|
HC INDR SPECT VISI DIALTOR
|
Facility
|
IP
|
$1,035.00
|
|
|
Service Code
|
CPT C1893
|
| Hospital Charge Code |
906812684
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$207.00 |
| Max. Negotiated Rate |
$931.50 |
| Rate for Payer: Adventist Health Commercial |
$207.00
|
| Rate for Payer: Cash Price |
$465.75
|
| Rate for Payer: Central Health Plan Commercial |
$828.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.00
|
| Rate for Payer: EPIC Health Plan Senior |
$414.00
|
| Rate for Payer: Galaxy Health WC |
$879.75
|
| Rate for Payer: Global Benefits Group Commercial |
$621.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$931.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$690.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$394.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$640.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.00
|
| Rate for Payer: Multiplan Commercial |
$776.25
|
| Rate for Payer: Networks By Design Commercial |
$672.75
|
| Rate for Payer: Prime Health Services Commercial |
$879.75
|
|
|
HC INDR SPECT VISI DIALTOR
|
Facility
|
OP
|
$1,035.00
|
|
|
Service Code
|
CPT C1893
|
| Hospital Charge Code |
906812684
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$207.00 |
| Max. Negotiated Rate |
$931.50 |
| Rate for Payer: Adventist Health Commercial |
$207.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$628.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$879.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$569.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$776.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$501.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$607.86
|
| Rate for Payer: Blue Shield of California Commercial |
$632.38
|
| Rate for Payer: Blue Shield of California EPN |
$412.96
|
| Rate for Payer: Cash Price |
$465.75
|
| Rate for Payer: Central Health Plan Commercial |
$828.00
|
| Rate for Payer: Cigna of CA HMO |
$662.40
|
| Rate for Payer: Cigna of CA PPO |
$765.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$879.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$879.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$879.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.00
|
| Rate for Payer: EPIC Health Plan Senior |
$414.00
|
| Rate for Payer: Galaxy Health WC |
$879.75
|
| Rate for Payer: Global Benefits Group Commercial |
$621.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$931.50
|
| Rate for Payer: InnovAge PACE Commercial |
$517.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$690.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$394.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$640.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$724.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$724.50
|
| Rate for Payer: Multiplan Commercial |
$776.25
|
| Rate for Payer: Networks By Design Commercial |
$672.75
|
| Rate for Payer: Prime Health Services Commercial |
$879.75
|
| Rate for Payer: Riverside University Health System MISP |
$414.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$621.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$621.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$517.50
|
| Rate for Payer: United Healthcare All Other HMO |
$517.50
|
| Rate for Payer: United Healthcare HMO Rider |
$517.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$517.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$879.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$879.75
|
| Rate for Payer: Vantage Medical Group Senior |
$879.75
|
|
|
HC INDR STJ APEEL CS
|
Facility
|
IP
|
$1,530.00
|
|
|
Service Code
|
CPT C1892
|
| Hospital Charge Code |
906813541
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$306.00 |
| Max. Negotiated Rate |
$1,377.00 |
| Rate for Payer: Adventist Health Commercial |
$306.00
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,224.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.00
|
| Rate for Payer: EPIC Health Plan Senior |
$612.00
|
| Rate for Payer: Galaxy Health WC |
$1,300.50
|
| Rate for Payer: Global Benefits Group Commercial |
$918.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,377.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,020.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$582.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$947.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$306.00
|
| Rate for Payer: Multiplan Commercial |
$1,147.50
|
| Rate for Payer: Networks By Design Commercial |
$994.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,300.50
|
|
|
HC INDR STJ APEEL CS
|
Facility
|
OP
|
$1,530.00
|
|
|
Service Code
|
CPT C1892
|
| Hospital Charge Code |
906813541
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$306.00 |
| Max. Negotiated Rate |
$1,377.00 |
| Rate for Payer: Adventist Health Commercial |
$306.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$929.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,300.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$841.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,147.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$740.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$898.57
|
| Rate for Payer: Blue Shield of California Commercial |
$934.83
|
| Rate for Payer: Blue Shield of California EPN |
$610.47
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,224.00
|
| Rate for Payer: Cigna of CA HMO |
$979.20
|
| Rate for Payer: Cigna of CA PPO |
$1,132.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,300.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,300.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,300.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.00
|
| Rate for Payer: EPIC Health Plan Senior |
$612.00
|
| Rate for Payer: Galaxy Health WC |
$1,300.50
|
| Rate for Payer: Global Benefits Group Commercial |
$918.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,377.00
|
| Rate for Payer: InnovAge PACE Commercial |
$765.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,020.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$582.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$947.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$306.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,071.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,071.00
|
| Rate for Payer: Multiplan Commercial |
$1,147.50
|
| Rate for Payer: Networks By Design Commercial |
$994.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,300.50
|
| Rate for Payer: Riverside University Health System MISP |
$612.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$918.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$918.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$765.00
|
| Rate for Payer: United Healthcare All Other HMO |
$765.00
|
| Rate for Payer: United Healthcare HMO Rider |
$765.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$765.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,300.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,300.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,300.50
|
|
|
HC INDR STJ FASTCATH 60 CM
|
Facility
|
IP
|
$478.21
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$95.64 |
| Max. Negotiated Rate |
$430.39 |
| Rate for Payer: Adventist Health Commercial |
$95.64
|
| Rate for Payer: Cash Price |
$215.19
|
| Rate for Payer: Central Health Plan Commercial |
$382.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$191.28
|
| Rate for Payer: EPIC Health Plan Senior |
$191.28
|
| Rate for Payer: Galaxy Health WC |
$406.48
|
| Rate for Payer: Global Benefits Group Commercial |
$286.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$430.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$318.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$182.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$296.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.64
|
| Rate for Payer: Multiplan Commercial |
$358.66
|
| Rate for Payer: Networks By Design Commercial |
$310.84
|
| Rate for Payer: Prime Health Services Commercial |
$406.48
|
|
|
HC INDR STJ FASTCATH 60 CM
|
Facility
|
OP
|
$478.21
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$95.64 |
| Max. Negotiated Rate |
$430.39 |
| Rate for Payer: Adventist Health Commercial |
$95.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$290.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$406.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$263.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$358.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$231.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$280.85
|
| Rate for Payer: Blue Shield of California Commercial |
$292.19
|
| Rate for Payer: Blue Shield of California EPN |
$190.81
|
| Rate for Payer: Cash Price |
$215.19
|
| Rate for Payer: Central Health Plan Commercial |
$382.57
|
| Rate for Payer: Cigna of CA HMO |
$306.05
|
| Rate for Payer: Cigna of CA PPO |
$353.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$406.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$406.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$406.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$191.28
|
| Rate for Payer: EPIC Health Plan Senior |
$191.28
|
| Rate for Payer: Galaxy Health WC |
$406.48
|
| Rate for Payer: Global Benefits Group Commercial |
$286.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$430.39
|
| Rate for Payer: InnovAge PACE Commercial |
$239.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$318.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$182.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$296.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$334.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$334.75
|
| Rate for Payer: Multiplan Commercial |
$358.66
|
| Rate for Payer: Networks By Design Commercial |
$310.84
|
| Rate for Payer: Prime Health Services Commercial |
$406.48
|
| Rate for Payer: Riverside University Health System MISP |
$191.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$286.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$286.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$239.10
|
| Rate for Payer: United Healthcare All Other HMO |
$239.10
|
| Rate for Payer: United Healthcare HMO Rider |
$239.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$239.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$406.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$406.48
|
| Rate for Payer: Vantage Medical Group Senior |
$406.48
|
|
|
HC INDR STJ FASTCATH 63CM 10FR
|
Facility
|
OP
|
$504.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812322
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.80 |
| Max. Negotiated Rate |
$453.60 |
| Rate for Payer: Adventist Health Commercial |
$100.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$306.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$428.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$378.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$244.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$296.00
|
| Rate for Payer: Blue Shield of California Commercial |
$307.94
|
| Rate for Payer: Blue Shield of California EPN |
$201.10
|
| Rate for Payer: Cash Price |
$226.80
|
| Rate for Payer: Central Health Plan Commercial |
$403.20
|
| Rate for Payer: Cigna of CA HMO |
$322.56
|
| Rate for Payer: Cigna of CA PPO |
$372.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$428.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$428.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$428.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.60
|
| Rate for Payer: EPIC Health Plan Senior |
$201.60
|
| Rate for Payer: Galaxy Health WC |
$428.40
|
| Rate for Payer: Global Benefits Group Commercial |
$302.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$453.60
|
| Rate for Payer: InnovAge PACE Commercial |
$252.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$336.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$192.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$311.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$352.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$352.80
|
| Rate for Payer: Multiplan Commercial |
$378.00
|
| Rate for Payer: Networks By Design Commercial |
$327.60
|
| Rate for Payer: Prime Health Services Commercial |
$428.40
|
| Rate for Payer: Riverside University Health System MISP |
$201.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$302.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$302.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$252.00
|
| Rate for Payer: United Healthcare All Other HMO |
$252.00
|
| Rate for Payer: United Healthcare HMO Rider |
$252.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$252.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$428.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$428.40
|
| Rate for Payer: Vantage Medical Group Senior |
$428.40
|
|
|
HC INDR STJ FASTCATH 63CM 10FR
|
Facility
|
IP
|
$504.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812322
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.80 |
| Max. Negotiated Rate |
$453.60 |
| Rate for Payer: Adventist Health Commercial |
$100.80
|
| Rate for Payer: Cash Price |
$226.80
|
| Rate for Payer: Central Health Plan Commercial |
$403.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.60
|
| Rate for Payer: EPIC Health Plan Senior |
$201.60
|
| Rate for Payer: Galaxy Health WC |
$428.40
|
| Rate for Payer: Global Benefits Group Commercial |
$302.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$453.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$336.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$192.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$311.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.80
|
| Rate for Payer: Multiplan Commercial |
$378.00
|
| Rate for Payer: Networks By Design Commercial |
$327.60
|
| Rate for Payer: Prime Health Services Commercial |
$428.40
|
|
|
HC INDR STJ MAXIMUM 021
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812399
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$39.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.16
|
| Rate for Payer: Blue Shield of California Commercial |
$50.10
|
| Rate for Payer: Blue Shield of California EPN |
$32.72
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$69.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: InnovAge PACE Commercial |
$41.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Riverside University Health System MISP |
$32.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.00
|
| Rate for Payer: United Healthcare All Other HMO |
$41.00
|
| Rate for Payer: United Healthcare HMO Rider |
$41.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.70
|
| Rate for Payer: Vantage Medical Group Senior |
$69.70
|
|
|
HC INDR STJ MAXIMUM 021
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812399
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
|
|
HC INDR TERUMO BOKARHI KIT
|
Facility
|
OP
|
$572.75
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812421
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$114.55 |
| Max. Negotiated Rate |
$515.48 |
| Rate for Payer: Adventist Health Commercial |
$114.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$347.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$486.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$315.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$429.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$277.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$336.38
|
| Rate for Payer: Blue Shield of California Commercial |
$349.95
|
| Rate for Payer: Blue Shield of California EPN |
$228.53
|
| Rate for Payer: Cash Price |
$257.74
|
| Rate for Payer: Central Health Plan Commercial |
$458.20
|
| Rate for Payer: Cigna of CA HMO |
$366.56
|
| Rate for Payer: Cigna of CA PPO |
$423.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$486.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$486.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$486.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$229.10
|
| Rate for Payer: EPIC Health Plan Senior |
$229.10
|
| Rate for Payer: Galaxy Health WC |
$486.84
|
| Rate for Payer: Global Benefits Group Commercial |
$343.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$515.48
|
| Rate for Payer: InnovAge PACE Commercial |
$286.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$382.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$218.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$354.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$400.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$400.93
|
| Rate for Payer: Multiplan Commercial |
$429.56
|
| Rate for Payer: Networks By Design Commercial |
$372.29
|
| Rate for Payer: Prime Health Services Commercial |
$486.84
|
| Rate for Payer: Riverside University Health System MISP |
$229.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$343.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$343.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$286.38
|
| Rate for Payer: United Healthcare All Other HMO |
$286.38
|
| Rate for Payer: United Healthcare HMO Rider |
$286.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$286.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$486.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$486.84
|
| Rate for Payer: Vantage Medical Group Senior |
$486.84
|
|
|
HC INDR TERUMO BOKARHI KIT
|
Facility
|
IP
|
$572.75
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812421
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$114.55 |
| Max. Negotiated Rate |
$515.48 |
| Rate for Payer: Adventist Health Commercial |
$114.55
|
| Rate for Payer: Cash Price |
$257.74
|
| Rate for Payer: Central Health Plan Commercial |
$458.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$229.10
|
| Rate for Payer: EPIC Health Plan Senior |
$229.10
|
| Rate for Payer: Galaxy Health WC |
$486.84
|
| Rate for Payer: Global Benefits Group Commercial |
$343.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$515.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$382.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$218.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$354.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.55
|
| Rate for Payer: Multiplan Commercial |
$429.56
|
| Rate for Payer: Networks By Design Commercial |
$372.29
|
| Rate for Payer: Prime Health Services Commercial |
$486.84
|
|
|
HC INDR TERUMO GLIDESHEATH
|
Facility
|
OP
|
$273.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812392
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.60 |
| Max. Negotiated Rate |
$245.70 |
| Rate for Payer: Adventist Health Commercial |
$54.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$165.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$232.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$150.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$204.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$132.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$160.33
|
| Rate for Payer: Blue Shield of California Commercial |
$166.80
|
| Rate for Payer: Blue Shield of California EPN |
$108.93
|
| Rate for Payer: Cash Price |
$122.85
|
| Rate for Payer: Central Health Plan Commercial |
$218.40
|
| Rate for Payer: Cigna of CA HMO |
$174.72
|
| Rate for Payer: Cigna of CA PPO |
$202.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$232.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$232.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$232.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.20
|
| Rate for Payer: EPIC Health Plan Senior |
$109.20
|
| Rate for Payer: Galaxy Health WC |
$232.05
|
| Rate for Payer: Global Benefits Group Commercial |
$163.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$245.70
|
| Rate for Payer: InnovAge PACE Commercial |
$136.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$182.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$168.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$191.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$191.10
|
| Rate for Payer: Multiplan Commercial |
$204.75
|
| Rate for Payer: Networks By Design Commercial |
$177.45
|
| Rate for Payer: Prime Health Services Commercial |
$232.05
|
| Rate for Payer: Riverside University Health System MISP |
$109.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$163.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$163.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$136.50
|
| Rate for Payer: United Healthcare All Other HMO |
$136.50
|
| Rate for Payer: United Healthcare HMO Rider |
$136.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$136.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$232.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$232.05
|
| Rate for Payer: Vantage Medical Group Senior |
$232.05
|
|
|
HC INDR TERUMO GLIDESHEATH
|
Facility
|
IP
|
$273.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812392
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.60 |
| Max. Negotiated Rate |
$245.70 |
| Rate for Payer: Adventist Health Commercial |
$54.60
|
| Rate for Payer: Cash Price |
$122.85
|
| Rate for Payer: Central Health Plan Commercial |
$218.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.20
|
| Rate for Payer: EPIC Health Plan Senior |
$109.20
|
| Rate for Payer: Galaxy Health WC |
$232.05
|
| Rate for Payer: Global Benefits Group Commercial |
$163.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$245.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$182.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$168.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.60
|
| Rate for Payer: Multiplan Commercial |
$204.75
|
| Rate for Payer: Networks By Design Commercial |
$177.45
|
| Rate for Payer: Prime Health Services Commercial |
$232.05
|
|
|
HC INDR TERUMO PINNACLE
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812394
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Adventist Health Commercial |
$14.00
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Central Health Plan Commercial |
$56.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.00
|
| Rate for Payer: EPIC Health Plan Senior |
$28.00
|
| Rate for Payer: Galaxy Health WC |
$59.50
|
| Rate for Payer: Global Benefits Group Commercial |
$42.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.00
|
| Rate for Payer: Multiplan Commercial |
$52.50
|
| Rate for Payer: Networks By Design Commercial |
$45.50
|
| Rate for Payer: Prime Health Services Commercial |
$59.50
|
|
|
HC INDR TERUMO PINNACLE
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812394
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Adventist Health Commercial |
$14.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$42.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$59.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$52.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$33.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.11
|
| Rate for Payer: Blue Shield of California Commercial |
$42.77
|
| Rate for Payer: Blue Shield of California EPN |
$27.93
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Central Health Plan Commercial |
$56.00
|
| Rate for Payer: Cigna of CA HMO |
$44.80
|
| Rate for Payer: Cigna of CA PPO |
$51.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$59.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$59.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.00
|
| Rate for Payer: EPIC Health Plan Senior |
$28.00
|
| Rate for Payer: Galaxy Health WC |
$59.50
|
| Rate for Payer: Global Benefits Group Commercial |
$42.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.00
|
| Rate for Payer: InnovAge PACE Commercial |
$35.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$49.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.00
|
| Rate for Payer: Multiplan Commercial |
$52.50
|
| Rate for Payer: Networks By Design Commercial |
$45.50
|
| Rate for Payer: Prime Health Services Commercial |
$59.50
|
| Rate for Payer: Riverside University Health System MISP |
$28.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.00
|
| Rate for Payer: United Healthcare All Other HMO |
$35.00
|
| Rate for Payer: United Healthcare HMO Rider |
$35.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$59.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$59.50
|
| Rate for Payer: Vantage Medical Group Senior |
$59.50
|
|
|
HC INDR TERUMO PINNACLE DSTN
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812528
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$352.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$280.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$340.63
|
| Rate for Payer: Blue Shield of California Commercial |
$354.38
|
| Rate for Payer: Blue Shield of California EPN |
$231.42
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Cigna of CA HMO |
$371.20
|
| Rate for Payer: Cigna of CA PPO |
$429.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$493.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: InnovAge PACE Commercial |
$290.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$406.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Riverside University Health System MISP |
$232.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$290.00
|
| Rate for Payer: United Healthcare All Other HMO |
$290.00
|
| Rate for Payer: United Healthcare HMO Rider |
$290.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC INDR TERUMO PINNACLE DSTN
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812528
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
|
|
HC INDR TERUMO SLENDER
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812551
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Adventist Health Commercial |
$35.00
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Central Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.00
|
| Rate for Payer: EPIC Health Plan Senior |
$70.00
|
| Rate for Payer: Galaxy Health WC |
$148.75
|
| Rate for Payer: Global Benefits Group Commercial |
$105.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$157.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$116.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$108.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.00
|
| Rate for Payer: Multiplan Commercial |
$131.25
|
| Rate for Payer: Networks By Design Commercial |
$113.75
|
| Rate for Payer: Prime Health Services Commercial |
$148.75
|
|
|
HC INDR TERUMO SLENDER
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812551
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Adventist Health Commercial |
$35.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$106.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$148.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$96.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$131.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$84.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$102.78
|
| Rate for Payer: Blue Shield of California Commercial |
$106.92
|
| Rate for Payer: Blue Shield of California EPN |
$69.83
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Central Health Plan Commercial |
$140.00
|
| Rate for Payer: Cigna of CA HMO |
$112.00
|
| Rate for Payer: Cigna of CA PPO |
$129.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$148.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$148.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.00
|
| Rate for Payer: EPIC Health Plan Senior |
$70.00
|
| Rate for Payer: Galaxy Health WC |
$148.75
|
| Rate for Payer: Global Benefits Group Commercial |
$105.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$157.50
|
| Rate for Payer: InnovAge PACE Commercial |
$87.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$116.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$108.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$122.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$122.50
|
| Rate for Payer: Multiplan Commercial |
$131.25
|
| Rate for Payer: Networks By Design Commercial |
$113.75
|
| Rate for Payer: Prime Health Services Commercial |
$148.75
|
| Rate for Payer: Riverside University Health System MISP |
$70.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$105.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$105.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$87.50
|
| Rate for Payer: United Healthcare All Other HMO |
$87.50
|
| Rate for Payer: United Healthcare HMO Rider |
$87.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$87.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$148.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.75
|
| Rate for Payer: Vantage Medical Group Senior |
$148.75
|
|
|
HC IND STJ UNIVERSAL DIRECT SL II
|
Facility
|
OP
|
$2,984.00
|
|
|
Service Code
|
CPT C1893
|
| Hospital Charge Code |
906812539
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$596.80 |
| Max. Negotiated Rate |
$2,685.60 |
| Rate for Payer: Adventist Health Commercial |
$596.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,812.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,536.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,641.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,238.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,444.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,752.50
|
| Rate for Payer: Blue Shield of California Commercial |
$1,823.22
|
| Rate for Payer: Blue Shield of California EPN |
$1,190.62
|
| Rate for Payer: Cash Price |
$1,342.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,387.20
|
| Rate for Payer: Cigna of CA HMO |
$1,909.76
|
| Rate for Payer: Cigna of CA PPO |
$2,208.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,536.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,536.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,536.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,193.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,193.60
|
| Rate for Payer: Galaxy Health WC |
$2,536.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,790.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,685.60
|
| Rate for Payer: InnovAge PACE Commercial |
$1,492.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,990.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,136.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,847.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$596.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,088.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,088.80
|
| Rate for Payer: Multiplan Commercial |
$2,238.00
|
| Rate for Payer: Networks By Design Commercial |
$1,939.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,536.40
|
| Rate for Payer: Riverside University Health System MISP |
$1,193.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,790.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,790.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,492.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,492.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,492.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,492.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,536.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,536.40
|
| Rate for Payer: Vantage Medical Group Senior |
$2,536.40
|
|
|
HC IND STJ UNIVERSAL DIRECT SL II
|
Facility
|
IP
|
$2,984.00
|
|
|
Service Code
|
CPT C1893
|
| Hospital Charge Code |
906812539
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$596.80 |
| Max. Negotiated Rate |
$2,685.60 |
| Rate for Payer: Adventist Health Commercial |
$596.80
|
| Rate for Payer: Cash Price |
$1,342.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,387.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,193.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,193.60
|
| Rate for Payer: Galaxy Health WC |
$2,536.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,790.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,685.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,990.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,136.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,847.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$596.80
|
| Rate for Payer: Multiplan Commercial |
$2,238.00
|
| Rate for Payer: Networks By Design Commercial |
$1,939.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,536.40
|
|
|
HC INFANT LOWER EXT 2 VIEW
|
Facility
|
IP
|
$657.00
|
|
|
Service Code
|
CPT 73592
|
| Hospital Charge Code |
909001630
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$131.40 |
| Max. Negotiated Rate |
$591.30 |
| Rate for Payer: Adventist Health Commercial |
$131.40
|
| Rate for Payer: Cash Price |
$295.65
|
| Rate for Payer: Central Health Plan Commercial |
$525.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$262.80
|
| Rate for Payer: EPIC Health Plan Senior |
$262.80
|
| Rate for Payer: Galaxy Health WC |
$558.45
|
| Rate for Payer: Global Benefits Group Commercial |
$394.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$591.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$438.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$250.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$406.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.40
|
| Rate for Payer: Multiplan Commercial |
$492.75
|
| Rate for Payer: Networks By Design Commercial |
$427.05
|
| Rate for Payer: Prime Health Services Commercial |
$558.45
|
|
|
HC INFANT LOWER EXT 2 VIEW
|
Facility
|
OP
|
$657.00
|
|
|
Service Code
|
CPT 73592
|
| Hospital Charge Code |
909001630
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$20.83 |
| Max. Negotiated Rate |
$591.30 |
| Rate for Payer: Adventist Health Commercial |
$131.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$399.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$102.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.83
|
| Rate for Payer: Blue Shield of California Commercial |
$398.80
|
| Rate for Payer: Blue Shield of California EPN |
$260.83
|
| Rate for Payer: Cash Price |
$295.65
|
| Rate for Payer: Cash Price |
$295.65
|
| Rate for Payer: Central Health Plan Commercial |
$525.60
|
| Rate for Payer: Cigna of CA HMO |
$420.48
|
| Rate for Payer: Cigna of CA PPO |
$486.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$558.45
|
| Rate for Payer: Global Benefits Group Commercial |
$394.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$591.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$35.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: InnovAge PACE Commercial |
$167.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$438.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$149.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$492.75
|
| Rate for Payer: Networks By Design Commercial |
$427.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.88
|
| Rate for Payer: Prime Health Services Commercial |
$558.45
|
| Rate for Payer: Prime Health Services Medicare |
$118.59
|
| Rate for Payer: Riverside University Health System MISP |
$123.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$394.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$394.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC INFANT PIV KIT
|
Facility
|
OP
|
$54.12
|
|
| Hospital Charge Code |
901698468
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$48.71 |
| Rate for Payer: Adventist Health Commercial |
$10.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$26.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.78
|
| Rate for Payer: Blue Shield of California Commercial |
$33.07
|
| Rate for Payer: Blue Shield of California EPN |
$21.59
|
| Rate for Payer: Cash Price |
$24.35
|
| Rate for Payer: Central Health Plan Commercial |
$43.30
|
| Rate for Payer: Cigna of CA HMO |
$34.64
|
| Rate for Payer: Cigna of CA PPO |
$40.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$46.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$46.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.65
|
| Rate for Payer: EPIC Health Plan Senior |
$21.65
|
| Rate for Payer: Galaxy Health WC |
$46.00
|
| Rate for Payer: Global Benefits Group Commercial |
$32.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.71
|
| Rate for Payer: InnovAge PACE Commercial |
$27.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37.88
|
| Rate for Payer: Multiplan Commercial |
$40.59
|
| Rate for Payer: Networks By Design Commercial |
$35.18
|
| Rate for Payer: Prime Health Services Commercial |
$46.00
|
| Rate for Payer: Riverside University Health System MISP |
$21.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.06
|
| Rate for Payer: United Healthcare All Other HMO |
$27.06
|
| Rate for Payer: United Healthcare HMO Rider |
$27.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$46.00
|
| Rate for Payer: Vantage Medical Group Senior |
$46.00
|
|
