|
HC IT PASSIVE RESTORATN CAP ONLY
|
Facility
|
OP
|
$3,672.00
|
|
|
Service Code
|
CPT L6370
|
| Hospital Charge Code |
915356370
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,202.58 |
| Max. Negotiated Rate |
$3,304.80 |
| Rate for Payer: Adventist Health Commercial |
$1,505.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,121.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,019.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,754.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,136.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,944.94
|
| Rate for Payer: Blue Shield of California EPN |
$1,850.69
|
| Rate for Payer: Cash Price |
$1,652.40
|
| Rate for Payer: Cash Price |
$1,652.40
|
| Rate for Payer: Central Health Plan Commercial |
$2,937.60
|
| Rate for Payer: Cigna of CA HMO |
$2,570.40
|
| Rate for Payer: Cigna of CA PPO |
$2,570.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,121.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,121.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,121.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,570.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,468.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,468.80
|
| Rate for Payer: Galaxy Health WC |
$3,121.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,203.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,304.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,291.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,331.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,531.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,166.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,505.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,570.40
|
| Rate for Payer: Multiplan Commercial |
$2,754.00
|
| Rate for Payer: Networks By Design Commercial |
$1,836.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,121.20
|
| Rate for Payer: Riverside University Health System MISP |
$1,468.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,203.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,203.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,378.10
|
| Rate for Payer: United Healthcare All Other HMO |
$1,341.38
|
| Rate for Payer: United Healthcare HMO Rider |
$1,312.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,202.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,121.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,121.20
|
| Rate for Payer: Vantage Medical Group Senior |
$3,121.20
|
|
|
HC IT PASSIVE RESTORATN CAP ONLY
|
Facility
|
OP
|
$3,672.00
|
|
|
Service Code
|
CPT L6370
|
| Hospital Charge Code |
905356370
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,202.58 |
| Max. Negotiated Rate |
$3,304.80 |
| Rate for Payer: Adventist Health Commercial |
$1,505.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,121.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,019.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,754.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,136.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,944.94
|
| Rate for Payer: Blue Shield of California EPN |
$1,850.69
|
| Rate for Payer: Cash Price |
$1,652.40
|
| Rate for Payer: Cash Price |
$1,652.40
|
| Rate for Payer: Central Health Plan Commercial |
$2,937.60
|
| Rate for Payer: Cigna of CA HMO |
$2,570.40
|
| Rate for Payer: Cigna of CA PPO |
$2,570.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,121.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,121.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,121.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,570.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,468.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,468.80
|
| Rate for Payer: Galaxy Health WC |
$3,121.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,203.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,304.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,291.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,331.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,531.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,166.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,505.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,570.40
|
| Rate for Payer: Multiplan Commercial |
$2,754.00
|
| Rate for Payer: Networks By Design Commercial |
$1,836.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,121.20
|
| Rate for Payer: Riverside University Health System MISP |
$1,468.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,203.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,203.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,378.10
|
| Rate for Payer: United Healthcare All Other HMO |
$1,341.38
|
| Rate for Payer: United Healthcare HMO Rider |
$1,312.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,202.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,121.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,121.20
|
| Rate for Payer: Vantage Medical Group Senior |
$3,121.20
|
|
|
HC IUD INSERTION
|
Facility
|
OP
|
$1,359.00
|
|
|
Service Code
|
CPT 58300
|
| Hospital Charge Code |
910400025
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$271.80 |
| Max. Negotiated Rate |
$1,223.10 |
| Rate for Payer: Adventist Health Commercial |
$271.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$317.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,155.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$747.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,019.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$658.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$790.53
|
| Rate for Payer: Blue Shield of California Commercial |
$861.61
|
| Rate for Payer: Blue Shield of California EPN |
$542.24
|
| Rate for Payer: Cash Price |
$611.55
|
| Rate for Payer: Cash Price |
$611.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,087.20
|
| Rate for Payer: Cigna of CA HMO |
$869.76
|
| Rate for Payer: Cigna of CA PPO |
$1,005.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,155.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,155.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,155.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$951.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$543.60
|
| Rate for Payer: EPIC Health Plan Senior |
$543.60
|
| Rate for Payer: Galaxy Health WC |
$1,155.15
|
| Rate for Payer: Global Benefits Group Commercial |
$815.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,223.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$289.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$862.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$319.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$801.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$271.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$951.30
|
| Rate for Payer: Multiplan Commercial |
$1,019.25
|
| Rate for Payer: Networks By Design Commercial |
$883.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,155.15
|
| Rate for Payer: Riverside University Health System MISP |
$543.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$815.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$815.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$679.50
|
| Rate for Payer: United Healthcare All Other HMO |
$679.50
|
| Rate for Payer: United Healthcare HMO Rider |
$679.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$679.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,155.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,155.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,155.15
|
|
|
HC IUD INSERTION
|
Facility
|
IP
|
$1,359.00
|
|
|
Service Code
|
CPT 58300
|
| Hospital Charge Code |
910400025
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$271.80 |
| Max. Negotiated Rate |
$1,223.10 |
| Rate for Payer: Adventist Health Commercial |
$271.80
|
| Rate for Payer: Cash Price |
$611.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,087.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$951.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$543.60
|
| Rate for Payer: EPIC Health Plan Senior |
$543.60
|
| Rate for Payer: Galaxy Health WC |
$1,155.15
|
| Rate for Payer: Global Benefits Group Commercial |
$815.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,223.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$862.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$801.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$271.80
|
| Rate for Payer: Multiplan Commercial |
$1,019.25
|
| Rate for Payer: Networks By Design Commercial |
$883.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,155.15
|
|
|
HC IUD REMOVAL
|
Facility
|
IP
|
$956.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
910400026
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$191.20 |
| Max. Negotiated Rate |
$860.40 |
| Rate for Payer: Adventist Health Commercial |
$191.20
|
| Rate for Payer: Cash Price |
$430.20
|
| Rate for Payer: Central Health Plan Commercial |
$764.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$669.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$382.40
|
| Rate for Payer: EPIC Health Plan Senior |
$382.40
|
| Rate for Payer: Galaxy Health WC |
$812.60
|
| Rate for Payer: Global Benefits Group Commercial |
$573.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$860.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$607.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$564.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$191.20
|
| Rate for Payer: Multiplan Commercial |
$717.00
|
| Rate for Payer: Networks By Design Commercial |
$621.40
|
| Rate for Payer: Prime Health Services Commercial |
$812.60
|
|
|
HC IUD REMOVAL
|
Facility
|
OP
|
$956.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
910400026
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$83.66 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$191.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$391.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$414.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$587.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$391.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$606.10
|
| Rate for Payer: Blue Shield of California EPN |
$381.44
|
| Rate for Payer: Cash Price |
$430.20
|
| Rate for Payer: Cash Price |
$430.20
|
| Rate for Payer: Cash Price |
$430.20
|
| Rate for Payer: Central Health Plan Commercial |
$764.80
|
| Rate for Payer: Cigna of CA HMO |
$611.84
|
| Rate for Payer: Cigna of CA PPO |
$707.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$587.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$391.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$669.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$646.68
|
| Rate for Payer: EPIC Health Plan Senior |
$431.12
|
| Rate for Payer: Galaxy Health WC |
$812.60
|
| Rate for Payer: Global Benefits Group Commercial |
$573.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$860.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$642.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$83.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$391.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$607.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$92.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$548.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$191.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$525.19
|
| Rate for Payer: Multiplan Commercial |
$717.00
|
| Rate for Payer: Networks By Design Commercial |
$621.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$391.93
|
| Rate for Payer: Prime Health Services Commercial |
$812.60
|
| Rate for Payer: Prime Health Services Medicare |
$415.45
|
| Rate for Payer: Riverside University Health System MISP |
$431.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$573.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$573.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$478.00
|
| Rate for Payer: United Healthcare All Other HMO |
$478.00
|
| Rate for Payer: United Healthcare HMO Rider |
$478.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$478.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$391.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$587.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.12
|
| Rate for Payer: Vantage Medical Group Senior |
$391.93
|
|
|
HC IUD REMOVAL
|
Facility
|
IP
|
$956.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
910400026
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$191.20 |
| Max. Negotiated Rate |
$860.40 |
| Rate for Payer: Adventist Health Commercial |
$191.20
|
| Rate for Payer: Cash Price |
$430.20
|
| Rate for Payer: Central Health Plan Commercial |
$764.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$669.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$382.40
|
| Rate for Payer: EPIC Health Plan Senior |
$382.40
|
| Rate for Payer: Galaxy Health WC |
$812.60
|
| Rate for Payer: Global Benefits Group Commercial |
$573.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$860.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$607.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$564.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$191.20
|
| Rate for Payer: Multiplan Commercial |
$717.00
|
| Rate for Payer: Networks By Design Commercial |
$621.40
|
| Rate for Payer: Prime Health Services Commercial |
$812.60
|
|
|
HC IUD REMOVAL
|
Facility
|
OP
|
$956.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
910400026
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$92.42 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$191.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$587.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$391.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$615.83
|
| Rate for Payer: Cash Price |
$430.20
|
| Rate for Payer: Cash Price |
$430.20
|
| Rate for Payer: Cash Price |
$430.20
|
| Rate for Payer: Cash Price |
$430.20
|
| Rate for Payer: Central Health Plan Commercial |
$764.80
|
| Rate for Payer: Cigna of CA HMO |
$611.84
|
| Rate for Payer: Cigna of CA PPO |
$707.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$587.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$391.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$669.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$646.68
|
| Rate for Payer: EPIC Health Plan Senior |
$431.12
|
| Rate for Payer: Galaxy Health WC |
$812.60
|
| Rate for Payer: Global Benefits Group Commercial |
$573.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$860.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$642.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$391.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$607.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$92.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$421.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$191.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$525.19
|
| Rate for Payer: Multiplan Commercial |
$717.00
|
| Rate for Payer: Multiplan WC |
$615.83
|
| Rate for Payer: Networks By Design Commercial |
$621.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$391.93
|
| Rate for Payer: Preferred Health Network WC |
$628.40
|
| Rate for Payer: Prime Health Services Commercial |
$812.60
|
| Rate for Payer: Prime Health Services Medicare |
$415.45
|
| Rate for Payer: Prime Health Services WC |
$609.55
|
| Rate for Payer: Riverside University Health System MISP |
$431.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$573.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$478.00
|
| Rate for Payer: United Healthcare All Other HMO |
$478.00
|
| Rate for Payer: United Healthcare HMO Rider |
$478.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$478.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$391.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$587.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.12
|
| Rate for Payer: Vantage Medical Group Senior |
$391.93
|
|
|
HC IUD REMOVAL
|
Facility
|
IP
|
$956.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
910400026
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$191.20 |
| Max. Negotiated Rate |
$860.40 |
| Rate for Payer: Adventist Health Commercial |
$191.20
|
| Rate for Payer: Cash Price |
$430.20
|
| Rate for Payer: Central Health Plan Commercial |
$764.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$669.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$382.40
|
| Rate for Payer: EPIC Health Plan Senior |
$382.40
|
| Rate for Payer: Galaxy Health WC |
$812.60
|
| Rate for Payer: Global Benefits Group Commercial |
$573.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$860.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$607.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$564.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$191.20
|
| Rate for Payer: Multiplan Commercial |
$717.00
|
| Rate for Payer: Networks By Design Commercial |
$621.40
|
| Rate for Payer: Prime Health Services Commercial |
$812.60
|
|
|
HC IUD REMOVAL
|
Facility
|
OP
|
$956.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
910400026
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$92.42 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$391.96
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$414.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$587.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$391.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$615.83
|
| Rate for Payer: Cash Price |
$430.20
|
| Rate for Payer: Cash Price |
$430.20
|
| Rate for Payer: Cash Price |
$430.20
|
| Rate for Payer: Cash Price |
$430.20
|
| Rate for Payer: Central Health Plan Commercial |
$764.80
|
| Rate for Payer: Cigna of CA HMO |
$611.84
|
| Rate for Payer: Cigna of CA PPO |
$707.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$587.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$391.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$669.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$646.68
|
| Rate for Payer: EPIC Health Plan Senior |
$431.12
|
| Rate for Payer: Galaxy Health WC |
$812.60
|
| Rate for Payer: Global Benefits Group Commercial |
$573.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$860.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$642.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$391.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$607.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$92.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$421.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$191.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$525.19
|
| Rate for Payer: Multiplan Commercial |
$717.00
|
| Rate for Payer: Multiplan WC |
$615.83
|
| Rate for Payer: Networks By Design Commercial |
$621.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$391.93
|
| Rate for Payer: Preferred Health Network WC |
$628.40
|
| Rate for Payer: Prime Health Services Commercial |
$812.60
|
| Rate for Payer: Prime Health Services Medicare |
$415.45
|
| Rate for Payer: Prime Health Services WC |
$609.55
|
| Rate for Payer: Riverside University Health System MISP |
$431.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$573.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$573.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$391.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$587.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.12
|
| Rate for Payer: Vantage Medical Group Senior |
$391.93
|
|
|
HC IVC FILTER REPOSITION
|
Facility
|
IP
|
$11,096.00
|
|
|
Service Code
|
CPT 37192
|
| Hospital Charge Code |
909037192
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,219.20 |
| Max. Negotiated Rate |
$9,986.40 |
| Rate for Payer: Adventist Health Commercial |
$2,219.20
|
| Rate for Payer: Cash Price |
$4,993.20
|
| Rate for Payer: Central Health Plan Commercial |
$8,876.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,767.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,438.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,438.40
|
| Rate for Payer: Galaxy Health WC |
$9,431.60
|
| Rate for Payer: Global Benefits Group Commercial |
$6,657.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,986.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,045.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,546.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,219.20
|
| Rate for Payer: Multiplan Commercial |
$8,322.00
|
| Rate for Payer: Networks By Design Commercial |
$7,212.40
|
| Rate for Payer: Prime Health Services Commercial |
$9,431.60
|
|
|
HC IVC FILTER REPOSITION
|
Facility
|
OP
|
$11,096.00
|
|
|
Service Code
|
CPT 37192
|
| Hospital Charge Code |
909037192
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$521.88 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$2,219.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,061.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,924.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,372.03
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$4,993.20
|
| Rate for Payer: Cash Price |
$4,993.20
|
| Rate for Payer: Cash Price |
$4,993.20
|
| Rate for Payer: Central Health Plan Commercial |
$8,876.80
|
| Rate for Payer: Cigna of CA HMO |
$7,101.44
|
| Rate for Payer: Cigna of CA PPO |
$8,211.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,767.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,700.73
|
| Rate for Payer: EPIC Health Plan Senior |
$4,467.15
|
| Rate for Payer: Galaxy Health WC |
$9,431.60
|
| Rate for Payer: Global Benefits Group Commercial |
$6,657.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,986.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,660.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$521.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,045.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$576.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,685.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,219.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$8,322.00
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$7,212.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Preferred Health Network WC |
$6,502.07
|
| Rate for Payer: Prime Health Services Commercial |
$9,431.60
|
| Rate for Payer: Prime Health Services Medicare |
$4,304.71
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Riverside University Health System MISP |
$4,467.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,657.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,548.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,061.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
HC IVC FILTER RETRIEVAL
|
Facility
|
IP
|
$8,704.00
|
|
|
Service Code
|
CPT 37193
|
| Hospital Charge Code |
909037193
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,740.80 |
| Max. Negotiated Rate |
$7,833.60 |
| Rate for Payer: Adventist Health Commercial |
$1,740.80
|
| Rate for Payer: Cash Price |
$3,916.80
|
| Rate for Payer: Central Health Plan Commercial |
$6,963.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,092.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,481.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,481.60
|
| Rate for Payer: Galaxy Health WC |
$7,398.40
|
| Rate for Payer: Global Benefits Group Commercial |
$5,222.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,833.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,527.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,135.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,740.80
|
| Rate for Payer: Multiplan Commercial |
$6,528.00
|
| Rate for Payer: Networks By Design Commercial |
$5,657.60
|
| Rate for Payer: Prime Health Services Commercial |
$7,398.40
|
|
|
HC IVC FILTER RETRIEVAL
|
Facility
|
OP
|
$8,704.00
|
|
|
Service Code
|
CPT 37193
|
| Hospital Charge Code |
909037193
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$521.25 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,740.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,061.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,924.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,372.03
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$3,916.80
|
| Rate for Payer: Cash Price |
$3,916.80
|
| Rate for Payer: Cash Price |
$3,916.80
|
| Rate for Payer: Central Health Plan Commercial |
$6,963.20
|
| Rate for Payer: Cigna of CA HMO |
$5,570.56
|
| Rate for Payer: Cigna of CA PPO |
$6,440.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,092.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,700.73
|
| Rate for Payer: EPIC Health Plan Senior |
$4,467.15
|
| Rate for Payer: Galaxy Health WC |
$7,398.40
|
| Rate for Payer: Global Benefits Group Commercial |
$5,222.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,833.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,660.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$521.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,527.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$575.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,685.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,740.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$6,528.00
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$5,657.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Preferred Health Network WC |
$6,502.07
|
| Rate for Payer: Prime Health Services Commercial |
$7,398.40
|
| Rate for Payer: Prime Health Services Medicare |
$4,304.71
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Riverside University Health System MISP |
$4,467.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,222.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,352.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,061.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
HC IV DRUG ADMIN SUPPLY
|
Facility
|
IP
|
$11.00
|
|
|
Service Code
|
CPT A4913
|
| Hospital Charge Code |
943100501
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Central Health Plan Commercial |
$8.80
|
| Rate for Payer: Adventist Health Commercial |
$2.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4.40
|
| Rate for Payer: Galaxy Health WC |
$9.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.20
|
| Rate for Payer: Multiplan Commercial |
$8.25
|
| Rate for Payer: Networks By Design Commercial |
$7.15
|
| Rate for Payer: Prime Health Services Commercial |
$9.35
|
|
|
HC IV DRUG ADMIN SUPPLY
|
Facility
|
OP
|
$11.00
|
|
|
Service Code
|
CPT A4913
|
| Hospital Charge Code |
941000501
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$49.09 |
| Rate for Payer: Adventist Health Commercial |
$2.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6.97
|
| Rate for Payer: Blue Shield of California EPN |
$4.39
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Central Health Plan Commercial |
$8.80
|
| Rate for Payer: Cigna of CA HMO |
$7.04
|
| Rate for Payer: Cigna of CA PPO |
$8.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4.40
|
| Rate for Payer: Galaxy Health WC |
$9.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.70
|
| Rate for Payer: Multiplan Commercial |
$8.25
|
| Rate for Payer: Networks By Design Commercial |
$7.15
|
| Rate for Payer: Prime Health Services Commercial |
$9.35
|
| Rate for Payer: Riverside University Health System MISP |
$4.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.35
|
| Rate for Payer: Vantage Medical Group Senior |
$9.35
|
|
|
HC IV DRUG ADMIN SUPPLY
|
Facility
|
OP
|
$11.00
|
|
|
Service Code
|
CPT A4913
|
| Hospital Charge Code |
949000501
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$49.09 |
| Rate for Payer: Dignity Health Medi-Cal |
$9.35
|
| Rate for Payer: Adventist Health Commercial |
$2.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6.97
|
| Rate for Payer: Blue Shield of California EPN |
$4.39
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Central Health Plan Commercial |
$8.80
|
| Rate for Payer: Cigna of CA HMO |
$7.04
|
| Rate for Payer: Cigna of CA PPO |
$8.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4.40
|
| Rate for Payer: Galaxy Health WC |
$9.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.70
|
| Rate for Payer: Multiplan Commercial |
$8.25
|
| Rate for Payer: Networks By Design Commercial |
$7.15
|
| Rate for Payer: Prime Health Services Commercial |
$9.35
|
| Rate for Payer: Riverside University Health System MISP |
$4.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.35
|
| Rate for Payer: Vantage Medical Group Senior |
$9.35
|
|
|
HC IV DRUG ADMIN SUPPLY
|
Facility
|
OP
|
$11.00
|
|
|
Service Code
|
CPT A4913
|
| Hospital Charge Code |
942100501
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$49.09 |
| Rate for Payer: Adventist Health Commercial |
$2.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6.97
|
| Rate for Payer: Blue Shield of California EPN |
$4.39
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Central Health Plan Commercial |
$8.80
|
| Rate for Payer: Cigna of CA HMO |
$7.04
|
| Rate for Payer: Cigna of CA PPO |
$8.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4.40
|
| Rate for Payer: Galaxy Health WC |
$9.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.70
|
| Rate for Payer: Multiplan Commercial |
$8.25
|
| Rate for Payer: Networks By Design Commercial |
$7.15
|
| Rate for Payer: Prime Health Services Commercial |
$9.35
|
| Rate for Payer: Riverside University Health System MISP |
$4.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.35
|
| Rate for Payer: Vantage Medical Group Senior |
$9.35
|
|
|
HC IV DRUG ADMIN SUPPLY
|
Facility
|
IP
|
$11.00
|
|
|
Service Code
|
CPT A4913
|
| Hospital Charge Code |
949000501
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Adventist Health Commercial |
$2.20
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Central Health Plan Commercial |
$8.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4.40
|
| Rate for Payer: Galaxy Health WC |
$9.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.20
|
| Rate for Payer: Multiplan Commercial |
$8.25
|
| Rate for Payer: Networks By Design Commercial |
$7.15
|
| Rate for Payer: Prime Health Services Commercial |
$9.35
|
|
|
HC IV DRUG ADMIN SUPPLY
|
Facility
|
IP
|
$11.00
|
|
|
Service Code
|
CPT A4913
|
| Hospital Charge Code |
942100501
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Adventist Health Commercial |
$2.20
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Central Health Plan Commercial |
$8.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4.40
|
| Rate for Payer: Galaxy Health WC |
$9.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.20
|
| Rate for Payer: Multiplan Commercial |
$8.25
|
| Rate for Payer: Networks By Design Commercial |
$7.15
|
| Rate for Payer: Prime Health Services Commercial |
$9.35
|
|
|
HC IV DRUG ADMIN SUPPLY
|
Facility
|
OP
|
$11.00
|
|
|
Service Code
|
CPT A4913
|
| Hospital Charge Code |
943100501
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$49.09 |
| Rate for Payer: Adventist Health Commercial |
$2.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6.97
|
| Rate for Payer: Blue Shield of California EPN |
$4.39
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Central Health Plan Commercial |
$8.80
|
| Rate for Payer: Cigna of CA HMO |
$7.04
|
| Rate for Payer: Cigna of CA PPO |
$8.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4.40
|
| Rate for Payer: Galaxy Health WC |
$9.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.70
|
| Rate for Payer: Multiplan Commercial |
$8.25
|
| Rate for Payer: Networks By Design Commercial |
$7.15
|
| Rate for Payer: Prime Health Services Commercial |
$9.35
|
| Rate for Payer: Riverside University Health System MISP |
$4.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.35
|
| Rate for Payer: Vantage Medical Group Senior |
$9.35
|
|
|
HC IV DRUG ADMIN SUPPLY
|
Facility
|
IP
|
$11.00
|
|
|
Service Code
|
CPT A4913
|
| Hospital Charge Code |
941000501
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Adventist Health Commercial |
$2.20
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Central Health Plan Commercial |
$8.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4.40
|
| Rate for Payer: Galaxy Health WC |
$9.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.20
|
| Rate for Payer: Multiplan Commercial |
$8.25
|
| Rate for Payer: Networks By Design Commercial |
$7.15
|
| Rate for Payer: Prime Health Services Commercial |
$9.35
|
|
|
HC IV INFUS EA ADD SEQ UP TO 1 HR
|
Facility
|
IP
|
$922.00
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
910196367
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$184.40 |
| Max. Negotiated Rate |
$829.80 |
| Rate for Payer: Adventist Health Commercial |
$184.40
|
| Rate for Payer: Cash Price |
$414.90
|
| Rate for Payer: Central Health Plan Commercial |
$737.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$645.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$368.80
|
| Rate for Payer: EPIC Health Plan Senior |
$368.80
|
| Rate for Payer: Galaxy Health WC |
$783.70
|
| Rate for Payer: Global Benefits Group Commercial |
$553.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$829.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$585.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$543.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.40
|
| Rate for Payer: Multiplan Commercial |
$691.50
|
| Rate for Payer: Networks By Design Commercial |
$599.30
|
| Rate for Payer: Prime Health Services Commercial |
$783.70
|
|
|
HC IV INFUS EA ADD SEQ UP TO 1 HR
|
Facility
|
IP
|
$922.00
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
910196367
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$184.40 |
| Max. Negotiated Rate |
$829.80 |
| Rate for Payer: Adventist Health Commercial |
$184.40
|
| Rate for Payer: Cash Price |
$414.90
|
| Rate for Payer: Central Health Plan Commercial |
$737.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$645.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$368.80
|
| Rate for Payer: EPIC Health Plan Senior |
$368.80
|
| Rate for Payer: Galaxy Health WC |
$783.70
|
| Rate for Payer: Global Benefits Group Commercial |
$553.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$829.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$585.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$543.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.40
|
| Rate for Payer: Multiplan Commercial |
$691.50
|
| Rate for Payer: Networks By Design Commercial |
$599.30
|
| Rate for Payer: Prime Health Services Commercial |
$783.70
|
|
|
HC IV INFUS EA ADD SEQ UP TO 1 HR
|
Facility
|
OP
|
$922.00
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
910196367
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$58.99 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Commercial |
$184.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$138.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$101.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$92.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,685.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$144.09
|
| Rate for Payer: Cash Price |
$414.90
|
| Rate for Payer: Cash Price |
$414.90
|
| Rate for Payer: Cash Price |
$414.90
|
| Rate for Payer: Cash Price |
$414.90
|
| Rate for Payer: Central Health Plan Commercial |
$737.60
|
| Rate for Payer: Cigna of CA HMO |
$590.08
|
| Rate for Payer: Cigna of CA PPO |
$682.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$138.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$101.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$92.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$645.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$152.79
|
| Rate for Payer: EPIC Health Plan Senior |
$101.86
|
| Rate for Payer: Galaxy Health WC |
$783.70
|
| Rate for Payer: Global Benefits Group Commercial |
$553.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$829.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$151.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$92.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$585.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$58.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$99.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$124.08
|
| Rate for Payer: Multiplan Commercial |
$691.50
|
| Rate for Payer: Multiplan WC |
$144.09
|
| Rate for Payer: Networks By Design Commercial |
$599.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$92.60
|
| Rate for Payer: Preferred Health Network WC |
$147.03
|
| Rate for Payer: Prime Health Services Commercial |
$783.70
|
| Rate for Payer: Prime Health Services Medicare |
$98.16
|
| Rate for Payer: Prime Health Services WC |
$142.62
|
| Rate for Payer: Riverside University Health System MISP |
$101.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$553.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$461.00
|
| Rate for Payer: United Healthcare All Other HMO |
$461.00
|
| Rate for Payer: United Healthcare HMO Rider |
$461.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$461.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$92.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$138.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$101.86
|
| Rate for Payer: Vantage Medical Group Senior |
$92.60
|
|
