CS
|
Facility
|
OP
|
$1,530.00
|
|
|
Service Code
|
CPT C1892
|
| Hospital Charge Code |
906813541
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$306.00 |
| Max. Negotiated Rate |
$1,377.00 |
| Rate for Payer: Adventist Health Commercial |
$306.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,142.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,300.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$841.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,147.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$740.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$890.00
|
| Rate for Payer: Blue Shield of California Commercial |
$970.02
|
| Rate for Payer: Blue Shield of California EPN |
$610.47
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,224.00
|
| Rate for Payer: Cigna of CA HMO |
$979.20
|
| Rate for Payer: Cigna of CA PPO |
$1,132.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,300.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,300.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,300.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,071.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.00
|
| Rate for Payer: EPIC Health Plan Senior |
$612.00
|
| Rate for Payer: Galaxy Health WC |
$1,300.50
|
| Rate for Payer: Global Benefits Group Commercial |
$918.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,377.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$971.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$555.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$902.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$306.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,071.00
|
| Rate for Payer: Multiplan Commercial |
$1,147.50
|
| Rate for Payer: Networks By Design Commercial |
$994.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,300.50
|
| Rate for Payer: Riverside University Health System MISP |
$612.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$918.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$918.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$765.00
|
| Rate for Payer: United Healthcare All Other HMO |
$765.00
|
| Rate for Payer: United Healthcare HMO Rider |
$765.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$765.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,300.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,300.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,300.50
|
|
|
HC INDR STJ APEEL CS
|
Facility
|
IP
|
$1,530.00
|
|
|
Service Code
|
CPT C1892
|
| Hospital Charge Code |
906813541
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$306.00 |
| Max. Negotiated Rate |
$1,377.00 |
| Rate for Payer: Adventist Health Commercial |
$306.00
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,224.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,071.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.00
|
| Rate for Payer: EPIC Health Plan Senior |
$612.00
|
| Rate for Payer: Galaxy Health WC |
$1,300.50
|
| Rate for Payer: Global Benefits Group Commercial |
$918.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,377.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$971.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$902.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$306.00
|
| Rate for Payer: Multiplan Commercial |
$1,147.50
|
| Rate for Payer: Networks By Design Commercial |
$994.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,300.50
|
|
|
HC INDR STJ FASTCATH 60 CM
|
Facility
|
IP
|
$478.21
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$95.64 |
| Max. Negotiated Rate |
$430.39 |
| Rate for Payer: Adventist Health Commercial |
$95.64
|
| Rate for Payer: Cash Price |
$215.19
|
| Rate for Payer: Central Health Plan Commercial |
$382.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$334.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$191.28
|
| Rate for Payer: EPIC Health Plan Senior |
$191.28
|
| Rate for Payer: Galaxy Health WC |
$406.48
|
| Rate for Payer: Global Benefits Group Commercial |
$286.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$430.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$303.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$282.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.64
|
| Rate for Payer: Multiplan Commercial |
$358.66
|
| Rate for Payer: Networks By Design Commercial |
$310.84
|
| Rate for Payer: Prime Health Services Commercial |
$406.48
|
|
|
HC INDR STJ FASTCATH 60 CM
|
Facility
|
OP
|
$478.21
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$95.64 |
| Max. Negotiated Rate |
$430.39 |
| Rate for Payer: Adventist Health Commercial |
$95.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$235.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$406.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$263.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$358.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$231.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$278.17
|
| Rate for Payer: Blue Shield of California Commercial |
$303.19
|
| Rate for Payer: Blue Shield of California EPN |
$190.81
|
| Rate for Payer: Cash Price |
$215.19
|
| Rate for Payer: Cash Price |
$215.19
|
| Rate for Payer: Central Health Plan Commercial |
$382.57
|
| Rate for Payer: Cigna of CA HMO |
$306.05
|
| Rate for Payer: Cigna of CA PPO |
$353.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$406.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$406.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$406.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$334.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$191.28
|
| Rate for Payer: EPIC Health Plan Senior |
$191.28
|
| Rate for Payer: Galaxy Health WC |
$406.48
|
| Rate for Payer: Global Benefits Group Commercial |
$286.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$430.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$303.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$173.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$282.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$334.75
|
| Rate for Payer: Multiplan Commercial |
$358.66
|
| Rate for Payer: Networks By Design Commercial |
$310.84
|
| Rate for Payer: Prime Health Services Commercial |
$406.48
|
| Rate for Payer: Riverside University Health System MISP |
$191.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$286.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$286.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$239.10
|
| Rate for Payer: United Healthcare All Other HMO |
$239.10
|
| Rate for Payer: United Healthcare HMO Rider |
$239.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$239.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$406.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$406.48
|
| Rate for Payer: Vantage Medical Group Senior |
$406.48
|
|
|
HC INDR STJ FASTCATH 63CM 10FR
|
Facility
|
OP
|
$504.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812322
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.80 |
| Max. Negotiated Rate |
$453.60 |
| Rate for Payer: Adventist Health Commercial |
$100.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$235.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$428.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$378.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$244.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$293.18
|
| Rate for Payer: Blue Shield of California Commercial |
$319.54
|
| Rate for Payer: Blue Shield of California EPN |
$201.10
|
| Rate for Payer: Cash Price |
$226.80
|
| Rate for Payer: Cash Price |
$226.80
|
| Rate for Payer: Central Health Plan Commercial |
$403.20
|
| Rate for Payer: Cigna of CA HMO |
$322.56
|
| Rate for Payer: Cigna of CA PPO |
$372.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$428.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$428.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$428.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$352.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.60
|
| Rate for Payer: EPIC Health Plan Senior |
$201.60
|
| Rate for Payer: Galaxy Health WC |
$428.40
|
| Rate for Payer: Global Benefits Group Commercial |
$302.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$453.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$320.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$182.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$297.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$352.80
|
| Rate for Payer: Multiplan Commercial |
$378.00
|
| Rate for Payer: Networks By Design Commercial |
$327.60
|
| Rate for Payer: Prime Health Services Commercial |
$428.40
|
| Rate for Payer: Riverside University Health System MISP |
$201.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$302.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$302.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$252.00
|
| Rate for Payer: United Healthcare All Other HMO |
$252.00
|
| Rate for Payer: United Healthcare HMO Rider |
$252.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$252.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$428.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$428.40
|
| Rate for Payer: Vantage Medical Group Senior |
$428.40
|
|
|
HC INDR STJ FASTCATH 63CM 10FR
|
Facility
|
IP
|
$504.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812322
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.80 |
| Max. Negotiated Rate |
$453.60 |
| Rate for Payer: Adventist Health Commercial |
$100.80
|
| Rate for Payer: Cash Price |
$226.80
|
| Rate for Payer: Central Health Plan Commercial |
$403.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$352.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.60
|
| Rate for Payer: EPIC Health Plan Senior |
$201.60
|
| Rate for Payer: Galaxy Health WC |
$428.40
|
| Rate for Payer: Global Benefits Group Commercial |
$302.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$453.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$320.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$297.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.80
|
| Rate for Payer: Multiplan Commercial |
$378.00
|
| Rate for Payer: Networks By Design Commercial |
$327.60
|
| Rate for Payer: Prime Health Services Commercial |
$428.40
|
|
|
HC INFANT LOWER EXT 2 VIEW
|
Facility
|
OP
|
$657.00
|
|
|
Service Code
|
CPT 73592
|
| Hospital Charge Code |
909001630
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$35.74 |
| Max. Negotiated Rate |
$591.30 |
| Rate for Payer: Adventist Health Commercial |
$131.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$146.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$102.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$142.72
|
| Rate for Payer: Blue Shield of California Commercial |
$413.91
|
| Rate for Payer: Blue Shield of California EPN |
$260.83
|
| Rate for Payer: Cash Price |
$295.65
|
| Rate for Payer: Cash Price |
$295.65
|
| Rate for Payer: Central Health Plan Commercial |
$525.60
|
| Rate for Payer: Cigna of CA HMO |
$420.48
|
| Rate for Payer: Cigna of CA PPO |
$486.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$459.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| Rate for Payer: Galaxy Health WC |
$558.45
|
| Rate for Payer: Global Benefits Group Commercial |
$394.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$591.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$35.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$417.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$492.75
|
| Rate for Payer: Networks By Design Commercial |
$427.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.93
|
| Rate for Payer: Prime Health Services Commercial |
$558.45
|
| Rate for Payer: Prime Health Services Medicare |
$118.65
|
| Rate for Payer: Riverside University Health System MISP |
$123.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$394.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$394.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
HC INFANT LOWER EXT 2 VIEW
|
Facility
|
IP
|
$657.00
|
|
|
Service Code
|
CPT 73592
|
| Hospital Charge Code |
909001630
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$131.40 |
| Max. Negotiated Rate |
$591.30 |
| Rate for Payer: Adventist Health Commercial |
$131.40
|
| Rate for Payer: Cash Price |
$295.65
|
| Rate for Payer: Central Health Plan Commercial |
$525.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$459.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$262.80
|
| Rate for Payer: EPIC Health Plan Senior |
$262.80
|
| Rate for Payer: Galaxy Health WC |
$558.45
|
| Rate for Payer: Global Benefits Group Commercial |
$394.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$591.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$417.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$387.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.40
|
| Rate for Payer: Multiplan Commercial |
$492.75
|
| Rate for Payer: Networks By Design Commercial |
$427.05
|
| Rate for Payer: Prime Health Services Commercial |
$558.45
|
|
|
HC INFANT PIV KIT
|
Facility
|
IP
|
$54.12
|
|
| Hospital Charge Code |
901698468
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$48.71 |
| Rate for Payer: Adventist Health Commercial |
$10.82
|
| Rate for Payer: Cash Price |
$24.35
|
| Rate for Payer: Central Health Plan Commercial |
$43.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.65
|
| Rate for Payer: EPIC Health Plan Senior |
$21.65
|
| Rate for Payer: Galaxy Health WC |
$46.00
|
| Rate for Payer: Global Benefits Group Commercial |
$32.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.82
|
| Rate for Payer: Multiplan Commercial |
$40.59
|
| Rate for Payer: Networks By Design Commercial |
$35.18
|
| Rate for Payer: Prime Health Services Commercial |
$46.00
|
|
|
HC INFANT PIV KIT
|
Facility
|
OP
|
$54.12
|
|
| Hospital Charge Code |
901698468
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$48.71 |
| Rate for Payer: Adventist Health Commercial |
$10.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$26.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.48
|
| Rate for Payer: Blue Shield of California Commercial |
$34.31
|
| Rate for Payer: Blue Shield of California EPN |
$21.59
|
| Rate for Payer: Cash Price |
$24.35
|
| Rate for Payer: Central Health Plan Commercial |
$43.30
|
| Rate for Payer: Cigna of CA HMO |
$34.64
|
| Rate for Payer: Cigna of CA PPO |
$40.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$46.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$46.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.65
|
| Rate for Payer: EPIC Health Plan Senior |
$21.65
|
| Rate for Payer: Galaxy Health WC |
$46.00
|
| Rate for Payer: Global Benefits Group Commercial |
$32.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$37.88
|
| Rate for Payer: Multiplan Commercial |
$40.59
|
| Rate for Payer: Networks By Design Commercial |
$35.18
|
| Rate for Payer: Prime Health Services Commercial |
$46.00
|
| Rate for Payer: Riverside University Health System MISP |
$21.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.06
|
| Rate for Payer: United Healthcare All Other HMO |
$27.06
|
| Rate for Payer: United Healthcare HMO Rider |
$27.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$46.00
|
| Rate for Payer: Vantage Medical Group Senior |
$46.00
|
|
|
HC INFANT UPPER EXT 2 VIEW
|
Facility
|
OP
|
$668.00
|
|
|
Service Code
|
CPT 73092
|
| Hospital Charge Code |
909001555
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$35.74 |
| Max. Negotiated Rate |
$601.20 |
| Rate for Payer: Adventist Health Commercial |
$133.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$134.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$143.94
|
| 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 |
$102.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$142.72
|
| Rate for Payer: Blue Shield of California Commercial |
$420.84
|
| Rate for Payer: Blue Shield of California EPN |
$265.20
|
| Rate for Payer: Cash Price |
$300.60
|
| Rate for Payer: Cash Price |
$300.60
|
| Rate for Payer: Central Health Plan Commercial |
$534.40
|
| Rate for Payer: Cigna of CA HMO |
$427.52
|
| Rate for Payer: Cigna of CA PPO |
$494.32
|
| 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 |
$467.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$567.80
|
| Rate for Payer: Global Benefits Group Commercial |
$400.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$601.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$35.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$424.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$501.00
|
| Rate for Payer: Networks By Design Commercial |
$434.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$134.46
|
| Rate for Payer: Prime Health Services Commercial |
$567.80
|
| 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 |
$400.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$400.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| 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 INFANT UPPER EXT 2 VIEW
|
Facility
|
IP
|
$668.00
|
|
|
Service Code
|
CPT 73092
|
| Hospital Charge Code |
909001555
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$133.60 |
| Max. Negotiated Rate |
$601.20 |
| Rate for Payer: Adventist Health Commercial |
$133.60
|
| Rate for Payer: Cash Price |
$300.60
|
| Rate for Payer: Central Health Plan Commercial |
$534.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$467.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$267.20
|
| Rate for Payer: EPIC Health Plan Senior |
$267.20
|
| Rate for Payer: Galaxy Health WC |
$567.80
|
| Rate for Payer: Global Benefits Group Commercial |
$400.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$601.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$424.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$394.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.60
|
| Rate for Payer: Multiplan Commercial |
$501.00
|
| Rate for Payer: Networks By Design Commercial |
$434.20
|
| Rate for Payer: Prime Health Services Commercial |
$567.80
|
|
|
HC INFANT URINE PVC CATH KIT 5FR
|
Facility
|
OP
|
$15.25
|
|
| Hospital Charge Code |
901698585
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.05 |
| Max. Negotiated Rate |
$13.72 |
| Rate for Payer: Adventist Health Commercial |
$3.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.87
|
| Rate for Payer: Blue Shield of California Commercial |
$9.67
|
| Rate for Payer: Blue Shield of California EPN |
$6.08
|
| Rate for Payer: Cash Price |
$6.86
|
| Rate for Payer: Central Health Plan Commercial |
$12.20
|
| Rate for Payer: Cigna of CA HMO |
$9.76
|
| Rate for Payer: Cigna of CA PPO |
$11.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.10
|
| Rate for Payer: EPIC Health Plan Senior |
$6.10
|
| Rate for Payer: Galaxy Health WC |
$12.96
|
| Rate for Payer: Global Benefits Group Commercial |
$9.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.68
|
| Rate for Payer: Multiplan Commercial |
$11.44
|
| Rate for Payer: Networks By Design Commercial |
$9.91
|
| Rate for Payer: Prime Health Services Commercial |
$12.96
|
| Rate for Payer: Riverside University Health System MISP |
$6.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.62
|
| Rate for Payer: United Healthcare All Other HMO |
$7.62
|
| Rate for Payer: United Healthcare HMO Rider |
$7.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.96
|
| Rate for Payer: Vantage Medical Group Senior |
$12.96
|
|
|
HC INFANT URINE PVC CATH KIT 5FR
|
Facility
|
IP
|
$15.25
|
|
| Hospital Charge Code |
901698585
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.05 |
| Max. Negotiated Rate |
$13.72 |
| Rate for Payer: Adventist Health Commercial |
$3.05
|
| Rate for Payer: Cash Price |
$6.86
|
| Rate for Payer: Central Health Plan Commercial |
$12.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.10
|
| Rate for Payer: EPIC Health Plan Senior |
$6.10
|
| Rate for Payer: Galaxy Health WC |
$12.96
|
| Rate for Payer: Global Benefits Group Commercial |
$9.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.05
|
| Rate for Payer: Multiplan Commercial |
$11.44
|
| Rate for Payer: Networks By Design Commercial |
$9.91
|
| Rate for Payer: Prime Health Services Commercial |
$12.96
|
|
|
HC INFLUENZA A ANTIGEN
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT 87400
|
| Hospital Charge Code |
900911778
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Central Health Plan Commercial |
$160.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$140.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Senior |
$80.00
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$180.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$127.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$118.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.00
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
|
|
HC INFLUENZA A ANTIGEN
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
CPT 87400
|
| Hospital Charge Code |
900911778
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.96 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$14.13
|
| Rate for Payer: Adventist Health Medi-Cal |
$14.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$33.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$33.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.98
|
| Rate for Payer: Blue Shield of California Commercial |
$26.46
|
| Rate for Payer: Blue Shield of California Commercial |
$126.00
|
| Rate for Payer: Blue Shield of California EPN |
$16.67
|
| Rate for Payer: Blue Shield of California EPN |
$79.40
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Central Health Plan Commercial |
$160.00
|
| Rate for Payer: Central Health Plan Commercial |
$33.60
|
| Rate for Payer: Cigna of CA HMO |
$26.88
|
| Rate for Payer: Cigna of CA HMO |
$128.00
|
| Rate for Payer: Cigna of CA PPO |
$31.08
|
| Rate for Payer: Cigna of CA PPO |
$148.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$140.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.31
|
| Rate for Payer: EPIC Health Plan Senior |
$15.54
|
| Rate for Payer: EPIC Health Plan Senior |
$15.54
|
| Rate for Payer: Galaxy Health WC |
$35.70
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$25.20
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$37.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$180.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.17
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$127.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.93
|
| Rate for Payer: Multiplan Commercial |
$31.50
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: Networks By Design Commercial |
$27.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14.13
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14.13
|
| Rate for Payer: Prime Health Services Commercial |
$35.70
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
| Rate for Payer: Prime Health Services Medicare |
$14.98
|
| Rate for Payer: Prime Health Services Medicare |
$14.98
|
| Rate for Payer: Riverside University Health System MISP |
$15.54
|
| Rate for Payer: Riverside University Health System MISP |
$15.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$120.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$120.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.45
|
| Rate for Payer: United Healthcare All Other HMO |
$11.45
|
| Rate for Payer: United Healthcare All Other HMO |
$11.45
|
| Rate for Payer: United Healthcare HMO Rider |
$11.45
|
| Rate for Payer: United Healthcare HMO Rider |
$11.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.45
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.13
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.54
|
| Rate for Payer: Vantage Medical Group Senior |
$14.13
|
| Rate for Payer: Vantage Medical Group Senior |
$14.13
|
|
