|
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 |
$39.44
|
| Rate for Payer: Blue Shield of California Commercial |
$41.03
|
| Rate for Payer: Blue Shield of California EPN |
$26.80
|
| Rate for Payer: Cash Price |
$36.94
|
| 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: 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: InnovAge PACE Commercial |
$33.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47.01
|
| Rate for Payer: Molina Healthcare of CA 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
|
Facility
|
OP
|
$4.92
|
|
| Hospital Charge Code |
901698283
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$4.43 |
| Rate for Payer: Adventist Health Commercial |
$0.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.89
|
| Rate for Payer: Blue Shield of California Commercial |
$3.01
|
| Rate for Payer: Blue Shield of California EPN |
$1.96
|
| Rate for Payer: Cash Price |
$2.71
|
| Rate for Payer: Central Health Plan Commercial |
$3.94
|
| Rate for Payer: Cigna of CA HMO |
$3.15
|
| Rate for Payer: Cigna of CA PPO |
$3.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.97
|
| Rate for Payer: EPIC Health Plan Senior |
$1.97
|
| Rate for Payer: Galaxy Health WC |
$4.18
|
| Rate for Payer: Global Benefits Group Commercial |
$2.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.43
|
| Rate for Payer: InnovAge PACE Commercial |
$2.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.44
|
| Rate for Payer: Multiplan Commercial |
$3.69
|
| Rate for Payer: Networks By Design Commercial |
$3.20
|
| Rate for Payer: Prime Health Services Commercial |
$4.18
|
| Rate for Payer: Riverside University Health System MISP |
$1.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.46
|
| Rate for Payer: United Healthcare All Other HMO |
$2.46
|
| Rate for Payer: United Healthcare HMO Rider |
$2.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.18
|
| Rate for Payer: Vantage Medical Group Senior |
$4.18
|
|
|
HC IV START KIT
|
Facility
|
IP
|
$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: Cash Price |
$36.94
|
| Rate for Payer: Central Health Plan Commercial |
$53.73
|
| 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 Permanente of CA Commercial/Self Funded |
$44.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.43
|
| 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
|
|
|
HC IV START KIT
|
Facility
|
IP
|
$4.92
|
|
| Hospital Charge Code |
901698283
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$4.43 |
| Rate for Payer: Adventist Health Commercial |
$0.98
|
| Rate for Payer: Cash Price |
$2.71
|
| Rate for Payer: Central Health Plan Commercial |
$3.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.97
|
| Rate for Payer: EPIC Health Plan Senior |
$1.97
|
| Rate for Payer: Galaxy Health WC |
$4.18
|
| Rate for Payer: Global Benefits Group Commercial |
$2.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.98
|
| Rate for Payer: Multiplan Commercial |
$3.69
|
| Rate for Payer: Networks By Design Commercial |
$3.20
|
| Rate for Payer: Prime Health Services Commercial |
$4.18
|
|
|
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 |
$12.96
|
| Rate for Payer: Blue Shield of California Commercial |
$13.48
|
| Rate for Payer: Blue Shield of California EPN |
$8.80
|
| Rate for Payer: Cash Price |
$12.13
|
| 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: 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: InnovAge PACE Commercial |
$11.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.44
|
| Rate for Payer: Molina Healthcare of CA 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 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 |
$12.13
|
| Rate for Payer: Central Health Plan Commercial |
$17.65
|
| 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 Permanente of CA Commercial/Self Funded |
$14.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.66
|
| 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 IVU EXCRETORY
|
Facility
|
OP
|
$1,248.00
|
|
|
Service Code
|
CPT 74400
|
| Hospital Charge Code |
909001910
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$71.06 |
| Max. Negotiated Rate |
$1,123.20 |
| Rate for Payer: Adventist Health Commercial |
$249.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$226.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$757.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$350.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$71.06
|
| Rate for Payer: Blue Shield of California Commercial |
$757.54
|
| Rate for Payer: Blue Shield of California EPN |
$495.46
|
| Rate for Payer: Cash Price |
$686.40
|
| Rate for Payer: Cash Price |
$686.40
|
| 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 |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.36
|
| Rate for Payer: EPIC Health Plan Senior |
$226.19
|
| 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 |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$113.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: InnovAge PACE Commercial |
$339.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$832.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$124.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$249.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$303.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$303.09
|
| 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 |
$226.19
|
| Rate for Payer: Prime Health Services Commercial |
$1,060.80
|
| Rate for Payer: Prime Health Services Medicare |
$239.76
|
| Rate for Payer: Riverside University Health System MISP |
$248.81
|
| 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 |
$226.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
|
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 |
$686.40
|
| Rate for Payer: Central Health Plan Commercial |
$998.40
|
| 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 Permanente of CA Commercial/Self Funded |
$832.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$475.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$772.51
|
| 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 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 |
$438.35
|
| Rate for Payer: Central Health Plan Commercial |
$637.60
|
| 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 Permanente of CA Commercial/Self Funded |
$531.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$303.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$493.34
|
| 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 IVU HYPERTENSIVE
|
Facility
|
OP
|
$797.00
|
|
|
Service Code
|
CPT 74415
|
| Hospital Charge Code |
909001911
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.01 |
| Max. Negotiated Rate |
$717.30 |
| Rate for Payer: Adventist Health Commercial |
$159.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$226.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$484.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$438.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$89.01
|
| Rate for Payer: Blue Shield of California Commercial |
$483.78
|
| Rate for Payer: Blue Shield of California EPN |
$316.41
|
| Rate for Payer: Cash Price |
$438.35
|
| Rate for Payer: Cash Price |
$438.35
|
| 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 |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.36
|
| Rate for Payer: EPIC Health Plan Senior |
$226.19
|
| 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 |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$170.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: InnovAge PACE Commercial |
$339.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$531.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$188.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$303.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$303.09
|
| 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 |
$226.19
|
| Rate for Payer: Prime Health Services Commercial |
$677.45
|
| Rate for Payer: Prime Health Services Medicare |
$239.76
|
| Rate for Payer: Riverside University Health System MISP |
$248.81
|
| 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 |
$226.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
|
HC IVUS ADD'L VESSEL
|
Facility
|
IP
|
$7,928.00
|
|
|
Service Code
|
CPT 92979
|
| Hospital Charge Code |
906820035
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,585.60 |
| Max. Negotiated Rate |
$7,135.20 |
| Rate for Payer: Adventist Health Commercial |
$1,585.60
|
| Rate for Payer: Cash Price |
$4,360.40
|
| Rate for Payer: Central Health Plan Commercial |
$6,342.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,171.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,171.20
|
| Rate for Payer: Galaxy Health WC |
$6,738.80
|
| Rate for Payer: Global Benefits Group Commercial |
$4,756.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,135.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,287.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,020.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,907.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,585.60
|
| Rate for Payer: Multiplan Commercial |
$5,946.00
|
| Rate for Payer: Networks By Design Commercial |
$5,153.20
|
| Rate for Payer: Prime Health Services Commercial |
$6,738.80
|
|
|
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 |
$3,706.45
|
| Rate for Payer: Central Health Plan Commercial |
$5,391.20
|
| 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 Permanente of CA Commercial/Self Funded |
$4,494.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,567.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,171.44
|
| 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 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 |
$3,263.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,957.81
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$3,706.45
|
| Rate for Payer: Cash Price |
$3,706.45
|
| Rate for Payer: Cash Price |
$3,706.45
|
| 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: 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: InnovAge PACE Commercial |
$3,369.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,494.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$261.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,171.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,347.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,717.30
|
| Rate for Payer: Molina Healthcare of CA 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 |
$1,932.00
|
| 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 |
$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
|
OP
|
$7,928.00
|
|
|
Service Code
|
CPT 92979
|
| Hospital Charge Code |
906820035
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$237.00 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,585.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,738.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,360.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,946.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,838.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,656.11
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$4,360.40
|
| Rate for Payer: Cash Price |
$4,360.40
|
| Rate for Payer: Cash Price |
$4,360.40
|
| Rate for Payer: Central Health Plan Commercial |
$6,342.40
|
| Rate for Payer: Cigna of CA HMO |
$5,153.20
|
| Rate for Payer: Cigna of CA PPO |
$5,866.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,738.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,738.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,738.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,171.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,171.20
|
| Rate for Payer: Galaxy Health WC |
$6,738.80
|
| Rate for Payer: Global Benefits Group Commercial |
$4,756.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,135.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$237.00
|
| Rate for Payer: InnovAge PACE Commercial |
$3,964.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,287.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$261.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,907.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,585.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,549.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,549.60
|
| Rate for Payer: Multiplan Commercial |
$5,946.00
|
| Rate for Payer: Networks By Design Commercial |
$5,153.20
|
| Rate for Payer: Prime Health Services Commercial |
$6,738.80
|
| Rate for Payer: Riverside University Health System MISP |
$3,171.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,756.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,756.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| 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 |
$6,738.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,738.80
|
| Rate for Payer: Vantage Medical Group Senior |
$6,738.80
|
|
|
HC IVUS INITIAL VESSEL
|
Facility
|
IP
|
$11,144.00
|
|
|
Service Code
|
CPT 92978
|
| Hospital Charge Code |
906820034
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,228.80 |
| Max. Negotiated Rate |
$10,029.60 |
| Rate for Payer: Adventist Health Commercial |
$2,228.80
|
| Rate for Payer: Cash Price |
$6,129.20
|
| Rate for Payer: Central Health Plan Commercial |
$8,915.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,457.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,457.60
|
| Rate for Payer: Galaxy Health WC |
$9,472.40
|
| Rate for Payer: Global Benefits Group Commercial |
$6,686.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,029.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,433.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,245.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,898.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,228.80
|
| Rate for Payer: Multiplan Commercial |
$8,358.00
|
| Rate for Payer: Networks By Design Commercial |
$7,243.60
|
| Rate for Payer: Prime Health Services Commercial |
$9,472.40
|
|
|
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 |
$5,209.60
|
| Rate for Payer: Central Health Plan Commercial |
$7,577.60
|
| 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 Permanente of CA Commercial/Self Funded |
$6,317.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,608.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,863.17
|
| 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 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 |
$4,586.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,562.91
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$5,209.60
|
| Rate for Payer: Cash Price |
$5,209.60
|
| Rate for Payer: Cash Price |
$5,209.60
|
| 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: 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: InnovAge PACE Commercial |
$4,736.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,317.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$427.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,863.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,894.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,630.40
|
| Rate for Payer: Molina Healthcare of CA 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 |
$1,932.00
|
| 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
|
OP
|
$11,144.00
|
|
|
Service Code
|
CPT 92978
|
| Hospital Charge Code |
906820034
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$387.33 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$2,228.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,472.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,129.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,358.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,395.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,544.87
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$6,129.20
|
| Rate for Payer: Cash Price |
$6,129.20
|
| Rate for Payer: Cash Price |
$6,129.20
|
| Rate for Payer: Central Health Plan Commercial |
$8,915.20
|
| Rate for Payer: Cigna of CA HMO |
$7,243.60
|
| Rate for Payer: Cigna of CA PPO |
$8,246.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,472.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,472.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,472.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,457.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,457.60
|
| Rate for Payer: Galaxy Health WC |
$9,472.40
|
| Rate for Payer: Global Benefits Group Commercial |
$6,686.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,029.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$387.33
|
| Rate for Payer: InnovAge PACE Commercial |
$5,572.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,433.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$427.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,898.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,228.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,800.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,800.80
|
| Rate for Payer: Multiplan Commercial |
$8,358.00
|
| Rate for Payer: Networks By Design Commercial |
$7,243.60
|
| Rate for Payer: Prime Health Services Commercial |
$9,472.40
|
| Rate for Payer: Riverside University Health System MISP |
$4,457.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,686.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,686.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| 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 |
$9,472.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,472.40
|
| Rate for Payer: Vantage Medical Group Senior |
$9,472.40
|
|
|
HC JEJUNOSTOMY PERC
|
Facility
|
OP
|
$1,066.00
|
|
|
Service Code
|
CPT 74355
|
| Hospital Charge Code |
909001868
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$110.71 |
| Max. Negotiated Rate |
$959.40 |
| Rate for Payer: Adventist Health Commercial |
$213.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$647.38
|
| 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 |
$110.71
|
| Rate for Payer: Blue Shield of California Commercial |
$647.06
|
| Rate for Payer: Blue Shield of California EPN |
$423.20
|
| Rate for Payer: Cash Price |
$586.30
|
| Rate for Payer: Cash Price |
$586.30
|
| 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: 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: InnovAge PACE Commercial |
$533.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$711.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$195.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$659.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$746.20
|
| Rate for Payer: Molina Healthcare of CA 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 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 |
$586.30
|
| Rate for Payer: Central Health Plan Commercial |
$852.80
|
| 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 Permanente of CA Commercial/Self Funded |
$711.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$406.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$659.85
|
| 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 TUBE PLACEMENT
|
Facility
|
IP
|
$668.00
|
|
|
Service Code
|
CPT 44015
|
| Hospital Charge Code |
906744015
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$133.60 |
| Max. Negotiated Rate |
$601.20 |
| Rate for Payer: Adventist Health Commercial |
$133.60
|
| Rate for Payer: Cash Price |
$367.40
|
| Rate for Payer: Central Health Plan Commercial |
$534.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$267.20
|
| Rate for Payer: EPIC Health Plan Senior |
$267.20
|
| Rate for Payer: Galaxy Health WC |
$567.80
|
| Rate for Payer: Global Benefits Group Commercial |
$400.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$601.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$445.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$254.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$413.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.60
|
| Rate for Payer: Multiplan Commercial |
$501.00
|
| Rate for Payer: Networks By Design Commercial |
$434.20
|
| Rate for Payer: Prime Health Services Commercial |
$567.80
|
|
|
HC JEJUNOSTOMY TUBE PLACEMENT
|
Facility
|
IP
|
$668.00
|
|
|
Service Code
|
CPT 44015
|
| Hospital Charge Code |
906744015
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$133.60 |
| Max. Negotiated Rate |
$601.20 |
| Rate for Payer: Adventist Health Commercial |
$133.60
|
| Rate for Payer: Cash Price |
$367.40
|
| Rate for Payer: Central Health Plan Commercial |
$534.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$267.20
|
| Rate for Payer: EPIC Health Plan Senior |
$267.20
|
| Rate for Payer: Galaxy Health WC |
$567.80
|
| Rate for Payer: Global Benefits Group Commercial |
$400.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$601.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$445.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$254.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$413.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.60
|
| Rate for Payer: Multiplan Commercial |
$501.00
|
| Rate for Payer: Networks By Design Commercial |
$434.20
|
| Rate for Payer: Prime Health Services Commercial |
$567.80
|
|
|
HC 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: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 Medicare Advantage/Dual Product |
$501.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$367.40
|
| Rate for Payer: Cash Price |
$367.40
|
| Rate for Payer: Central Health Plan Commercial |
$534.40
|
| Rate for Payer: Cigna of CA HMO |
$427.52
|
| Rate for Payer: Cigna of CA PPO |
$494.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$567.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$567.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$567.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$267.20
|
| Rate for Payer: EPIC Health Plan Senior |
$267.20
|
| Rate for Payer: Galaxy Health WC |
$567.80
|
| Rate for Payer: Global Benefits Group Commercial |
$400.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$601.20
|
| Rate for Payer: InnovAge PACE Commercial |
$334.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$445.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$413.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$467.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$467.60
|
| Rate for Payer: Multiplan Commercial |
$501.00
|
| Rate for Payer: Networks By Design Commercial |
$434.20
|
| Rate for Payer: Prime Health Services Commercial |
$567.80
|
| Rate for Payer: Riverside University Health System MISP |
$267.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$400.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$400.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| 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 Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$567.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$567.80
|
| Rate for Payer: Vantage Medical Group Senior |
$567.80
|
|
|
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: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 Medicare Advantage/Dual Product |
$501.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$367.40
|
| Rate for Payer: Cash Price |
$367.40
|
| Rate for Payer: Central Health Plan Commercial |
$534.40
|
| Rate for Payer: Cigna of CA HMO |
$427.52
|
| Rate for Payer: Cigna of CA PPO |
$494.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$567.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$567.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$567.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$267.20
|
| Rate for Payer: EPIC Health Plan Senior |
$267.20
|
| Rate for Payer: Galaxy Health WC |
$567.80
|
| Rate for Payer: Global Benefits Group Commercial |
$400.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$601.20
|
| Rate for Payer: InnovAge PACE Commercial |
$334.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$445.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$413.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$467.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$467.60
|
| Rate for Payer: Multiplan Commercial |
$501.00
|
| Rate for Payer: Networks By Design Commercial |
$434.20
|
| Rate for Payer: Prime Health Services Commercial |
$567.80
|
| Rate for Payer: Riverside University Health System MISP |
$267.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$400.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| 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 Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$567.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$567.80
|
| Rate for Payer: Vantage Medical Group Senior |
$567.80
|
|
|
HC JO-1 AUTO AB
|
Facility
|
IP
|
$44.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913526
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.80 |
| Max. Negotiated Rate |
$39.60 |
| Rate for Payer: Adventist Health Commercial |
$8.80
|
| Rate for Payer: Cash Price |
$24.20
|
| Rate for Payer: Central Health Plan Commercial |
$35.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.60
|
| Rate for Payer: EPIC Health Plan Senior |
$17.60
|
| Rate for Payer: Galaxy Health WC |
$37.40
|
| Rate for Payer: Global Benefits Group Commercial |
$26.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.80
|
| Rate for Payer: Multiplan Commercial |
$33.00
|
| Rate for Payer: Networks By Design Commercial |
$28.60
|
| Rate for Payer: Prime Health Services Commercial |
$37.40
|
|
