|
HC HYDROCOIL DETACHMENT CONTROLLE
|
Facility
IP
|
$828.00
|
|
| Hospital Charge Code |
909020029
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$165.60 |
| Max. Negotiated Rate |
$745.20 |
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Central Health Plan Commercial |
$662.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$331.20
|
| Rate for Payer: Galaxy Health WC |
$703.80
|
| Rate for Payer: Global Benefits Group Commercial |
$496.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$745.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$552.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.60
|
| Rate for Payer: Multiplan Commercial |
$621.00
|
| Rate for Payer: Networks By Design Commercial |
$538.20
|
| Rate for Payer: Prime Health Services Commercial |
$703.80
|
|
|
HC HYDROGEL 4OZ WOUND DRESSING
|
Facility
OP
|
$46.17
|
|
|
Service Code
|
CPT A6248
|
| Hospital Charge Code |
901698768
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$9.23 |
| Max. Negotiated Rate |
$42.64 |
| Rate for Payer: Aetna of CA HMO/PPO |
$42.64
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$39.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$25.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$25.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$22.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.28
|
| Rate for Payer: BCBS Transplant Transplant |
$27.70
|
| Rate for Payer: Blue Shield of California Commercial |
$29.04
|
| Rate for Payer: Blue Shield of California EPN |
$22.58
|
| Rate for Payer: Cash Price |
$20.78
|
| Rate for Payer: Cash Price |
$20.78
|
| Rate for Payer: Central Health Plan Commercial |
$36.94
|
| Rate for Payer: Cigna of CA HMO |
$29.55
|
| Rate for Payer: Cigna of CA PPO |
$34.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.47
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.47
|
| Rate for Payer: Galaxy Health WC |
$39.24
|
| Rate for Payer: Global Benefits Group Commercial |
$27.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$41.55
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$34.63
|
| Rate for Payer: IEHP medi-cal |
$16.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.23
|
| Rate for Payer: Multiplan Commercial |
$34.63
|
| Rate for Payer: Networks By Design Commercial |
$30.01
|
| Rate for Payer: Prime Health Services Commercial |
$39.24
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$27.70
|
| Rate for Payer: Riverside University Health MISP |
$18.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.08
|
| Rate for Payer: United Healthcare All Other HMO |
$23.08
|
| Rate for Payer: United Healthcare HMO Rider |
$23.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39.24
|
| Rate for Payer: Vantage Medical Group Senior |
$39.24
|
|
|
HC HYDROGEL 4OZ WOUND DRESSING
|
Facility
IP
|
$46.17
|
|
|
Service Code
|
CPT A6248
|
| Hospital Charge Code |
901698768
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$9.23 |
| Max. Negotiated Rate |
$41.55 |
| Rate for Payer: Cash Price |
$20.78
|
| Rate for Payer: Central Health Plan Commercial |
$36.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.47
|
| Rate for Payer: Galaxy Health WC |
$39.24
|
| Rate for Payer: Global Benefits Group Commercial |
$27.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$41.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.23
|
| Rate for Payer: Multiplan Commercial |
$34.63
|
| Rate for Payer: Networks By Design Commercial |
$30.01
|
| Rate for Payer: Prime Health Services Commercial |
$39.24
|
|
|
HC HYMENOTOMY, SIMPLE INCISION
|
Facility
OP
|
$8,243.00
|
|
|
Service Code
|
CPT 56442
|
| Hospital Charge Code |
900506442
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$7,418.70 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,906.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: BCBS Transplant Transplant |
$4,945.80
|
| Rate for Payer: Caremore Medicare Advantage |
$3,906.18
|
| Rate for Payer: Cash Price |
$3,709.35
|
| Rate for Payer: Cash Price |
$3,709.35
|
| Rate for Payer: Cash Price |
$3,709.35
|
| Rate for Payer: Cash Price |
$3,709.35
|
| Rate for Payer: Central Health Plan Commercial |
$6,594.40
|
| Rate for Payer: Cigna of CA PPO |
$6,099.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,859.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,273.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,906.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,906.18
|
| Rate for Payer: Galaxy Health WC |
$7,006.55
|
| Rate for Payer: Global Benefits Group Commercial |
$4,945.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,418.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6,182.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,406.14
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$3,906.18
|
| Rate for Payer: Innovage PACE Commercial |
$5,859.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,498.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,906.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,648.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,234.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,234.28
|
| Rate for Payer: Multiplan Commercial |
$6,182.25
|
| Rate for Payer: Networks By Design Commercial |
$5,357.95
|
| Rate for Payer: Prime Health Services Commercial |
$7,006.55
|
| Rate for Payer: Prime Health Services Medicare |
$4,140.55
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4,945.80
|
| Rate for Payer: Riverside University Health MISP |
$4,296.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,945.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,121.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,121.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,121.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,906.18
|
|
|
HC HYMENOTOMY, SIMPLE INCISION
|
Facility
IP
|
$8,243.00
|
|
|
Service Code
|
CPT 56442
|
| Hospital Charge Code |
900506442
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,648.60 |
| Max. Negotiated Rate |
$7,418.70 |
| Rate for Payer: Cash Price |
$3,709.35
|
| Rate for Payer: Central Health Plan Commercial |
$6,594.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,297.20
|
| Rate for Payer: Galaxy Health WC |
$7,006.55
|
| Rate for Payer: Global Benefits Group Commercial |
$4,945.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,418.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,498.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,648.60
|
| Rate for Payer: Multiplan Commercial |
$6,182.25
|
| Rate for Payer: Networks By Design Commercial |
$5,357.95
|
| Rate for Payer: Prime Health Services Commercial |
$7,006.55
|
|
|
HC HYSTEROSALPINGOGRAM
|
Facility
OP
|
$477.00
|
|
|
Service Code
|
CPT 58340
|
| Hospital Charge Code |
909000176
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$95.40 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$405.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$262.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$262.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: BCBS Transplant Transplant |
$286.20
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$214.65
|
| Rate for Payer: Cash Price |
$214.65
|
| Rate for Payer: Cash Price |
$214.65
|
| Rate for Payer: Central Health Plan Commercial |
$381.60
|
| Rate for Payer: Cigna of CA PPO |
$352.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$405.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$190.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$190.80
|
| Rate for Payer: Galaxy Health WC |
$405.45
|
| Rate for Payer: Global Benefits Group Commercial |
$286.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$429.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$357.75
|
| Rate for Payer: IEHP medi-cal |
$166.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$318.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.40
|
| Rate for Payer: Multiplan Commercial |
$357.75
|
| Rate for Payer: Networks By Design Commercial |
$310.05
|
| Rate for Payer: Prime Health Services Commercial |
$405.45
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$286.20
|
| Rate for Payer: Riverside University Health MISP |
$190.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$286.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$405.45
|
| Rate for Payer: Vantage Medical Group Senior |
$405.45
|
|
|
HC HYSTEROSALPINGOGRAM
|
Facility
IP
|
$477.00
|
|
|
Service Code
|
CPT 58340
|
| Hospital Charge Code |
909000176
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$95.40 |
| Max. Negotiated Rate |
$429.30 |
| Rate for Payer: Cash Price |
$214.65
|
| Rate for Payer: Central Health Plan Commercial |
$381.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$190.80
|
| Rate for Payer: Galaxy Health WC |
$405.45
|
| Rate for Payer: Global Benefits Group Commercial |
$286.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$429.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$318.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.40
|
| Rate for Payer: Multiplan Commercial |
$357.75
|
| Rate for Payer: Networks By Design Commercial |
$310.05
|
| Rate for Payer: Prime Health Services Commercial |
$405.45
|
|
|
HC HYSTEROSALPINGOGRAM EXAM
|
Facility
OP
|
$1,118.00
|
|
|
Service Code
|
CPT 74740
|
| Hospital Charge Code |
909001930
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$223.60 |
| Max. Negotiated Rate |
$1,006.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$306.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$340.96
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$269.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$329.05
|
| Rate for Payer: BCBS Transplant Transplant |
$670.80
|
| Rate for Payer: Blue Shield of California Commercial |
$690.92
|
| Rate for Payer: Blue Shield of California EPN |
$543.35
|
| Rate for Payer: Caremore Medicare Advantage |
$306.16
|
| Rate for Payer: Cash Price |
$503.10
|
| Rate for Payer: Cash Price |
$503.10
|
| Rate for Payer: Central Health Plan Commercial |
$894.40
|
| Rate for Payer: Cigna of CA HMO |
$715.52
|
| Rate for Payer: Cigna of CA PPO |
$827.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$413.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$306.16
|
| Rate for Payer: Galaxy Health WC |
$950.30
|
| Rate for Payer: Global Benefits Group Commercial |
$670.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,006.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$838.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$502.10
|
| Rate for Payer: IEHP medi-cal |
$505.16
|
| Rate for Payer: IEHP Medicare Advantage |
$306.16
|
| Rate for Payer: Innovage PACE Commercial |
$459.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$745.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$410.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$410.25
|
| Rate for Payer: Multiplan Commercial |
$838.50
|
| Rate for Payer: Networks By Design Commercial |
$726.70
|
| Rate for Payer: Prime Health Services Commercial |
$950.30
|
| Rate for Payer: Prime Health Services Medicare |
$324.53
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$670.80
|
| Rate for Payer: Riverside University Health MISP |
$336.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$670.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$670.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$605.23
|
| Rate for Payer: United Healthcare All Other HMO |
$605.23
|
| Rate for Payer: United Healthcare HMO Rider |
$605.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC HYSTEROSALPINGOGRAM EXAM
|
Facility
IP
|
$1,118.00
|
|
|
Service Code
|
CPT 74740
|
| Hospital Charge Code |
909001930
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$223.60 |
| Max. Negotiated Rate |
$1,006.20 |
| Rate for Payer: Cash Price |
$503.10
|
| Rate for Payer: Central Health Plan Commercial |
$894.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$447.20
|
| Rate for Payer: Galaxy Health WC |
$950.30
|
| Rate for Payer: Global Benefits Group Commercial |
$670.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,006.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$745.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.60
|
| Rate for Payer: Multiplan Commercial |
$838.50
|
| Rate for Payer: Networks By Design Commercial |
$726.70
|
| Rate for Payer: Prime Health Services Commercial |
$950.30
|
|
|
HC I-111 OXINE PER .5 MCI
|
Facility
OP
|
$1,468.00
|
|
|
Service Code
|
CPT A9547
|
| Hospital Charge Code |
909301529
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$293.60 |
| Max. Negotiated Rate |
$1,321.20 |
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,247.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$807.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$807.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$534.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$585.09
|
| Rate for Payer: BCBS Transplant Transplant |
$880.80
|
| Rate for Payer: Blue Shield of California Commercial |
$923.37
|
| Rate for Payer: Blue Shield of California EPN |
$717.85
|
| Rate for Payer: Cash Price |
$660.60
|
| Rate for Payer: Cash Price |
$660.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,174.40
|
| Rate for Payer: Cigna of CA HMO |
$1,027.60
|
| Rate for Payer: Cigna of CA PPO |
$1,027.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,247.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$587.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$587.20
|
| Rate for Payer: Galaxy Health WC |
$1,247.80
|
| Rate for Payer: Global Benefits Group Commercial |
$880.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,321.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,101.00
|
| Rate for Payer: IEHP medi-cal |
$513.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$979.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$293.60
|
| Rate for Payer: Multiplan Commercial |
$1,101.00
|
| Rate for Payer: Networks By Design Commercial |
$734.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,247.80
|
| Rate for Payer: Riverside University Health MISP |
$587.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$880.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$880.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$734.00
|
| Rate for Payer: United Healthcare All Other HMO |
$734.00
|
| Rate for Payer: United Healthcare HMO Rider |
$734.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$734.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,247.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,247.80
|
|
|
HC I-111 OXINE PER .5 MCI
|
Facility
IP
|
$1,468.00
|
|
|
Service Code
|
CPT A9547
|
| Hospital Charge Code |
909301529
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$293.60 |
| Max. Negotiated Rate |
$1,321.20 |
| Rate for Payer: Blue Shield of California Commercial |
$1,101.00
|
| Rate for Payer: Blue Shield of California EPN |
$783.91
|
| Rate for Payer: Cash Price |
$660.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,174.40
|
| Rate for Payer: Cigna of CA HMO |
$1,027.60
|
| Rate for Payer: Cigna of CA PPO |
$1,027.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$587.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$587.20
|
| Rate for Payer: Galaxy Health WC |
$1,247.80
|
| Rate for Payer: Global Benefits Group Commercial |
$880.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,321.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$979.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$293.60
|
| Rate for Payer: Multiplan Commercial |
$1,101.00
|
| Rate for Payer: Networks By Design Commercial |
$734.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,247.80
|
|
|
HC I-123 CAPSULES PER 100-999 UCI
|
Facility
IP
|
$310.00
|
|
|
Service Code
|
CPT A9516
|
| Hospital Charge Code |
909301511
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$62.00 |
| Max. Negotiated Rate |
$279.00 |
| Rate for Payer: Blue Shield of California Commercial |
$232.50
|
| Rate for Payer: Blue Shield of California EPN |
$165.54
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Central Health Plan Commercial |
$248.00
|
| Rate for Payer: Cigna of CA HMO |
$217.00
|
| Rate for Payer: Cigna of CA PPO |
$217.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$124.00
|
| Rate for Payer: Galaxy Health WC |
$263.50
|
| Rate for Payer: Global Benefits Group Commercial |
$186.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$279.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$206.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.00
|
| Rate for Payer: Multiplan Commercial |
$232.50
|
| Rate for Payer: Networks By Design Commercial |
$155.00
|
| Rate for Payer: Prime Health Services Commercial |
$263.50
|
|
|
HC I-123 CAPSULES PER 100-999 UCI
|
Facility
OP
|
$310.00
|
|
|
Service Code
|
CPT A9516
|
| Hospital Charge Code |
909301511
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$62.00 |
| Max. Negotiated Rate |
$279.00 |
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$263.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$170.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$170.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$112.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$123.61
|
| Rate for Payer: BCBS Transplant Transplant |
$186.00
|
| Rate for Payer: Blue Shield of California Commercial |
$194.99
|
| Rate for Payer: Blue Shield of California EPN |
$151.59
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Central Health Plan Commercial |
$248.00
|
| Rate for Payer: Cigna of CA HMO |
$217.00
|
| Rate for Payer: Cigna of CA PPO |
$217.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$263.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$124.00
|
| Rate for Payer: Galaxy Health WC |
$263.50
|
| Rate for Payer: Global Benefits Group Commercial |
$186.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$279.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$232.50
|
| Rate for Payer: IEHP medi-cal |
$108.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$206.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.00
|
| Rate for Payer: Multiplan Commercial |
$232.50
|
| Rate for Payer: Networks By Design Commercial |
$155.00
|
| Rate for Payer: Prime Health Services Commercial |
$263.50
|
| Rate for Payer: Riverside University Health MISP |
$124.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$186.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$186.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$155.00
|
| Rate for Payer: United Healthcare All Other HMO |
$155.00
|
| Rate for Payer: United Healthcare HMO Rider |
$155.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$155.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$263.50
|
| Rate for Payer: Vantage Medical Group Senior |
$263.50
|
|
|
HC I-125 SEED
|
Facility
OP
|
$263.00
|
|
|
Service Code
|
CPT A4648
|
| Hospital Charge Code |
909301514
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$52.60 |
| Max. Negotiated Rate |
$746.78 |
| Rate for Payer: Aetna of CA HMO/PPO |
$746.78
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$223.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$144.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$144.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$120.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$146.49
|
| Rate for Payer: BCBS Transplant Transplant |
$157.80
|
| Rate for Payer: Blue Shield of California Commercial |
$197.25
|
| Rate for Payer: Blue Shield of California EPN |
$143.07
|
| Rate for Payer: Cash Price |
$118.35
|
| Rate for Payer: Cash Price |
$118.35
|
| Rate for Payer: Central Health Plan Commercial |
$210.40
|
| Rate for Payer: Cigna of CA HMO |
$184.10
|
| Rate for Payer: Cigna of CA PPO |
$184.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$223.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$105.20
|
| Rate for Payer: Galaxy Health WC |
$223.55
|
| Rate for Payer: Global Benefits Group Commercial |
$157.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$236.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$197.25
|
| Rate for Payer: IEHP medi-cal |
$92.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$175.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.60
|
| Rate for Payer: Multiplan Commercial |
$197.25
|
| Rate for Payer: Networks By Design Commercial |
$131.50
|
| Rate for Payer: Prime Health Services Commercial |
$223.55
|
| Rate for Payer: Riverside University Health MISP |
$105.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$157.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$157.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$131.50
|
| Rate for Payer: United Healthcare All Other HMO |
$131.50
|
| Rate for Payer: United Healthcare HMO Rider |
$131.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$131.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$223.55
|
| Rate for Payer: Vantage Medical Group Senior |
$223.55
|
|
|
HC I-125 SEED
|
Facility
IP
|
$263.00
|
|
|
Service Code
|
CPT A4648
|
| Hospital Charge Code |
909301514
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$52.60 |
| Max. Negotiated Rate |
$236.70 |
| Rate for Payer: Blue Shield of California EPN |
$140.44
|
| Rate for Payer: Cash Price |
$118.35
|
| Rate for Payer: Central Health Plan Commercial |
$210.40
|
| Rate for Payer: Cigna of CA HMO |
$184.10
|
| Rate for Payer: Cigna of CA PPO |
$184.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$105.20
|
| Rate for Payer: Galaxy Health WC |
$223.55
|
| Rate for Payer: Global Benefits Group Commercial |
$157.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$236.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$175.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.60
|
| Rate for Payer: Multiplan Commercial |
$197.25
|
| Rate for Payer: Prime Health Services Commercial |
$223.55
|
|
|
HC I-125 SERUM ALBUMIN PER 5 UCI
|
Facility
IP
|
$438.00
|
|
|
Service Code
|
CPT A9532
|
| Hospital Charge Code |
909301517
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$87.60 |
| Max. Negotiated Rate |
$394.20 |
| Rate for Payer: Blue Shield of California Commercial |
$328.50
|
| Rate for Payer: Blue Shield of California EPN |
$233.89
|
| Rate for Payer: Cash Price |
$197.10
|
| Rate for Payer: Central Health Plan Commercial |
$350.40
|
| Rate for Payer: Cigna of CA HMO |
$306.60
|
| Rate for Payer: Cigna of CA PPO |
$306.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$175.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$175.20
|
| Rate for Payer: Galaxy Health WC |
$372.30
|
| Rate for Payer: Global Benefits Group Commercial |
$262.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$394.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$292.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.60
|
| Rate for Payer: Multiplan Commercial |
$328.50
|
| Rate for Payer: Networks By Design Commercial |
$219.00
|
| Rate for Payer: Prime Health Services Commercial |
$372.30
|
|
|
HC I-125 SERUM ALBUMIN PER 5 UCI
|
Facility
OP
|
$438.00
|
|
|
Service Code
|
CPT A9532
|
| Hospital Charge Code |
909301517
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.01 |
| Max. Negotiated Rate |
$394.20 |
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$372.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$240.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$240.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.95
|
| Rate for Payer: BCBS Transplant Transplant |
$262.80
|
| Rate for Payer: Blue Shield of California Commercial |
$275.50
|
| Rate for Payer: Blue Shield of California EPN |
$214.18
|
| Rate for Payer: Cash Price |
$197.10
|
| Rate for Payer: Cash Price |
$197.10
|
| Rate for Payer: Central Health Plan Commercial |
$350.40
|
| Rate for Payer: Cigna of CA HMO |
$306.60
|
| Rate for Payer: Cigna of CA PPO |
$306.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$372.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$175.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$175.20
|
| Rate for Payer: Galaxy Health WC |
$372.30
|
| Rate for Payer: Global Benefits Group Commercial |
$262.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$394.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$328.50
|
| Rate for Payer: IEHP medi-cal |
$153.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$292.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.60
|
| Rate for Payer: Multiplan Commercial |
$328.50
|
| Rate for Payer: Networks By Design Commercial |
$219.00
|
| Rate for Payer: Prime Health Services Commercial |
$372.30
|
| Rate for Payer: Riverside University Health MISP |
$175.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$262.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$262.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$219.00
|
| Rate for Payer: United Healthcare All Other HMO |
$219.00
|
| Rate for Payer: United Healthcare HMO Rider |
$219.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$219.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$372.30
|
| Rate for Payer: Vantage Medical Group Senior |
$372.30
|
|
|
HC I-131 IOBENGUANE/MIBG PER.5MCI
|
Facility
IP
|
$5,753.00
|
|
|
Service Code
|
CPT A9508
|
| Hospital Charge Code |
909301519
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,150.60 |
| Max. Negotiated Rate |
$5,177.70 |
| Rate for Payer: Blue Shield of California Commercial |
$4,314.75
|
| Rate for Payer: Blue Shield of California EPN |
$3,072.10
|
| Rate for Payer: Cash Price |
$2,588.85
|
| Rate for Payer: Central Health Plan Commercial |
$4,602.40
|
| Rate for Payer: Cigna of CA HMO |
$4,027.10
|
| Rate for Payer: Cigna of CA PPO |
$4,027.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,301.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,301.20
|
| Rate for Payer: Galaxy Health WC |
$4,890.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,451.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,177.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,837.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,150.60
|
| Rate for Payer: Multiplan Commercial |
$4,314.75
|
| Rate for Payer: Networks By Design Commercial |
$2,876.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,890.05
|
|
|
HC I-131 IOBENGUANE/MIBG PER.5MCI
|
Facility
OP
|
$5,753.00
|
|
|
Service Code
|
CPT A9508
|
| Hospital Charge Code |
909301519
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$860.47 |
| Max. Negotiated Rate |
$5,177.70 |
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,890.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,164.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,164.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$860.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$942.13
|
| Rate for Payer: BCBS Transplant Transplant |
$3,451.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,618.64
|
| Rate for Payer: Blue Shield of California EPN |
$2,813.22
|
| Rate for Payer: Cash Price |
$2,588.85
|
| Rate for Payer: Cash Price |
$2,588.85
|
| Rate for Payer: Central Health Plan Commercial |
$4,602.40
|
| Rate for Payer: Cigna of CA HMO |
$4,027.10
|
| Rate for Payer: Cigna of CA PPO |
$4,027.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,890.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,301.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,301.20
|
| Rate for Payer: Galaxy Health WC |
$4,890.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,451.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,177.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4,314.75
|
| Rate for Payer: IEHP medi-cal |
$2,013.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,837.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,150.60
|
| Rate for Payer: Multiplan Commercial |
$4,314.75
|
| Rate for Payer: Networks By Design Commercial |
$2,876.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,890.05
|
| Rate for Payer: Riverside University Health MISP |
$2,301.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,451.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,451.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,876.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,876.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,876.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,876.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,890.05
|
| Rate for Payer: Vantage Medical Group Senior |
$4,890.05
|
|
|
HC I-131 SODIUM IODIDE SOL/MCI TH
|
Facility
IP
|
$189.00
|
|
|
Service Code
|
CPT A9530
|
| Hospital Charge Code |
909301569
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$170.10 |
| Rate for Payer: Blue Shield of California Commercial |
$141.75
|
| Rate for Payer: Blue Shield of California EPN |
$100.93
|
| Rate for Payer: Cash Price |
$85.05
|
| Rate for Payer: Central Health Plan Commercial |
$151.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.60
|
| Rate for Payer: Galaxy Health WC |
$160.65
|
| Rate for Payer: Global Benefits Group Commercial |
$113.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$170.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$126.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.80
|
| Rate for Payer: Multiplan Commercial |
$141.75
|
| Rate for Payer: Networks By Design Commercial |
$122.85
|
| Rate for Payer: Prime Health Services Commercial |
$160.65
|
|
|
HC I-131 SODIUM IODIDE SOL/MCI TH
|
Facility
OP
|
$189.00
|
|
|
Service Code
|
CPT A9530
|
| Hospital Charge Code |
909301569
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$170.10 |
| Rate for Payer: Adventist Health Medi-Cal |
$20.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$129.65
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$30.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$22.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$20.40
|
| Rate for Payer: BCBS Transplant Transplant |
$113.40
|
| Rate for Payer: Blue Shield of California Commercial |
$116.80
|
| Rate for Payer: Blue Shield of California EPN |
$91.85
|
| Rate for Payer: Caremore Medicare Advantage |
$20.40
|
| Rate for Payer: Cash Price |
$85.05
|
| Rate for Payer: Cash Price |
$85.05
|
| Rate for Payer: Central Health Plan Commercial |
$151.20
|
| Rate for Payer: Cigna of CA HMO |
$120.96
|
| Rate for Payer: Cigna of CA PPO |
$139.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.54
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$20.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.40
|
| Rate for Payer: Galaxy Health WC |
$160.65
|
| Rate for Payer: Global Benefits Group Commercial |
$113.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$170.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$141.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$33.46
|
| Rate for Payer: IEHP medi-cal |
$33.66
|
| Rate for Payer: IEHP Medicare Advantage |
$20.40
|
| Rate for Payer: Innovage PACE Commercial |
$30.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$126.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.34
|
| Rate for Payer: Multiplan Commercial |
$141.75
|
| Rate for Payer: Networks By Design Commercial |
$122.85
|
| Rate for Payer: Prime Health Services Commercial |
$160.65
|
| Rate for Payer: Prime Health Services Medicare |
$21.62
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$113.40
|
| Rate for Payer: Riverside University Health MISP |
$22.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$113.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$113.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$94.50
|
| Rate for Payer: United Healthcare All Other HMO |
$94.50
|
| Rate for Payer: United Healthcare HMO Rider |
$94.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$94.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.44
|
| Rate for Payer: Vantage Medical Group Senior |
$20.40
|
|
|
HC IAP MONITORIN DEVICE
|
Facility
OP
|
$456.58
|
|
| Hospital Charge Code |
901698334
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$91.32 |
| Max. Negotiated Rate |
$410.92 |
| Rate for Payer: Aetna of CA HMO/PPO |
$277.28
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$388.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$251.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$251.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$221.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$269.75
|
| Rate for Payer: BCBS Transplant Transplant |
$273.95
|
| Rate for Payer: Blue Shield of California Commercial |
$287.19
|
| Rate for Payer: Blue Shield of California EPN |
$223.27
|
| Rate for Payer: Cash Price |
$205.46
|
| Rate for Payer: Central Health Plan Commercial |
$365.26
|
| Rate for Payer: Cigna of CA HMO |
$292.21
|
| Rate for Payer: Cigna of CA PPO |
$337.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$388.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$182.63
|
| Rate for Payer: Galaxy Health WC |
$388.09
|
| Rate for Payer: Global Benefits Group Commercial |
$273.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$410.92
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$342.44
|
| Rate for Payer: IEHP medi-cal |
$159.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$304.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.32
|
| Rate for Payer: Multiplan Commercial |
$342.44
|
| Rate for Payer: Networks By Design Commercial |
$296.78
|
| Rate for Payer: Prime Health Services Commercial |
$388.09
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$273.95
|
| Rate for Payer: Riverside University Health MISP |
$182.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$273.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$273.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$228.29
|
| Rate for Payer: United Healthcare All Other HMO |
$228.29
|
| Rate for Payer: United Healthcare HMO Rider |
$228.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$228.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$388.09
|
| Rate for Payer: Vantage Medical Group Senior |
$388.09
|
|
|
HC IAP MONITORIN DEVICE
|
Facility
IP
|
$456.58
|
|
| Hospital Charge Code |
901698334
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$91.32 |
| Max. Negotiated Rate |
$410.92 |
| Rate for Payer: Cash Price |
$205.46
|
| Rate for Payer: Central Health Plan Commercial |
$365.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.63
|
| Rate for Payer: Galaxy Health WC |
$388.09
|
| Rate for Payer: Global Benefits Group Commercial |
$273.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$410.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$304.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.32
|
| Rate for Payer: Multiplan Commercial |
$342.44
|
| Rate for Payer: Networks By Design Commercial |
$296.78
|
| Rate for Payer: Prime Health Services Commercial |
$388.09
|
|
|
HC IAP MONITORING DEVICE
|
Facility
IP
|
$544.62
|
|
| Hospital Charge Code |
901698404
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$108.92 |
| Max. Negotiated Rate |
$490.16 |
| Rate for Payer: Cash Price |
$245.08
|
| Rate for Payer: Central Health Plan Commercial |
$435.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$217.85
|
| Rate for Payer: Galaxy Health WC |
$462.93
|
| Rate for Payer: Global Benefits Group Commercial |
$326.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$490.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$363.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.92
|
| Rate for Payer: Multiplan Commercial |
$408.46
|
| Rate for Payer: Networks By Design Commercial |
$354.00
|
| Rate for Payer: Prime Health Services Commercial |
$462.93
|
|
|
HC IAP MONITORING DEVICE
|
Facility
OP
|
$544.62
|
|
| Hospital Charge Code |
901698404
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$108.92 |
| Max. Negotiated Rate |
$490.16 |
| Rate for Payer: Aetna of CA HMO/PPO |
$330.75
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$462.93
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$299.54
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$299.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$263.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$321.76
|
| Rate for Payer: BCBS Transplant Transplant |
$326.77
|
| Rate for Payer: Blue Shield of California Commercial |
$342.57
|
| Rate for Payer: Blue Shield of California EPN |
$266.32
|
| Rate for Payer: Cash Price |
$245.08
|
| Rate for Payer: Central Health Plan Commercial |
$435.70
|
| Rate for Payer: Cigna of CA HMO |
$348.56
|
| Rate for Payer: Cigna of CA PPO |
$403.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$462.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$217.85
|
| Rate for Payer: EPIC Health Plan Transplant |
$217.85
|
| Rate for Payer: Galaxy Health WC |
$462.93
|
| Rate for Payer: Global Benefits Group Commercial |
$326.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$490.16
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$408.46
|
| Rate for Payer: IEHP medi-cal |
$190.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$363.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.92
|
| Rate for Payer: Multiplan Commercial |
$408.46
|
| Rate for Payer: Networks By Design Commercial |
$354.00
|
| Rate for Payer: Prime Health Services Commercial |
$462.93
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$326.77
|
| Rate for Payer: Riverside University Health MISP |
$217.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$326.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$326.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$272.31
|
| Rate for Payer: United Healthcare All Other HMO |
$272.31
|
| Rate for Payer: United Healthcare HMO Rider |
$272.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$272.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$462.93
|
| Rate for Payer: Vantage Medical Group Senior |
$462.93
|
|
