|
HC IV START KIT
|
Facility
|
OP
|
$67.16
|
|
| Hospital Charge Code |
901698271
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.43 |
| Max. Negotiated Rate |
$60.44 |
| Rate for Payer: Adventist Health Commercial |
$13.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$40.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$57.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$36.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$50.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$32.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.07
|
| Rate for Payer: Blue Shield of California Commercial |
$42.58
|
| Rate for Payer: Blue Shield of California EPN |
$26.80
|
| Rate for Payer: Cash Price |
$30.22
|
| Rate for Payer: Central Health Plan Commercial |
$53.73
|
| Rate for Payer: Cigna of CA HMO |
$42.98
|
| Rate for Payer: Cigna of CA PPO |
$49.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$57.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$57.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$57.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$47.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.86
|
| Rate for Payer: EPIC Health Plan Senior |
$26.86
|
| Rate for Payer: Galaxy Health WC |
$57.09
|
| Rate for Payer: Global Benefits Group Commercial |
$40.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$60.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$42.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$39.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$47.01
|
| Rate for Payer: Multiplan Commercial |
$50.37
|
| Rate for Payer: Networks By Design Commercial |
$43.65
|
| Rate for Payer: Prime Health Services Commercial |
$57.09
|
| Rate for Payer: Riverside University Health System MISP |
$26.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$40.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$40.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.58
|
| Rate for Payer: United Healthcare All Other HMO |
$33.58
|
| Rate for Payer: United Healthcare HMO Rider |
$33.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$33.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$57.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$57.09
|
| Rate for Payer: Vantage Medical Group Senior |
$57.09
|
|
|
HC IV START KIT W/SM BORE EXT SET
|
Facility
|
IP
|
$22.06
|
|
| Hospital Charge Code |
901698434
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.41 |
| Max. Negotiated Rate |
$19.85 |
| Rate for Payer: Adventist Health Commercial |
$4.41
|
| Rate for Payer: Cash Price |
$9.93
|
| Rate for Payer: Central Health Plan Commercial |
$17.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.82
|
| Rate for Payer: EPIC Health Plan Senior |
$8.82
|
| Rate for Payer: Galaxy Health WC |
$18.75
|
| Rate for Payer: Global Benefits Group Commercial |
$13.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.41
|
| Rate for Payer: Multiplan Commercial |
$16.55
|
| Rate for Payer: Networks By Design Commercial |
$14.34
|
| Rate for Payer: Prime Health Services Commercial |
$18.75
|
|
|
HC IV START KIT W/SM BORE EXT SET
|
Facility
|
OP
|
$22.06
|
|
| Hospital Charge Code |
901698434
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.41 |
| Max. Negotiated Rate |
$19.85 |
| Rate for Payer: Adventist Health Commercial |
$4.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.83
|
| Rate for Payer: Blue Shield of California Commercial |
$13.99
|
| Rate for Payer: Blue Shield of California EPN |
$8.80
|
| Rate for Payer: Cash Price |
$9.93
|
| Rate for Payer: Central Health Plan Commercial |
$17.65
|
| Rate for Payer: Cigna of CA HMO |
$14.12
|
| Rate for Payer: Cigna of CA PPO |
$16.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.82
|
| Rate for Payer: EPIC Health Plan Senior |
$8.82
|
| Rate for Payer: Galaxy Health WC |
$18.75
|
| Rate for Payer: Global Benefits Group Commercial |
$13.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.44
|
| Rate for Payer: Multiplan Commercial |
$16.55
|
| Rate for Payer: Networks By Design Commercial |
$14.34
|
| Rate for Payer: Prime Health Services Commercial |
$18.75
|
| Rate for Payer: Riverside University Health System MISP |
$8.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.03
|
| Rate for Payer: United Healthcare All Other HMO |
$11.03
|
| Rate for Payer: United Healthcare HMO Rider |
$11.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.75
|
| Rate for Payer: Vantage Medical Group Senior |
$18.75
|
|
|
HC IVU EXCRETORY
|
Facility
|
IP
|
$1,248.00
|
|
|
Service Code
|
CPT 74400
|
| Hospital Charge Code |
909001910
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$249.60 |
| Max. Negotiated Rate |
$1,123.20 |
| Rate for Payer: Adventist Health Commercial |
$249.60
|
| Rate for Payer: Cash Price |
$561.60
|
| Rate for Payer: Central Health Plan Commercial |
$998.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$873.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$499.20
|
| Rate for Payer: EPIC Health Plan Senior |
$499.20
|
| Rate for Payer: Galaxy Health WC |
$1,060.80
|
| Rate for Payer: Global Benefits Group Commercial |
$748.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,123.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$792.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$736.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$249.60
|
| Rate for Payer: Multiplan Commercial |
$936.00
|
| Rate for Payer: Networks By Design Commercial |
$811.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,060.80
|
|
|
HC IVU EXCRETORY
|
Facility
|
OP
|
$1,248.00
|
|
|
Service Code
|
CPT 74400
|
| Hospital Charge Code |
909001910
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$113.07 |
| Max. Negotiated Rate |
$1,123.20 |
| Rate for Payer: Adventist Health Commercial |
$249.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$225.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$559.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$350.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$486.78
|
| Rate for Payer: Blue Shield of California Commercial |
$786.24
|
| Rate for Payer: Blue Shield of California EPN |
$495.46
|
| Rate for Payer: Cash Price |
$561.60
|
| Rate for Payer: Cash Price |
$561.60
|
| Rate for Payer: Central Health Plan Commercial |
$998.40
|
| Rate for Payer: Cigna of CA HMO |
$798.72
|
| Rate for Payer: Cigna of CA PPO |
$923.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$873.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.22
|
| Rate for Payer: EPIC Health Plan Senior |
$248.15
|
| Rate for Payer: Galaxy Health WC |
$1,060.80
|
| Rate for Payer: Global Benefits Group Commercial |
$748.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,123.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$369.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$113.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$792.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$124.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$249.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$302.29
|
| Rate for Payer: Multiplan Commercial |
$936.00
|
| Rate for Payer: Networks By Design Commercial |
$811.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$225.59
|
| Rate for Payer: Prime Health Services Commercial |
$1,060.80
|
| Rate for Payer: Prime Health Services Medicare |
$239.13
|
| Rate for Payer: Riverside University Health System MISP |
$248.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$748.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$748.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$470.69
|
| Rate for Payer: United Healthcare All Other HMO |
$470.69
|
| Rate for Payer: United Healthcare HMO Rider |
$470.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$470.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$225.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
|
|
HC IVU HYPERTENSIVE
|
Facility
|
OP
|
$797.00
|
|
|
Service Code
|
CPT 74415
|
| Hospital Charge Code |
909001911
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$159.40 |
| Max. Negotiated Rate |
$717.30 |
| Rate for Payer: Adventist Health Commercial |
$159.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$225.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$714.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$438.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$609.75
|
| Rate for Payer: Blue Shield of California Commercial |
$502.11
|
| Rate for Payer: Blue Shield of California EPN |
$316.41
|
| Rate for Payer: Cash Price |
$358.65
|
| Rate for Payer: Cash Price |
$358.65
|
| Rate for Payer: Central Health Plan Commercial |
$637.60
|
| Rate for Payer: Cigna of CA HMO |
$510.08
|
| Rate for Payer: Cigna of CA PPO |
$589.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$557.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.22
|
| Rate for Payer: EPIC Health Plan Senior |
$248.15
|
| Rate for Payer: Galaxy Health WC |
$677.45
|
| Rate for Payer: Global Benefits Group Commercial |
$478.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$717.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$369.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$170.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$506.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$188.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$302.29
|
| Rate for Payer: Multiplan Commercial |
$597.75
|
| Rate for Payer: Networks By Design Commercial |
$518.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$225.59
|
| Rate for Payer: Prime Health Services Commercial |
$677.45
|
| Rate for Payer: Prime Health Services Medicare |
$239.13
|
| Rate for Payer: Riverside University Health System MISP |
$248.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$478.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$478.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$470.69
|
| Rate for Payer: United Healthcare All Other HMO |
$470.69
|
| Rate for Payer: United Healthcare HMO Rider |
$470.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$470.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$225.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
|
|
HC IVU HYPERTENSIVE
|
Facility
|
IP
|
$797.00
|
|
|
Service Code
|
CPT 74415
|
| Hospital Charge Code |
909001911
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$159.40 |
| Max. Negotiated Rate |
$717.30 |
| Rate for Payer: Adventist Health Commercial |
$159.40
|
| Rate for Payer: Cash Price |
$358.65
|
| Rate for Payer: Central Health Plan Commercial |
$637.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$557.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$318.80
|
| Rate for Payer: EPIC Health Plan Senior |
$318.80
|
| Rate for Payer: Galaxy Health WC |
$677.45
|
| Rate for Payer: Global Benefits Group Commercial |
$478.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$717.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$506.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$470.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.40
|
| Rate for Payer: Multiplan Commercial |
$597.75
|
| Rate for Payer: Networks By Design Commercial |
$518.05
|
| Rate for Payer: Prime Health Services Commercial |
$677.45
|
|
|
HC IVUS ADD'L VESSEL
|
Facility
|
OP
|
$6,739.00
|
|
|
Service Code
|
CPT 92979
|
| Hospital Charge Code |
906811210
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$237.00 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,347.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,728.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,706.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,054.25
|
| 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 |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$3,032.55
|
| Rate for Payer: Cash Price |
$3,032.55
|
| Rate for Payer: Cash Price |
$3,032.55
|
| Rate for Payer: Central Health Plan Commercial |
$5,391.20
|
| Rate for Payer: Cigna of CA HMO |
$4,380.35
|
| Rate for Payer: Cigna of CA PPO |
$4,986.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,728.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,728.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,728.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,717.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,695.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,695.60
|
| Rate for Payer: Galaxy Health WC |
$5,728.15
|
| Rate for Payer: Global Benefits Group Commercial |
$4,043.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,065.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$237.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,279.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$261.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,976.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,347.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,717.30
|
| Rate for Payer: Multiplan Commercial |
$5,054.25
|
| Rate for Payer: Networks By Design Commercial |
$4,380.35
|
| Rate for Payer: Prime Health Services Commercial |
$5,728.15
|
| Rate for Payer: Riverside University Health System MISP |
$2,695.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,043.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,043.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,369.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,728.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,728.15
|
| Rate for Payer: Vantage Medical Group Senior |
$5,728.15
|
|
|
HC IVUS ADD'L VESSEL
|
Facility
|
IP
|
$6,739.00
|
|
|
Service Code
|
CPT 92979
|
| Hospital Charge Code |
906811210
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,347.80 |
| Max. Negotiated Rate |
$6,065.10 |
| Rate for Payer: Adventist Health Commercial |
$1,347.80
|
| Rate for Payer: Cash Price |
$3,032.55
|
| Rate for Payer: Central Health Plan Commercial |
$5,391.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,717.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,695.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,695.60
|
| Rate for Payer: Galaxy Health WC |
$5,728.15
|
| Rate for Payer: Global Benefits Group Commercial |
$4,043.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,065.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,279.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,976.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,347.80
|
| Rate for Payer: Multiplan Commercial |
$5,054.25
|
| Rate for Payer: Networks By Design Commercial |
$4,380.35
|
| Rate for Payer: Prime Health Services Commercial |
$5,728.15
|
|
|
HC IVUS INITIAL VESSEL
|
Facility
|
OP
|
$9,472.00
|
|
|
Service Code
|
CPT 92978
|
| Hospital Charge Code |
906811200
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$387.33 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,894.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,051.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,209.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,104.00
|
| 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 |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$4,262.40
|
| Rate for Payer: Cash Price |
$4,262.40
|
| Rate for Payer: Cash Price |
$4,262.40
|
| Rate for Payer: Central Health Plan Commercial |
$7,577.60
|
| Rate for Payer: Cigna of CA HMO |
$6,156.80
|
| Rate for Payer: Cigna of CA PPO |
$7,009.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,051.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,051.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,051.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,630.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,788.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,788.80
|
| Rate for Payer: Galaxy Health WC |
$8,051.20
|
| Rate for Payer: Global Benefits Group Commercial |
$5,683.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,524.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$387.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,014.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$427.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,588.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,894.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,630.40
|
| Rate for Payer: Multiplan Commercial |
$7,104.00
|
| Rate for Payer: Networks By Design Commercial |
$6,156.80
|
| Rate for Payer: Prime Health Services Commercial |
$8,051.20
|
| Rate for Payer: Riverside University Health System MISP |
$3,788.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,683.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,683.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,736.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,051.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,051.20
|
| Rate for Payer: Vantage Medical Group Senior |
$8,051.20
|
|
|
HC IVUS INITIAL VESSEL
|
Facility
|
IP
|
$9,472.00
|
|
|
Service Code
|
CPT 92978
|
| Hospital Charge Code |
906811200
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,894.40 |
| Max. Negotiated Rate |
$8,524.80 |
| Rate for Payer: Adventist Health Commercial |
$1,894.40
|
| Rate for Payer: Cash Price |
$4,262.40
|
| Rate for Payer: Central Health Plan Commercial |
$7,577.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,630.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,788.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,788.80
|
| Rate for Payer: Galaxy Health WC |
$8,051.20
|
| Rate for Payer: Global Benefits Group Commercial |
$5,683.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,524.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,014.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,588.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,894.40
|
| Rate for Payer: Multiplan Commercial |
$7,104.00
|
| Rate for Payer: Networks By Design Commercial |
$6,156.80
|
| Rate for Payer: Prime Health Services Commercial |
$8,051.20
|
|
|
HC JEJUNOSTOMY PERC
|
Facility
|
IP
|
$1,066.00
|
|
|
Service Code
|
CPT 74355
|
| Hospital Charge Code |
909001868
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$213.20 |
| Max. Negotiated Rate |
$959.40 |
| Rate for Payer: Adventist Health Commercial |
$213.20
|
| Rate for Payer: Cash Price |
$479.70
|
| Rate for Payer: Central Health Plan Commercial |
$852.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$746.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$426.40
|
| Rate for Payer: EPIC Health Plan Senior |
$426.40
|
| Rate for Payer: Galaxy Health WC |
$906.10
|
| Rate for Payer: Global Benefits Group Commercial |
$639.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$959.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$676.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$628.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.20
|
| Rate for Payer: Multiplan Commercial |
$799.50
|
| Rate for Payer: Networks By Design Commercial |
$692.90
|
| Rate for Payer: Prime Health Services Commercial |
$906.10
|
|
|
HC JEJUNOSTOMY PERC
|
Facility
|
OP
|
$1,066.00
|
|
|
Service Code
|
CPT 74355
|
| Hospital Charge Code |
909001868
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$177.26 |
| Max. Negotiated Rate |
$959.40 |
| Rate for Payer: Adventist Health Commercial |
$213.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$664.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$906.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$586.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$799.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$545.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$758.39
|
| Rate for Payer: Blue Shield of California Commercial |
$671.58
|
| Rate for Payer: Blue Shield of California EPN |
$423.20
|
| Rate for Payer: Cash Price |
$479.70
|
| Rate for Payer: Cash Price |
$479.70
|
| Rate for Payer: Central Health Plan Commercial |
$852.80
|
| Rate for Payer: Cigna of CA HMO |
$682.24
|
| Rate for Payer: Cigna of CA PPO |
$788.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$906.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$906.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$906.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$746.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$426.40
|
| Rate for Payer: EPIC Health Plan Senior |
$426.40
|
| Rate for Payer: Galaxy Health WC |
$906.10
|
| Rate for Payer: Global Benefits Group Commercial |
$639.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$959.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$177.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$676.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$195.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$628.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$746.20
|
| Rate for Payer: Multiplan Commercial |
$799.50
|
| Rate for Payer: Networks By Design Commercial |
$692.90
|
| Rate for Payer: Prime Health Services Commercial |
$906.10
|
| Rate for Payer: Riverside University Health System MISP |
$426.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$639.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$639.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$533.00
|
| Rate for Payer: United Healthcare All Other HMO |
$533.00
|
| Rate for Payer: United Healthcare HMO Rider |
$533.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$533.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$906.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$906.10
|
| Rate for Payer: Vantage Medical Group Senior |
$906.10
|
|
|
HC JEJUNOSTOMY TUBE PLACEMENT
|
Facility
|
OP
|
$668.00
|
|
|
Service Code
|
CPT 44015
|
| Hospital Charge Code |
906744015
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$133.60 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$133.60
|
| Rate for Payer: Adventist Health Commercial |
$201.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$855.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$567.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$367.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$553.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$501.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$754.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$300.60
|
| Rate for Payer: Cash Price |
$452.70
|
| Rate for Payer: Cash Price |
$452.70
|
| Rate for Payer: Cash Price |
$300.60
|
| Rate for Payer: Central Health Plan Commercial |
$534.40
|
| Rate for Payer: Central Health Plan Commercial |
$804.80
|
| Rate for Payer: Cigna of CA HMO |
$427.52
|
| Rate for Payer: Cigna of CA HMO |
$643.84
|
| Rate for Payer: Cigna of CA PPO |
$494.32
|
| Rate for Payer: Cigna of CA PPO |
$744.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$855.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$567.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$855.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$567.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$567.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$855.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$467.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$704.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$267.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$402.40
|
| Rate for Payer: EPIC Health Plan Senior |
$267.20
|
| Rate for Payer: EPIC Health Plan Senior |
$402.40
|
| Rate for Payer: Galaxy Health WC |
$855.10
|
| Rate for Payer: Galaxy Health WC |
$567.80
|
| Rate for Payer: Global Benefits Group Commercial |
$603.60
|
| Rate for Payer: Global Benefits Group Commercial |
$400.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$601.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$905.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$424.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$638.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$593.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$394.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$467.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$704.20
|
| Rate for Payer: Multiplan Commercial |
$501.00
|
| Rate for Payer: Multiplan Commercial |
$754.50
|
| Rate for Payer: Networks By Design Commercial |
$434.20
|
| Rate for Payer: Networks By Design Commercial |
$653.90
|
| Rate for Payer: Prime Health Services Commercial |
$855.10
|
| Rate for Payer: Prime Health Services Commercial |
$567.80
|
| Rate for Payer: Riverside University Health System MISP |
$267.20
|
| Rate for Payer: Riverside University Health System MISP |
$402.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$603.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$400.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$334.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$503.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$567.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$855.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$855.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$567.80
|
| Rate for Payer: Vantage Medical Group Senior |
$567.80
|
| Rate for Payer: Vantage Medical Group Senior |
$855.10
|
|
|
HC JEJUNOSTOMY TUBE PLACEMENT
|
Facility
|
IP
|
$1,006.00
|
|
|
Service Code
|
CPT 44015
|
| Hospital Charge Code |
906744015
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$201.20 |
| Max. Negotiated Rate |
$905.40 |
| Rate for Payer: Adventist Health Commercial |
$201.20
|
| Rate for Payer: Cash Price |
$452.70
|
| Rate for Payer: Central Health Plan Commercial |
$804.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$704.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$402.40
|
| Rate for Payer: EPIC Health Plan Senior |
$402.40
|
| Rate for Payer: Galaxy Health WC |
$855.10
|
| Rate for Payer: Global Benefits Group Commercial |
$603.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$905.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$638.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$593.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.20
|
| Rate for Payer: Multiplan Commercial |
$754.50
|
| Rate for Payer: Networks By Design Commercial |
$653.90
|
| Rate for Payer: Prime Health Services Commercial |
$855.10
|
|
|
HC JEJUNOSTOMY TUBE PLACEMENT
|
Facility
|
OP
|
$668.00
|
|
|
Service Code
|
CPT 44015
|
| Hospital Charge Code |
906744015
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$133.60 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$133.60
|
| Rate for Payer: Adventist Health Commercial |
$201.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$855.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$567.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$553.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$367.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$501.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$754.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$300.60
|
| Rate for Payer: Cash Price |
$300.60
|
| Rate for Payer: Cash Price |
$452.70
|
| Rate for Payer: Cash Price |
$452.70
|
| Rate for Payer: Central Health Plan Commercial |
$804.80
|
| Rate for Payer: Central Health Plan Commercial |
$534.40
|
| Rate for Payer: Cigna of CA HMO |
$427.52
|
| Rate for Payer: Cigna of CA HMO |
$643.84
|
| Rate for Payer: Cigna of CA PPO |
$494.32
|
| Rate for Payer: Cigna of CA PPO |
$744.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$855.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$567.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$567.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$855.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$567.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$855.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$467.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$704.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$402.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$267.20
|
| Rate for Payer: EPIC Health Plan Senior |
$267.20
|
| Rate for Payer: EPIC Health Plan Senior |
$402.40
|
| Rate for Payer: Galaxy Health WC |
$567.80
|
| Rate for Payer: Galaxy Health WC |
$855.10
|
| Rate for Payer: Global Benefits Group Commercial |
$400.80
|
| Rate for Payer: Global Benefits Group Commercial |
$603.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$905.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$601.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$638.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$424.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$593.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$394.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$704.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$467.60
|
| Rate for Payer: Multiplan Commercial |
$501.00
|
| Rate for Payer: Multiplan Commercial |
$754.50
|
| Rate for Payer: Networks By Design Commercial |
$434.20
|
| Rate for Payer: Networks By Design Commercial |
$653.90
|
| Rate for Payer: Prime Health Services Commercial |
$567.80
|
| Rate for Payer: Prime Health Services Commercial |
$855.10
|
| Rate for Payer: Riverside University Health System MISP |
$267.20
|
| Rate for Payer: Riverside University Health System MISP |
$402.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$603.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$400.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$400.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$603.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$503.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$334.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$855.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$567.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$855.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$567.80
|
| Rate for Payer: Vantage Medical Group Senior |
$855.10
|
| Rate for Payer: Vantage Medical Group Senior |
$567.80
|
|
|
HC JEJUNOSTOMY TUBE PLACEMENT
|
Facility
|
IP
|
$1,006.00
|
|
|
Service Code
|
CPT 44015
|
| Hospital Charge Code |
906744015
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$201.20 |
| Max. Negotiated Rate |
$905.40 |
| Rate for Payer: Adventist Health Commercial |
$201.20
|
| Rate for Payer: Cash Price |
$452.70
|
| Rate for Payer: Central Health Plan Commercial |
$804.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$704.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$402.40
|
| Rate for Payer: EPIC Health Plan Senior |
$402.40
|
| Rate for Payer: Galaxy Health WC |
$855.10
|
| Rate for Payer: Global Benefits Group Commercial |
$603.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$905.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$638.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$593.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.20
|
| Rate for Payer: Multiplan Commercial |
$754.50
|
| Rate for Payer: Networks By Design Commercial |
$653.90
|
| Rate for Payer: Prime Health Services Commercial |
$855.10
|
|
|
HC JO-1 AUTO AB
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913526
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.53 |
| Max. Negotiated Rate |
$154.02 |
| Rate for Payer: Adventist Health Commercial |
$34.20
|
| Rate for Payer: Adventist Health Commercial |
$8.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$17.93
|
| Rate for Payer: Adventist Health Medi-Cal |
$17.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$120.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$120.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$110.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$110.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$154.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$154.02
|
| Rate for Payer: Blue Shield of California Commercial |
$27.72
|
| Rate for Payer: Blue Shield of California Commercial |
$107.73
|
| Rate for Payer: Blue Shield of California EPN |
$17.47
|
| Rate for Payer: Blue Shield of California EPN |
$67.89
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: Central Health Plan Commercial |
$136.80
|
| Rate for Payer: Central Health Plan Commercial |
$35.20
|
| Rate for Payer: Cigna of CA HMO |
$28.16
|
| Rate for Payer: Cigna of CA HMO |
$109.44
|
| Rate for Payer: Cigna of CA PPO |
$32.56
|
| Rate for Payer: Cigna of CA PPO |
$126.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$119.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.58
|
| Rate for Payer: EPIC Health Plan Senior |
$19.72
|
| Rate for Payer: EPIC Health Plan Senior |
$19.72
|
| Rate for Payer: Galaxy Health WC |
$37.40
|
| Rate for Payer: Galaxy Health WC |
$145.35
|
| Rate for Payer: Global Benefits Group Commercial |
$26.40
|
| Rate for Payer: Global Benefits Group Commercial |
$102.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$153.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.41
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$108.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Multiplan Commercial |
$33.00
|
| Rate for Payer: Multiplan Commercial |
$128.25
|
| Rate for Payer: Networks By Design Commercial |
$111.15
|
| Rate for Payer: Networks By Design Commercial |
$28.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.93
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.93
|
| Rate for Payer: Prime Health Services Commercial |
$37.40
|
| Rate for Payer: Prime Health Services Commercial |
$145.35
|
| Rate for Payer: Prime Health Services Medicare |
$19.01
|
| Rate for Payer: Prime Health Services Medicare |
$19.01
|
| Rate for Payer: Riverside University Health System MISP |
$19.72
|
| Rate for Payer: Riverside University Health System MISP |
$19.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$102.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$102.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.53
|
| Rate for Payer: United Healthcare All Other HMO |
$14.53
|
| Rate for Payer: United Healthcare All Other HMO |
$14.53
|
| Rate for Payer: United Healthcare HMO Rider |
$14.53
|
| Rate for Payer: United Healthcare HMO Rider |
$14.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.93
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC JO-1 AUTO AB
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913526
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$34.20 |
| Max. Negotiated Rate |
$153.90 |
| Rate for Payer: Adventist Health Commercial |
$34.20
|
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: Central Health Plan Commercial |
$136.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$119.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.40
|
| Rate for Payer: EPIC Health Plan Senior |
$68.40
|
| Rate for Payer: Galaxy Health WC |
$145.35
|
| Rate for Payer: Global Benefits Group Commercial |
$102.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$153.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$108.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$100.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.20
|
| Rate for Payer: Multiplan Commercial |
$128.25
|
| Rate for Payer: Networks By Design Commercial |
$111.15
|
| Rate for Payer: Prime Health Services Commercial |
$145.35
|
|
|
HC JOINT ASPIR/INJ-INTER JOINT
|
Facility
|
IP
|
$1,931.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
909000110
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$386.20 |
| Max. Negotiated Rate |
$1,737.90 |
| Rate for Payer: Adventist Health Commercial |
$386.20
|
| Rate for Payer: Cash Price |
$868.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,544.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,351.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$772.40
|
| Rate for Payer: EPIC Health Plan Senior |
$772.40
|
| Rate for Payer: Galaxy Health WC |
$1,641.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,158.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,737.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,226.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,139.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$386.20
|
| Rate for Payer: Multiplan Commercial |
$1,448.25
|
| Rate for Payer: Networks By Design Commercial |
$1,255.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,641.35
|
|
|
HC JOINT ASPIR/INJ-INTER JOINT
|
Facility
|
OP
|
$1,931.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
909000110
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$65.31 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$386.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$394.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$394.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$597.61
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$868.95
|
| Rate for Payer: Cash Price |
$868.95
|
| Rate for Payer: Cash Price |
$868.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,544.80
|
| Rate for Payer: Cigna of CA HMO |
$1,235.84
|
| Rate for Payer: Cigna of CA PPO |
$1,428.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$592.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$434.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$394.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,351.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$651.40
|
| Rate for Payer: EPIC Health Plan Senior |
$434.27
|
| Rate for Payer: Galaxy Health WC |
$1,641.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,158.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,737.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$647.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$65.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$394.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,226.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$72.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$552.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$386.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$529.02
|
| Rate for Payer: Multiplan Commercial |
$1,448.25
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: Networks By Design Commercial |
$1,255.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$394.79
|
| Rate for Payer: Preferred Health Network WC |
$609.81
|
| Rate for Payer: Prime Health Services Commercial |
$1,641.35
|
| Rate for Payer: Prime Health Services Medicare |
$418.48
|
| Rate for Payer: Prime Health Services WC |
$591.52
|
| Rate for Payer: Riverside University Health System MISP |
$434.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,158.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$965.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$394.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Vantage Medical Group Senior |
$394.79
|
|
|
HC JUG R 1 (WALNUT), IGE
|
Facility
|
IP
|
$18.49
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
900913739
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.70 |
| Max. Negotiated Rate |
$16.64 |
| Rate for Payer: Adventist Health Commercial |
$3.70
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Central Health Plan Commercial |
$14.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.40
|
| Rate for Payer: EPIC Health Plan Senior |
$7.40
|
| Rate for Payer: Galaxy Health WC |
$15.72
|
| Rate for Payer: Global Benefits Group Commercial |
$11.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.70
|
| Rate for Payer: Multiplan Commercial |
$13.87
|
| Rate for Payer: Networks By Design Commercial |
$12.02
|
| Rate for Payer: Prime Health Services Commercial |
$15.72
|
|
|
HC JUG R 1 (WALNUT), IGE
|
Facility
|
OP
|
$15.41
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
900913739
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$167.30 |
| Rate for Payer: Adventist Health Commercial |
$3.08
|
| Rate for Payer: Adventist Health Commercial |
$3.70
|
| Rate for Payer: Adventist Health Medi-Cal |
$17.93
|
| Rate for Payer: Adventist Health Medi-Cal |
$17.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$115.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$115.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$120.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$120.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$167.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$167.30
|
| Rate for Payer: Blue Shield of California Commercial |
$11.65
|
| Rate for Payer: Blue Shield of California Commercial |
$9.71
|
| Rate for Payer: Blue Shield of California EPN |
$7.34
|
| Rate for Payer: Blue Shield of California EPN |
$6.12
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cash Price |
$6.93
|
| Rate for Payer: Cash Price |
$6.93
|
| Rate for Payer: Central Health Plan Commercial |
$12.33
|
| Rate for Payer: Central Health Plan Commercial |
$14.79
|
| Rate for Payer: Cigna of CA HMO |
$11.83
|
| Rate for Payer: Cigna of CA HMO |
$9.86
|
| Rate for Payer: Cigna of CA PPO |
$13.68
|
| Rate for Payer: Cigna of CA PPO |
$11.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.58
|
| Rate for Payer: EPIC Health Plan Senior |
$19.72
|
| Rate for Payer: EPIC Health Plan Senior |
$19.72
|
| Rate for Payer: Galaxy Health WC |
$15.72
|
| Rate for Payer: Galaxy Health WC |
$13.10
|
| Rate for Payer: Global Benefits Group Commercial |
$11.09
|
| Rate for Payer: Global Benefits Group Commercial |
$9.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.87
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.41
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Multiplan Commercial |
$13.87
|
| Rate for Payer: Multiplan Commercial |
$11.56
|
| Rate for Payer: Networks By Design Commercial |
$10.02
|
| Rate for Payer: Networks By Design Commercial |
$12.02
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.93
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.93
|
| Rate for Payer: Prime Health Services Commercial |
$15.72
|
| Rate for Payer: Prime Health Services Commercial |
$13.10
|
| Rate for Payer: Prime Health Services Medicare |
$19.01
|
| Rate for Payer: Prime Health Services Medicare |
$19.01
|
| Rate for Payer: Riverside University Health System MISP |
$19.72
|
| Rate for Payer: Riverside University Health System MISP |
$19.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.53
|
| Rate for Payer: United Healthcare All Other HMO |
$14.53
|
| Rate for Payer: United Healthcare All Other HMO |
$14.53
|
| Rate for Payer: United Healthcare HMO Rider |
$14.53
|
| Rate for Payer: United Healthcare HMO Rider |
$14.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.93
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC JUG R 3 (WALNUT), IGE
|
Facility
|
IP
|
$18.49
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
900913740
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.70 |
| Max. Negotiated Rate |
$16.64 |
| Rate for Payer: Adventist Health Commercial |
$3.70
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Central Health Plan Commercial |
$14.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.40
|
| Rate for Payer: EPIC Health Plan Senior |
$7.40
|
| Rate for Payer: Galaxy Health WC |
$15.72
|
| Rate for Payer: Global Benefits Group Commercial |
$11.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.70
|
| Rate for Payer: Multiplan Commercial |
$13.87
|
| Rate for Payer: Networks By Design Commercial |
$12.02
|
| Rate for Payer: Prime Health Services Commercial |
$15.72
|
|
|
HC JUG R 3 (WALNUT), IGE
|
Facility
|
OP
|
$15.41
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
900913740
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$167.30 |
| Rate for Payer: Adventist Health Commercial |
$3.08
|
| Rate for Payer: Adventist Health Commercial |
$3.70
|
| Rate for Payer: Adventist Health Medi-Cal |
$17.93
|
| Rate for Payer: Adventist Health Medi-Cal |
$17.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$115.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$115.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$120.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$120.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$167.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$167.30
|
| Rate for Payer: Blue Shield of California Commercial |
$11.65
|
| Rate for Payer: Blue Shield of California Commercial |
$9.71
|
| Rate for Payer: Blue Shield of California EPN |
$7.34
|
| Rate for Payer: Blue Shield of California EPN |
$6.12
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cash Price |
$6.93
|
| Rate for Payer: Cash Price |
$6.93
|
| Rate for Payer: Central Health Plan Commercial |
$12.33
|
| Rate for Payer: Central Health Plan Commercial |
$14.79
|
| Rate for Payer: Cigna of CA HMO |
$11.83
|
| Rate for Payer: Cigna of CA HMO |
$9.86
|
| Rate for Payer: Cigna of CA PPO |
$13.68
|
| Rate for Payer: Cigna of CA PPO |
$11.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.58
|
| Rate for Payer: EPIC Health Plan Senior |
$19.72
|
| Rate for Payer: EPIC Health Plan Senior |
$19.72
|
| Rate for Payer: Galaxy Health WC |
$15.72
|
| Rate for Payer: Galaxy Health WC |
$13.10
|
| Rate for Payer: Global Benefits Group Commercial |
$11.09
|
| Rate for Payer: Global Benefits Group Commercial |
$9.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.87
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.41
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Multiplan Commercial |
$13.87
|
| Rate for Payer: Multiplan Commercial |
$11.56
|
| Rate for Payer: Networks By Design Commercial |
$10.02
|
| Rate for Payer: Networks By Design Commercial |
$12.02
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.93
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.93
|
| Rate for Payer: Prime Health Services Commercial |
$15.72
|
| Rate for Payer: Prime Health Services Commercial |
$13.10
|
| Rate for Payer: Prime Health Services Medicare |
$19.01
|
| Rate for Payer: Prime Health Services Medicare |
$19.01
|
| Rate for Payer: Riverside University Health System MISP |
$19.72
|
| Rate for Payer: Riverside University Health System MISP |
$19.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.53
|
| Rate for Payer: United Healthcare All Other HMO |
$14.53
|
| Rate for Payer: United Healthcare All Other HMO |
$14.53
|
| Rate for Payer: United Healthcare HMO Rider |
$14.53
|
| Rate for Payer: United Healthcare HMO Rider |
$14.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.93
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
