|
HC DUPLX LO EXT ARTERY UNI
|
Facility
|
OP
|
$1,863.00
|
|
|
Service Code
|
CPT 93926
|
| Hospital Charge Code |
908100123
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$1,676.70 |
| Rate for Payer: Adventist Health Medi-Cal |
$137.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$586.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$667.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,100.66
|
| Rate for Payer: Blue Distinction Transplant |
$1,117.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,151.33
|
| Rate for Payer: Blue Shield of California EPN |
$905.42
|
| Rate for Payer: Caremore Medicare Advantage |
$137.36
|
| Rate for Payer: Cash Price |
$838.35
|
| Rate for Payer: Cash Price |
$838.35
|
| Rate for Payer: Cash Price |
$838.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,490.40
|
| Rate for Payer: Cigna of CA HMO |
$1,192.32
|
| Rate for Payer: Cigna of CA PPO |
$1,378.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$1,583.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,117.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,676.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,397.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$226.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: InnovAge PACE Commercial |
$206.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,242.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$161.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$372.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$1,397.25
|
| Rate for Payer: Networks By Design Commercial |
$1,210.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,583.55
|
| Rate for Payer: Prime Health Services Medicare |
$145.60
|
| Rate for Payer: Riverside University Health System MISP |
$151.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,117.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,117.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,507.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,228.00
|
| Rate for Payer: United Healthcare HMO Rider |
$931.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$851.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC DUPLX LO EXT ARTERY UNI
|
Facility
|
IP
|
$1,863.00
|
|
|
Service Code
|
CPT 93926
|
| Hospital Charge Code |
908100123
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$372.60 |
| Max. Negotiated Rate |
$1,676.70 |
| Rate for Payer: Cash Price |
$838.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,490.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$745.20
|
| Rate for Payer: Galaxy Health WC |
$1,583.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,117.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,676.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,242.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$709.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$372.60
|
| Rate for Payer: Multiplan Commercial |
$1,397.25
|
| Rate for Payer: Networks By Design Commercial |
$1,210.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,583.55
|
|
|
HC DUPLX UP EXT ARTERY BILAT
|
Facility
|
IP
|
$2,464.00
|
|
|
Service Code
|
CPT 93930
|
| Hospital Charge Code |
908100105
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$492.80 |
| Max. Negotiated Rate |
$2,217.60 |
| Rate for Payer: Cash Price |
$1,108.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,971.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$985.60
|
| Rate for Payer: Galaxy Health WC |
$2,094.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,478.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,217.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,643.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$938.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$492.80
|
| Rate for Payer: Multiplan Commercial |
$1,848.00
|
| Rate for Payer: Networks By Design Commercial |
$1,601.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,094.40
|
|
|
HC DUPLX UP EXT ARTERY BILAT
|
Facility
|
OP
|
$2,464.00
|
|
|
Service Code
|
CPT 93930
|
| Hospital Charge Code |
908100105
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$176.72 |
| Max. Negotiated Rate |
$2,217.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$306.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$931.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,057.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,455.73
|
| Rate for Payer: Blue Distinction Transplant |
$1,478.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,522.75
|
| Rate for Payer: Blue Shield of California EPN |
$1,197.50
|
| Rate for Payer: Caremore Medicare Advantage |
$306.16
|
| Rate for Payer: Cash Price |
$1,108.80
|
| Rate for Payer: Cash Price |
$1,108.80
|
| Rate for Payer: Cash Price |
$1,108.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,971.20
|
| Rate for Payer: Cigna of CA HMO |
$1,576.96
|
| Rate for Payer: Cigna of CA PPO |
$1,823.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Media |
$306.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$413.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$306.16
|
| Rate for Payer: Galaxy Health WC |
$2,094.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,478.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,217.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,848.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$502.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$505.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.16
|
| Rate for Payer: InnovAge PACE Commercial |
$459.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,643.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$176.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$492.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$410.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$410.25
|
| Rate for Payer: Multiplan Commercial |
$1,848.00
|
| Rate for Payer: Networks By Design Commercial |
$1,601.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,094.40
|
| Rate for Payer: Prime Health Services Medicare |
$324.53
|
| Rate for Payer: Riverside University Health System MISP |
$336.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,478.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,478.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,507.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,228.00
|
| Rate for Payer: United Healthcare HMO Rider |
$931.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$851.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC DUPLX UP EXT ARTERY UNI
|
Facility
|
OP
|
$2,067.00
|
|
|
Service Code
|
CPT 93931
|
| Hospital Charge Code |
908100120
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$1,860.30 |
| Rate for Payer: Adventist Health Medi-Cal |
$137.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$586.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$703.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,221.18
|
| Rate for Payer: Blue Distinction Transplant |
$1,240.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,277.41
|
| Rate for Payer: Blue Shield of California EPN |
$1,004.56
|
| Rate for Payer: Caremore Medicare Advantage |
$137.36
|
| Rate for Payer: Cash Price |
$930.15
|
| Rate for Payer: Cash Price |
$930.15
|
| Rate for Payer: Cash Price |
$930.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,653.60
|
| Rate for Payer: Cigna of CA HMO |
$1,322.88
|
| Rate for Payer: Cigna of CA PPO |
$1,529.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$1,756.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,240.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,860.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,550.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$226.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: InnovAge PACE Commercial |
$206.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,378.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$157.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$413.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$1,550.25
|
| Rate for Payer: Networks By Design Commercial |
$1,343.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,756.95
|
| Rate for Payer: Prime Health Services Medicare |
$145.60
|
| Rate for Payer: Riverside University Health System MISP |
$151.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,240.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,240.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,507.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,228.00
|
| Rate for Payer: United Healthcare HMO Rider |
$931.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$851.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC DUPLX UP EXT ARTERY UNI
|
Facility
|
IP
|
$2,067.00
|
|
|
Service Code
|
CPT 93931
|
| Hospital Charge Code |
908100120
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$413.40 |
| Max. Negotiated Rate |
$1,860.30 |
| Rate for Payer: Cash Price |
$930.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,653.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$826.80
|
| Rate for Payer: Galaxy Health WC |
$1,756.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,240.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,860.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,378.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$787.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$413.40
|
| Rate for Payer: Multiplan Commercial |
$1,550.25
|
| Rate for Payer: Networks By Design Commercial |
$1,343.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,756.95
|
|
|
HC DUP SCAN EXTRACRANIAL ART COMPLEX
|
Facility
|
OP
|
$2,432.00
|
|
|
Service Code
|
CPT 93880
|
| Hospital Charge Code |
908100102
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$220.00 |
| Max. Negotiated Rate |
$2,188.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$306.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$931.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$994.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,436.83
|
| Rate for Payer: Blue Distinction Transplant |
$1,459.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,502.98
|
| Rate for Payer: Blue Shield of California EPN |
$1,181.95
|
| Rate for Payer: Caremore Medicare Advantage |
$306.16
|
| Rate for Payer: Cash Price |
$1,094.40
|
| Rate for Payer: Cash Price |
$1,094.40
|
| Rate for Payer: Cash Price |
$1,094.40
|
| Rate for Payer: Center for Health Promotion Commercial |
$220.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,945.60
|
| Rate for Payer: Cigna of CA HMO |
$1,556.48
|
| Rate for Payer: Cigna of CA PPO |
$1,799.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Media |
$306.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$413.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$306.16
|
| Rate for Payer: Galaxy Health WC |
$2,067.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,459.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,188.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,824.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$502.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$505.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.16
|
| Rate for Payer: InnovAge PACE Commercial |
$459.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,622.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$486.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$410.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$410.25
|
| Rate for Payer: Multiplan Commercial |
$1,824.00
|
| Rate for Payer: Networks By Design Commercial |
$1,580.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,067.20
|
| Rate for Payer: Prime Health Services Medicare |
$324.53
|
| Rate for Payer: Riverside University Health System MISP |
$336.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,459.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,459.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,507.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,228.00
|
| Rate for Payer: United Healthcare HMO Rider |
$931.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$851.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC DUP SCAN EXTRACRANIAL ART COMPLEX
|
Facility
|
IP
|
$2,432.00
|
|
|
Service Code
|
CPT 93880
|
| Hospital Charge Code |
908100102
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$486.40 |
| Max. Negotiated Rate |
$2,188.80 |
| Rate for Payer: Cash Price |
$1,094.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,945.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$972.80
|
| Rate for Payer: Galaxy Health WC |
$2,067.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,459.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,188.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,622.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$926.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$486.40
|
| Rate for Payer: Multiplan Commercial |
$1,824.00
|
| Rate for Payer: Networks By Design Commercial |
$1,580.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,067.20
|
|
|
HC DUP SCAN EXTRACRANIAL ART LIMITED
|
Facility
|
OP
|
$1,183.00
|
|
|
Service Code
|
CPT 93882
|
| Hospital Charge Code |
908100116
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$1,507.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$137.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$929.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$660.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$698.92
|
| Rate for Payer: Blue Distinction Transplant |
$709.80
|
| Rate for Payer: Blue Shield of California Commercial |
$731.09
|
| Rate for Payer: Blue Shield of California EPN |
$574.94
|
| Rate for Payer: Caremore Medicare Advantage |
$137.36
|
| Rate for Payer: Cash Price |
$532.35
|
| Rate for Payer: Cash Price |
$532.35
|
| Rate for Payer: Cash Price |
$532.35
|
| Rate for Payer: Central Health Plan Commercial |
$946.40
|
| Rate for Payer: Cigna of CA HMO |
$757.12
|
| Rate for Payer: Cigna of CA PPO |
$875.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$1,005.55
|
| Rate for Payer: Global Benefits Group Commercial |
$709.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,064.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$887.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$226.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: InnovAge PACE Commercial |
$206.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$789.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$236.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$887.25
|
| Rate for Payer: Networks By Design Commercial |
$768.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,005.55
|
| Rate for Payer: Prime Health Services Medicare |
$145.60
|
| Rate for Payer: Riverside University Health System MISP |
$151.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$709.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$709.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,507.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,228.00
|
| Rate for Payer: United Healthcare HMO Rider |
$931.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$851.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC DUP SCAN EXTRACRANIAL ART LIMITED
|
Facility
|
IP
|
$1,183.00
|
|
|
Service Code
|
CPT 93882
|
| Hospital Charge Code |
908100116
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$236.60 |
| Max. Negotiated Rate |
$1,064.70 |
| Rate for Payer: Cash Price |
$532.35
|
| Rate for Payer: Central Health Plan Commercial |
$946.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$473.20
|
| Rate for Payer: Galaxy Health WC |
$1,005.55
|
| Rate for Payer: Global Benefits Group Commercial |
$709.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,064.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$789.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$450.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$236.60
|
| Rate for Payer: Multiplan Commercial |
$887.25
|
| Rate for Payer: Networks By Design Commercial |
$768.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,005.55
|
|
|
HC DVC BERLIN HEART DRIVING UNIT
|
Facility
|
IP
|
$16,170.00
|
|
| Hospital Charge Code |
901692008
|
|
Hospital Revenue Code
|
291
|
| Min. Negotiated Rate |
$3,234.00 |
| Max. Negotiated Rate |
$14,553.00 |
| Rate for Payer: Cash Price |
$7,276.50
|
| Rate for Payer: Central Health Plan Commercial |
$12,936.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,468.00
|
| Rate for Payer: Galaxy Health WC |
$13,744.50
|
| Rate for Payer: Global Benefits Group Commercial |
$9,702.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,553.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,785.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,160.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,234.00
|
| Rate for Payer: Multiplan Commercial |
$12,127.50
|
| Rate for Payer: Networks By Design Commercial |
$10,510.50
|
| Rate for Payer: Prime Health Services Commercial |
$13,744.50
|
|
|
HC DVC BERLIN HEART DRIVING UNIT
|
Facility
|
OP
|
$16,170.00
|
|
| Hospital Charge Code |
901692008
|
|
Hospital Revenue Code
|
291
|
| Min. Negotiated Rate |
$3,234.00 |
| Max. Negotiated Rate |
$14,553.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,820.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,744.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,893.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,893.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7,829.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,553.24
|
| Rate for Payer: Blue Distinction Transplant |
$9,702.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,170.93
|
| Rate for Payer: Blue Shield of California EPN |
$7,907.13
|
| Rate for Payer: Cash Price |
$7,276.50
|
| Rate for Payer: Central Health Plan Commercial |
$12,936.00
|
| Rate for Payer: Cigna of CA HMO |
$10,348.80
|
| Rate for Payer: Cigna of CA PPO |
$11,965.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,744.50
|
| Rate for Payer: Dignity Health Media |
$13,744.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,744.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,468.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,468.00
|
| Rate for Payer: Galaxy Health WC |
$13,744.50
|
| Rate for Payer: Global Benefits Group Commercial |
$9,702.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,553.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12,127.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5,659.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,785.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,160.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,234.00
|
| Rate for Payer: Multiplan Commercial |
$12,127.50
|
| Rate for Payer: Networks By Design Commercial |
$10,510.50
|
| Rate for Payer: Prime Health Services Commercial |
$13,744.50
|
| Rate for Payer: Riverside University Health System MISP |
$6,468.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,702.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,702.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,085.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,085.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,085.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,085.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,744.50
|
| Rate for Payer: Vantage Medical Group Senior |
$13,744.50
|
|
|
HC DVC FEEDING TUBE 5-18FR
|
Facility
|
IP
|
$15.91
|
|
|
Service Code
|
CPT B9998
|
| Hospital Charge Code |
901698340
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.18 |
| Max. Negotiated Rate |
$14.32 |
| Rate for Payer: Cash Price |
$7.16
|
| Rate for Payer: Central Health Plan Commercial |
$12.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.36
|
| Rate for Payer: Galaxy Health WC |
$13.52
|
| Rate for Payer: Global Benefits Group Commercial |
$9.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.18
|
| Rate for Payer: Multiplan Commercial |
$11.93
|
| Rate for Payer: Networks By Design Commercial |
$10.34
|
| Rate for Payer: Prime Health Services Commercial |
$13.52
|
|
|
HC DVC FEEDING TUBE 5-18FR
|
Facility
|
OP
|
$15.91
|
|
|
Service Code
|
CPT B9998
|
| Hospital Charge Code |
901698340
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.18 |
| Max. Negotiated Rate |
$14.32 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.40
|
| Rate for Payer: Blue Distinction Transplant |
$9.55
|
| Rate for Payer: Blue Shield of California Commercial |
$10.01
|
| Rate for Payer: Blue Shield of California EPN |
$7.78
|
| Rate for Payer: Cash Price |
$7.16
|
| Rate for Payer: Central Health Plan Commercial |
$12.73
|
| Rate for Payer: Cigna of CA HMO |
$10.18
|
| Rate for Payer: Cigna of CA PPO |
$11.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.52
|
| Rate for Payer: Dignity Health Media |
$13.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.36
|
| Rate for Payer: Galaxy Health WC |
$13.52
|
| Rate for Payer: Global Benefits Group Commercial |
$9.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.32
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.18
|
| Rate for Payer: Multiplan Commercial |
$11.93
|
| Rate for Payer: Networks By Design Commercial |
$10.34
|
| Rate for Payer: Prime Health Services Commercial |
$13.52
|
| Rate for Payer: Riverside University Health System MISP |
$6.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.96
|
| Rate for Payer: United Healthcare All Other HMO |
$7.96
|
| Rate for Payer: United Healthcare HMO Rider |
$7.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.52
|
| Rate for Payer: Vantage Medical Group Senior |
$13.52
|
|
|
HC DVC NASAL SUCTION
|
Facility
|
OP
|
$17.63
|
|
| Hospital Charge Code |
901604906
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.53 |
| Max. Negotiated Rate |
$15.87 |
| Rate for Payer: Aetna of CA HMO/PPO |
$10.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.42
|
| Rate for Payer: Blue Distinction Transplant |
$10.58
|
| Rate for Payer: Blue Shield of California Commercial |
$11.09
|
| Rate for Payer: Blue Shield of California EPN |
$8.62
|
| Rate for Payer: Cash Price |
$7.93
|
| Rate for Payer: Central Health Plan Commercial |
$14.10
|
| Rate for Payer: Cigna of CA HMO |
$11.28
|
| Rate for Payer: Cigna of CA PPO |
$13.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.99
|
| Rate for Payer: Dignity Health Media |
$14.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.05
|
| Rate for Payer: Galaxy Health WC |
$14.99
|
| Rate for Payer: Global Benefits Group Commercial |
$10.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.87
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$13.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.53
|
| Rate for Payer: Multiplan Commercial |
$13.22
|
| Rate for Payer: Networks By Design Commercial |
$11.46
|
| Rate for Payer: Prime Health Services Commercial |
$14.99
|
| Rate for Payer: Riverside University Health System MISP |
$7.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.82
|
| Rate for Payer: United Healthcare All Other HMO |
$8.82
|
| Rate for Payer: United Healthcare HMO Rider |
$8.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.99
|
| Rate for Payer: Vantage Medical Group Senior |
$14.99
|
|
|
HC DVC NASAL SUCTION
|
Facility
|
IP
|
$17.63
|
|
| Hospital Charge Code |
901604906
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.53 |
| Max. Negotiated Rate |
$15.87 |
| Rate for Payer: Cash Price |
$7.93
|
| Rate for Payer: Central Health Plan Commercial |
$14.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.05
|
| Rate for Payer: Galaxy Health WC |
$14.99
|
| Rate for Payer: Global Benefits Group Commercial |
$10.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.53
|
| Rate for Payer: Multiplan Commercial |
$13.22
|
| Rate for Payer: Networks By Design Commercial |
$11.46
|
| Rate for Payer: Prime Health Services Commercial |
$14.99
|
|
|
HC DVC NASAL SUCTION PREEMIE
|
Facility
|
OP
|
$19.02
|
|
| Hospital Charge Code |
901605138
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$17.12 |
| Rate for Payer: Aetna of CA HMO/PPO |
$11.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.24
|
| Rate for Payer: Blue Distinction Transplant |
$11.41
|
| Rate for Payer: Blue Shield of California Commercial |
$11.96
|
| Rate for Payer: Blue Shield of California EPN |
$9.30
|
| Rate for Payer: Cash Price |
$8.56
|
| Rate for Payer: Central Health Plan Commercial |
$15.22
|
| Rate for Payer: Cigna of CA HMO |
$12.17
|
| Rate for Payer: Cigna of CA PPO |
$14.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.17
|
| Rate for Payer: Dignity Health Media |
$16.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.61
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.61
|
| Rate for Payer: Galaxy Health WC |
$16.17
|
| Rate for Payer: Global Benefits Group Commercial |
$11.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.12
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$14.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.80
|
| Rate for Payer: Multiplan Commercial |
$14.26
|
| Rate for Payer: Networks By Design Commercial |
$12.36
|
| Rate for Payer: Prime Health Services Commercial |
$16.17
|
| Rate for Payer: Riverside University Health System MISP |
$7.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.51
|
| Rate for Payer: United Healthcare All Other HMO |
$9.51
|
| Rate for Payer: United Healthcare HMO Rider |
$9.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.17
|
| Rate for Payer: Vantage Medical Group Senior |
$16.17
|
|
|
HC DVC NASAL SUCTION PREEMIE
|
Facility
|
IP
|
$19.02
|
|
| Hospital Charge Code |
901605138
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$17.12 |
| Rate for Payer: Cash Price |
$8.56
|
| Rate for Payer: Central Health Plan Commercial |
$15.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.61
|
| Rate for Payer: Galaxy Health WC |
$16.17
|
| Rate for Payer: Global Benefits Group Commercial |
$11.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.80
|
| Rate for Payer: Multiplan Commercial |
$14.26
|
| Rate for Payer: Networks By Design Commercial |
$12.36
|
| Rate for Payer: Prime Health Services Commercial |
$16.17
|
|
|
HC DVC NASAL SUCTION STD W/COVER
|
Facility
|
OP
|
$21.65
|
|
| Hospital Charge Code |
901698481
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.33 |
| Max. Negotiated Rate |
$19.48 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.79
|
| Rate for Payer: Blue Distinction Transplant |
$12.99
|
| Rate for Payer: Blue Shield of California Commercial |
$13.62
|
| Rate for Payer: Blue Shield of California EPN |
$10.59
|
| Rate for Payer: Cash Price |
$9.74
|
| Rate for Payer: Central Health Plan Commercial |
$17.32
|
| Rate for Payer: Cigna of CA HMO |
$13.86
|
| Rate for Payer: Cigna of CA PPO |
$16.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.40
|
| Rate for Payer: Dignity Health Media |
$18.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.66
|
| Rate for Payer: Galaxy Health WC |
$18.40
|
| Rate for Payer: Global Benefits Group Commercial |
$12.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.48
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$16.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.33
|
| Rate for Payer: Multiplan Commercial |
$16.24
|
| Rate for Payer: Networks By Design Commercial |
$14.07
|
| Rate for Payer: Prime Health Services Commercial |
$18.40
|
| Rate for Payer: Riverside University Health System MISP |
$8.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.82
|
| Rate for Payer: United Healthcare All Other HMO |
$10.82
|
| Rate for Payer: United Healthcare HMO Rider |
$10.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.40
|
| Rate for Payer: Vantage Medical Group Senior |
$18.40
|
|
|
HC DVC NASAL SUCTION STD W/COVER
|
Facility
|
IP
|
$21.65
|
|
| Hospital Charge Code |
901698481
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.33 |
| Max. Negotiated Rate |
$19.48 |
| Rate for Payer: Cash Price |
$9.74
|
| Rate for Payer: Central Health Plan Commercial |
$17.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.66
|
| Rate for Payer: Galaxy Health WC |
$18.40
|
| Rate for Payer: Global Benefits Group Commercial |
$12.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.33
|
| Rate for Payer: Multiplan Commercial |
$16.24
|
| Rate for Payer: Networks By Design Commercial |
$14.07
|
| Rate for Payer: Prime Health Services Commercial |
$18.40
|
|
|
HC DVC NASAL SUCTION STNDR
|
Facility
|
OP
|
$19.84
|
|
| Hospital Charge Code |
901605137
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.97 |
| Max. Negotiated Rate |
$17.86 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.72
|
| Rate for Payer: Blue Distinction Transplant |
$11.90
|
| Rate for Payer: Blue Shield of California Commercial |
$12.48
|
| Rate for Payer: Blue Shield of California EPN |
$9.70
|
| Rate for Payer: Cash Price |
$8.93
|
| Rate for Payer: Central Health Plan Commercial |
$15.87
|
| Rate for Payer: Cigna of CA HMO |
$12.70
|
| Rate for Payer: Cigna of CA PPO |
$14.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.86
|
| Rate for Payer: Dignity Health Media |
$16.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.94
|
| Rate for Payer: Galaxy Health WC |
$16.86
|
| Rate for Payer: Global Benefits Group Commercial |
$11.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.86
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$14.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.97
|
| Rate for Payer: Multiplan Commercial |
$14.88
|
| Rate for Payer: Networks By Design Commercial |
$12.90
|
| Rate for Payer: Prime Health Services Commercial |
$16.86
|
| Rate for Payer: Riverside University Health System MISP |
$7.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.92
|
| Rate for Payer: United Healthcare All Other HMO |
$9.92
|
| Rate for Payer: United Healthcare HMO Rider |
$9.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.86
|
| Rate for Payer: Vantage Medical Group Senior |
$16.86
|
|
|
HC DVC NASAL SUCTION STNDR
|
Facility
|
IP
|
$19.84
|
|
| Hospital Charge Code |
901605137
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.97 |
| Max. Negotiated Rate |
$17.86 |
| Rate for Payer: Cash Price |
$8.93
|
| Rate for Payer: Central Health Plan Commercial |
$15.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.94
|
| Rate for Payer: Galaxy Health WC |
$16.86
|
| Rate for Payer: Global Benefits Group Commercial |
$11.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.97
|
| Rate for Payer: Multiplan Commercial |
$14.88
|
| Rate for Payer: Networks By Design Commercial |
$12.90
|
| Rate for Payer: Prime Health Services Commercial |
$16.86
|
|
|
HC DVC NASAL SUCTN PREEMIE W/CVR
|
Facility
|
OP
|
$21.65
|
|
| Hospital Charge Code |
901698482
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.33 |
| Max. Negotiated Rate |
$19.48 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.79
|
| Rate for Payer: Blue Distinction Transplant |
$12.99
|
| Rate for Payer: Blue Shield of California Commercial |
$13.62
|
| Rate for Payer: Blue Shield of California EPN |
$10.59
|
| Rate for Payer: Cash Price |
$9.74
|
| Rate for Payer: Central Health Plan Commercial |
$17.32
|
| Rate for Payer: Cigna of CA HMO |
$13.86
|
| Rate for Payer: Cigna of CA PPO |
$16.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.40
|
| Rate for Payer: Dignity Health Media |
$18.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.66
|
| Rate for Payer: Galaxy Health WC |
$18.40
|
| Rate for Payer: Global Benefits Group Commercial |
$12.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.48
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$16.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.33
|
| Rate for Payer: Multiplan Commercial |
$16.24
|
| Rate for Payer: Networks By Design Commercial |
$14.07
|
| Rate for Payer: Prime Health Services Commercial |
$18.40
|
| Rate for Payer: Riverside University Health System MISP |
$8.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.82
|
| Rate for Payer: United Healthcare All Other HMO |
$10.82
|
| Rate for Payer: United Healthcare HMO Rider |
$10.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.40
|
| Rate for Payer: Vantage Medical Group Senior |
$18.40
|
|
|
HC DVC NASAL SUCTN PREEMIE W/CVR
|
Facility
|
IP
|
$21.65
|
|
| Hospital Charge Code |
901698482
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.33 |
| Max. Negotiated Rate |
$19.48 |
| Rate for Payer: Cash Price |
$9.74
|
| Rate for Payer: Central Health Plan Commercial |
$17.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.66
|
| Rate for Payer: Galaxy Health WC |
$18.40
|
| Rate for Payer: Global Benefits Group Commercial |
$12.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.33
|
| Rate for Payer: Multiplan Commercial |
$16.24
|
| Rate for Payer: Networks By Design Commercial |
$14.07
|
| Rate for Payer: Prime Health Services Commercial |
$18.40
|
|
|
HC DVC PELVIC ORTHOTIC TPOD
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT E0944
|
| Hospital Charge Code |
901605152
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
|
