|
HC OUTFLARE WEDGE
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT L3390
|
| Hospital Charge Code |
905353390
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$32.75 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Adventist Health Commercial |
$41.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$85.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$58.17
|
| Rate for Payer: Blue Shield of California Commercial |
$80.20
|
| Rate for Payer: Blue Shield of California EPN |
$50.40
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Central Health Plan Commercial |
$80.00
|
| Rate for Payer: Cigna of CA HMO |
$70.00
|
| Rate for Payer: Cigna of CA PPO |
$70.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$85.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$85.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$85.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$70.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Senior |
$40.00
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$32.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$63.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$36.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
| Rate for Payer: Networks By Design Commercial |
$50.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
| Rate for Payer: Riverside University Health System MISP |
$40.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.53
|
| Rate for Payer: United Healthcare All Other HMO |
$36.53
|
| Rate for Payer: United Healthcare HMO Rider |
$35.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$85.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$85.00
|
| Rate for Payer: Vantage Medical Group Senior |
$85.00
|
|
|
HC OVA & PARASITES, PRESERVED
|
Facility
|
OP
|
$142.00
|
|
|
Service Code
|
CPT 87177
|
| Hospital Charge Code |
900911726
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.21 |
| Max. Negotiated Rate |
$127.80 |
| Rate for Payer: Adventist Health Commercial |
$28.40
|
| Rate for Payer: Adventist Health Commercial |
$19.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$8.90
|
| Rate for Payer: Adventist Health Medi-Cal |
$8.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$65.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$65.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$64.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$64.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$89.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$89.54
|
| Rate for Payer: Blue Shield of California Commercial |
$59.85
|
| Rate for Payer: Blue Shield of California Commercial |
$89.46
|
| Rate for Payer: Blue Shield of California EPN |
$37.72
|
| Rate for Payer: Blue Shield of California EPN |
$56.37
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Central Health Plan Commercial |
$113.60
|
| Rate for Payer: Central Health Plan Commercial |
$76.00
|
| Rate for Payer: Cigna of CA HMO |
$60.80
|
| Rate for Payer: Cigna of CA HMO |
$90.88
|
| Rate for Payer: Cigna of CA PPO |
$70.30
|
| Rate for Payer: Cigna of CA PPO |
$105.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.79
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$99.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$66.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.69
|
| Rate for Payer: EPIC Health Plan Senior |
$9.79
|
| Rate for Payer: EPIC Health Plan Senior |
$9.79
|
| Rate for Payer: Galaxy Health WC |
$80.75
|
| Rate for Payer: Galaxy Health WC |
$120.70
|
| Rate for Payer: Global Benefits Group Commercial |
$57.00
|
| Rate for Payer: Global Benefits Group Commercial |
$85.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$85.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$127.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$90.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$60.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11.93
|
| Rate for Payer: Multiplan Commercial |
$71.25
|
| Rate for Payer: Multiplan Commercial |
$106.50
|
| Rate for Payer: Networks By Design Commercial |
$92.30
|
| Rate for Payer: Networks By Design Commercial |
$61.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$8.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$8.90
|
| Rate for Payer: Prime Health Services Commercial |
$80.75
|
| Rate for Payer: Prime Health Services Commercial |
$120.70
|
| Rate for Payer: Prime Health Services Medicare |
$9.43
|
| Rate for Payer: Prime Health Services Medicare |
$9.43
|
| Rate for Payer: Riverside University Health System MISP |
$9.79
|
| Rate for Payer: Riverside University Health System MISP |
$9.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$85.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$85.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.21
|
| Rate for Payer: United Healthcare All Other HMO |
$7.21
|
| Rate for Payer: United Healthcare All Other HMO |
$7.21
|
| Rate for Payer: United Healthcare HMO Rider |
$7.21
|
| Rate for Payer: United Healthcare HMO Rider |
$7.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.21
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.90
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.79
|
| Rate for Payer: Vantage Medical Group Senior |
$8.90
|
| Rate for Payer: Vantage Medical Group Senior |
$8.90
|
|
|
HC OVA & PARASITES, PRESERVED
|
Facility
|
IP
|
$142.00
|
|
|
Service Code
|
CPT 87177
|
| Hospital Charge Code |
900911726
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$28.40 |
| Max. Negotiated Rate |
$127.80 |
| Rate for Payer: Adventist Health Commercial |
$28.40
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Central Health Plan Commercial |
$113.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$99.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.80
|
| Rate for Payer: EPIC Health Plan Senior |
$56.80
|
| Rate for Payer: Galaxy Health WC |
$120.70
|
| Rate for Payer: Global Benefits Group Commercial |
$85.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$127.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$90.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$83.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.40
|
| Rate for Payer: Multiplan Commercial |
$106.50
|
| Rate for Payer: Networks By Design Commercial |
$92.30
|
| Rate for Payer: Prime Health Services Commercial |
$120.70
|
|
|
HC OVARIAN DIAGNOSTIC VENOGRAPHY
|
Facility
|
IP
|
$6,571.00
|
|
|
Service Code
|
CPT 76496
|
| Hospital Charge Code |
906811500
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,314.20 |
| Max. Negotiated Rate |
$5,913.90 |
| Rate for Payer: Adventist Health Commercial |
$1,314.20
|
| Rate for Payer: Cash Price |
$2,956.95
|
| Rate for Payer: Central Health Plan Commercial |
$5,256.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,599.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,628.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,628.40
|
| Rate for Payer: Galaxy Health WC |
$5,585.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,942.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,913.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,172.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,876.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,314.20
|
| Rate for Payer: Multiplan Commercial |
$4,928.25
|
| Rate for Payer: Networks By Design Commercial |
$4,271.15
|
| Rate for Payer: Prime Health Services Commercial |
$5,585.35
|
|
|
HC OVARIAN DIAGNOSTIC VENOGRAPHY
|
Facility
|
OP
|
$6,571.00
|
|
|
Service Code
|
CPT 76496
|
| Hospital Charge Code |
906811500
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$111.93 |
| Max. Negotiated Rate |
$5,913.90 |
| Rate for Payer: Adventist Health Commercial |
$1,314.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$530.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,181.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,822.35
|
| Rate for Payer: Blue Shield of California Commercial |
$4,139.73
|
| Rate for Payer: Blue Shield of California EPN |
$2,608.69
|
| Rate for Payer: Cash Price |
$2,956.95
|
| Rate for Payer: Cash Price |
$2,956.95
|
| Rate for Payer: Central Health Plan Commercial |
$5,256.80
|
| Rate for Payer: Cigna of CA HMO |
$4,205.44
|
| Rate for Payer: Cigna of CA PPO |
$4,862.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,599.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| Rate for Payer: Galaxy Health WC |
$5,585.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,942.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,913.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,172.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,314.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$4,928.25
|
| Rate for Payer: Networks By Design Commercial |
$4,271.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.93
|
| Rate for Payer: Prime Health Services Commercial |
$5,585.35
|
| Rate for Payer: Prime Health Services Medicare |
$118.65
|
| Rate for Payer: Riverside University Health System MISP |
$123.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,942.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,942.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$225.63
|
| Rate for Payer: United Healthcare All Other HMO |
$225.63
|
| Rate for Payer: United Healthcare HMO Rider |
$225.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$225.63
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
HC OXYGEN PER HOUR
|
Facility
|
IP
|
$30.00
|
|
| Hospital Charge Code |
900800650
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Central Health Plan Commercial |
$24.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
|
|
HC OXYGEN PER HOUR
|
Facility
|
OP
|
$29.00
|
|
| Hospital Charge Code |
900802001
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.80 |
| Max. Negotiated Rate |
$26.10 |
| Rate for Payer: Adventist Health Commercial |
$5.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.87
|
| Rate for Payer: Blue Shield of California Commercial |
$18.39
|
| Rate for Payer: Blue Shield of California EPN |
$11.57
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Central Health Plan Commercial |
$23.20
|
| Rate for Payer: Cigna of CA HMO |
$18.56
|
| Rate for Payer: Cigna of CA PPO |
$21.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.60
|
| Rate for Payer: EPIC Health Plan Senior |
$11.60
|
| Rate for Payer: Galaxy Health WC |
$24.65
|
| Rate for Payer: Global Benefits Group Commercial |
$17.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.30
|
| Rate for Payer: Multiplan Commercial |
$21.75
|
| Rate for Payer: Networks By Design Commercial |
$18.85
|
| Rate for Payer: Prime Health Services Commercial |
$24.65
|
| Rate for Payer: Riverside University Health System MISP |
$11.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.50
|
| Rate for Payer: United Healthcare All Other HMO |
$14.50
|
| Rate for Payer: United Healthcare HMO Rider |
$14.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.65
|
| Rate for Payer: Vantage Medical Group Senior |
$24.65
|
|
|
HC OXYGEN PER HOUR
|
Facility
|
IP
|
$29.00
|
|
| Hospital Charge Code |
900802001
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.80 |
| Max. Negotiated Rate |
$26.10 |
| Rate for Payer: Adventist Health Commercial |
$5.80
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Central Health Plan Commercial |
$23.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.60
|
| Rate for Payer: EPIC Health Plan Senior |
$11.60
|
| Rate for Payer: Galaxy Health WC |
$24.65
|
| Rate for Payer: Global Benefits Group Commercial |
$17.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.80
|
| Rate for Payer: Multiplan Commercial |
$21.75
|
| Rate for Payer: Networks By Design Commercial |
$18.85
|
| Rate for Payer: Prime Health Services Commercial |
$24.65
|
|
|
HC OXYGEN PER HOUR
|
Facility
|
OP
|
$30.00
|
|
| Hospital Charge Code |
900800650
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.45
|
| Rate for Payer: Blue Shield of California Commercial |
$19.02
|
| Rate for Payer: Blue Shield of California EPN |
$11.97
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Central Health Plan Commercial |
$24.00
|
| Rate for Payer: Cigna of CA HMO |
$19.20
|
| Rate for Payer: Cigna of CA PPO |
$22.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21.00
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
| Rate for Payer: Riverside University Health System MISP |
$12.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15.00
|
| Rate for Payer: United Healthcare HMO Rider |
$15.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.50
|
| Rate for Payer: Vantage Medical Group Senior |
$25.50
|
|
|
HC OXYGEN PER HOUR PACU
|
Facility
|
IP
|
$29.00
|
|
| Hospital Charge Code |
900100043
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.80 |
| Max. Negotiated Rate |
$26.10 |
| Rate for Payer: Adventist Health Commercial |
$5.80
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Central Health Plan Commercial |
$23.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.60
|
| Rate for Payer: EPIC Health Plan Senior |
$11.60
|
| Rate for Payer: Galaxy Health WC |
$24.65
|
| Rate for Payer: Global Benefits Group Commercial |
$17.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.80
|
| Rate for Payer: Multiplan Commercial |
$21.75
|
| Rate for Payer: Networks By Design Commercial |
$18.85
|
| Rate for Payer: Prime Health Services Commercial |
$24.65
|
|
|
HC OXYGEN PER HOUR PACU
|
Facility
|
OP
|
$29.00
|
|
| Hospital Charge Code |
900100043
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.80 |
| Max. Negotiated Rate |
$26.10 |
| Rate for Payer: Adventist Health Commercial |
$5.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.87
|
| Rate for Payer: Blue Shield of California Commercial |
$18.39
|
| Rate for Payer: Blue Shield of California EPN |
$11.57
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Central Health Plan Commercial |
$23.20
|
| Rate for Payer: Cigna of CA HMO |
$18.56
|
| Rate for Payer: Cigna of CA PPO |
$21.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.60
|
| Rate for Payer: EPIC Health Plan Senior |
$11.60
|
| Rate for Payer: Galaxy Health WC |
$24.65
|
| Rate for Payer: Global Benefits Group Commercial |
$17.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.30
|
| Rate for Payer: Multiplan Commercial |
$21.75
|
| Rate for Payer: Networks By Design Commercial |
$18.85
|
| Rate for Payer: Prime Health Services Commercial |
$24.65
|
| Rate for Payer: Riverside University Health System MISP |
$11.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.50
|
| Rate for Payer: United Healthcare All Other HMO |
$14.50
|
| Rate for Payer: United Healthcare HMO Rider |
$14.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.65
|
| Rate for Payer: Vantage Medical Group Senior |
$24.65
|
|
|
HC P32 CHROMIC PHOSPHATE PER MCI
|
Facility
|
IP
|
$34,181.00
|
|
|
Service Code
|
CPT A9564
|
| Hospital Charge Code |
909301556
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$6,836.20 |
| Max. Negotiated Rate |
$30,762.90 |
| Rate for Payer: Adventist Health Commercial |
$6,836.20
|
| Rate for Payer: Cash Price |
$15,381.45
|
| Rate for Payer: Central Health Plan Commercial |
$27,344.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23,926.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,672.40
|
| Rate for Payer: EPIC Health Plan Senior |
$13,672.40
|
| Rate for Payer: Galaxy Health WC |
$29,053.85
|
| Rate for Payer: Global Benefits Group Commercial |
$20,508.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$30,762.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21,704.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20,166.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,836.20
|
| Rate for Payer: Multiplan Commercial |
$25,635.75
|
| Rate for Payer: Networks By Design Commercial |
$22,217.65
|
| Rate for Payer: Prime Health Services Commercial |
$29,053.85
|
|
|
HC P32 CHROMIC PHOSPHATE PER MCI
|
Facility
|
OP
|
$34,181.00
|
|
|
Service Code
|
CPT A9564
|
| Hospital Charge Code |
909301556
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$904.07 |
| Max. Negotiated Rate |
$30,762.90 |
| Rate for Payer: Adventist Health Commercial |
$6,836.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,775.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29,053.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18,799.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25,635.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,425.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,778.99
|
| Rate for Payer: Blue Shield of California Commercial |
$21,534.03
|
| Rate for Payer: Blue Shield of California EPN |
$13,569.86
|
| Rate for Payer: Cash Price |
$15,381.45
|
| Rate for Payer: Cash Price |
$15,381.45
|
| Rate for Payer: Central Health Plan Commercial |
$27,344.80
|
| Rate for Payer: Cigna of CA HMO |
$21,875.84
|
| Rate for Payer: Cigna of CA PPO |
$25,293.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29,053.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$29,053.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29,053.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23,926.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,672.40
|
| Rate for Payer: EPIC Health Plan Senior |
$13,672.40
|
| Rate for Payer: Galaxy Health WC |
$29,053.85
|
| Rate for Payer: Global Benefits Group Commercial |
$20,508.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$30,762.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$904.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21,704.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$998.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20,166.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,836.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23,926.70
|
| Rate for Payer: Multiplan Commercial |
$25,635.75
|
| Rate for Payer: Networks By Design Commercial |
$22,217.65
|
| Rate for Payer: Prime Health Services Commercial |
$29,053.85
|
| Rate for Payer: Riverside University Health System MISP |
$13,672.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20,508.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20,508.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,090.50
|
| Rate for Payer: United Healthcare All Other HMO |
$17,090.50
|
| Rate for Payer: United Healthcare HMO Rider |
$17,090.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17,090.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29,053.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29,053.85
|
| Rate for Payer: Vantage Medical Group Senior |
$29,053.85
|
|
|
HC P32 SODIUM PHOSPHATE PER MCI
|
Facility
|
OP
|
$5,922.00
|
|
|
Service Code
|
CPT A9563
|
| Hospital Charge Code |
909301555
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$140.81 |
| Max. Negotiated Rate |
$5,329.80 |
| Rate for Payer: Adventist Health Commercial |
$1,184.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$278.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,863.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$347.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$306.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$140.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$175.72
|
| Rate for Payer: Blue Shield of California Commercial |
$3,730.86
|
| Rate for Payer: Blue Shield of California EPN |
$2,351.03
|
| Rate for Payer: Cash Price |
$2,664.90
|
| Rate for Payer: Cash Price |
$2,664.90
|
| Rate for Payer: Central Health Plan Commercial |
$4,737.60
|
| Rate for Payer: Cigna of CA HMO |
$3,790.08
|
| Rate for Payer: Cigna of CA PPO |
$4,382.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$347.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$306.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,145.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$459.10
|
| Rate for Payer: EPIC Health Plan Senior |
$306.06
|
| Rate for Payer: Galaxy Health WC |
$5,033.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,553.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,329.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$456.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$168.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$278.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,760.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$186.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$389.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,184.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$372.84
|
| Rate for Payer: Multiplan Commercial |
$4,441.50
|
| Rate for Payer: Networks By Design Commercial |
$3,849.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$278.24
|
| Rate for Payer: Prime Health Services Commercial |
$5,033.70
|
| Rate for Payer: Prime Health Services Medicare |
$294.93
|
| Rate for Payer: Riverside University Health System MISP |
$306.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,553.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,553.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,222.53
|
| Rate for Payer: United Healthcare All Other HMO |
$2,163.31
|
| Rate for Payer: United Healthcare HMO Rider |
$2,116.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,939.45
|
| Rate for Payer: Upland Medical Group Pediatric |
$278.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$347.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$306.06
|
| Rate for Payer: Vantage Medical Group Senior |
$306.06
|
|
|
HC P32 SODIUM PHOSPHATE PER MCI
|
Facility
|
IP
|
$5,922.00
|
|
|
Service Code
|
CPT A9563
|
| Hospital Charge Code |
909301555
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$1,184.40 |
| Max. Negotiated Rate |
$5,329.80 |
| Rate for Payer: Adventist Health Commercial |
$1,184.40
|
| Rate for Payer: Blue Shield of California Commercial |
$4,749.44
|
| Rate for Payer: Blue Shield of California EPN |
$2,984.69
|
| Rate for Payer: Cash Price |
$2,664.90
|
| Rate for Payer: Central Health Plan Commercial |
$4,737.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,145.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,368.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,368.80
|
| Rate for Payer: Galaxy Health WC |
$5,033.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,553.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,329.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,760.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,493.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,184.40
|
| Rate for Payer: Multiplan Commercial |
$4,441.50
|
| Rate for Payer: Networks By Design Commercial |
$3,849.30
|
| Rate for Payer: Prime Health Services Commercial |
$5,033.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,222.53
|
| Rate for Payer: United Healthcare All Other HMO |
$2,163.31
|
| Rate for Payer: United Healthcare HMO Rider |
$2,116.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,939.45
|
|
|
HC PACE ACTIVITY THERAPY, PER SESSION 45 MIN OR MORE
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G0176
|
| Hospital Charge Code |
900200013
|
|
Hospital Revenue Code
|
904
|
| Max. Negotiated Rate |
$425.14 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$425.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.00
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$60.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$66.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Riverside University Health System MISP |
$0.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC PACE ACTIVITY THERAPY, PER SESSION 45 MIN OR MORE
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G0176
|
| Hospital Charge Code |
900200013
|
|
Hospital Revenue Code
|
904
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
HC PACE INSERT EXIST MULT HC LEADS
|
Facility
|
IP
|
$22,080.00
|
|
|
Service Code
|
CPT 33221
|
| Hospital Charge Code |
906811421
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,416.00 |
| Max. Negotiated Rate |
$19,872.00 |
| Rate for Payer: Adventist Health Commercial |
$4,416.00
|
| Rate for Payer: Cash Price |
$9,936.00
|
| Rate for Payer: Central Health Plan Commercial |
$17,664.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15,456.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,832.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8,832.00
|
| Rate for Payer: Galaxy Health WC |
$18,768.00
|
| Rate for Payer: Global Benefits Group Commercial |
$13,248.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$19,872.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14,020.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13,027.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,416.00
|
| Rate for Payer: Multiplan Commercial |
$16,560.00
|
| Rate for Payer: Networks By Design Commercial |
$14,352.00
|
| Rate for Payer: Prime Health Services Commercial |
$18,768.00
|
|
|
HC PACE INSERT EXIST MULT HC LEADS
|
Facility
|
OP
|
$22,080.00
|
|
|
Service Code
|
CPT 33221
|
| Hospital Charge Code |
906811421
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$500.76 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$4,416.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$24,773.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37,160.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27,251.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24,773.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10,526.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,632.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$38,609.08
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$9,936.00
|
| Rate for Payer: Cash Price |
$9,936.00
|
| Rate for Payer: Cash Price |
$9,936.00
|
| Rate for Payer: Central Health Plan Commercial |
$17,664.00
|
| Rate for Payer: Cigna of CA HMO |
$14,131.20
|
| Rate for Payer: Cigna of CA PPO |
$16,339.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37,160.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$27,251.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24,773.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15,456.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$40,876.69
|
| Rate for Payer: EPIC Health Plan Senior |
$27,251.12
|
| Rate for Payer: Galaxy Health WC |
$18,768.00
|
| Rate for Payer: Global Benefits Group Commercial |
$13,248.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$19,872.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$40,628.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$500.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24,773.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14,020.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$553.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$34,683.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,416.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$33,196.82
|
| Rate for Payer: Multiplan Commercial |
$16,560.00
|
| Rate for Payer: Multiplan WC |
$38,609.08
|
| Rate for Payer: Networks By Design Commercial |
$14,352.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$24,773.75
|
| Rate for Payer: Preferred Health Network WC |
$39,397.02
|
| Rate for Payer: Prime Health Services Commercial |
$18,768.00
|
| Rate for Payer: Prime Health Services Medicare |
$26,260.17
|
| Rate for Payer: Prime Health Services WC |
$38,215.11
|
| Rate for Payer: Riverside University Health System MISP |
$27,251.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13,248.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,040.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$24,773.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37,160.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27,251.12
|
| Rate for Payer: Vantage Medical Group Senior |
$24,773.75
|
|
|
HC PACEMAKER INSERTION KIT
|
Facility
|
OP
|
$508.97
|
|
| Hospital Charge Code |
901698281
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.79 |
| Max. Negotiated Rate |
$458.07 |
| Rate for Payer: Adventist Health Commercial |
$101.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$309.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$432.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$279.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$381.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$246.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$296.07
|
| Rate for Payer: Blue Shield of California Commercial |
$322.69
|
| Rate for Payer: Blue Shield of California EPN |
$203.08
|
| Rate for Payer: Cash Price |
$229.04
|
| Rate for Payer: Central Health Plan Commercial |
$407.18
|
| Rate for Payer: Cigna of CA HMO |
$325.74
|
| Rate for Payer: Cigna of CA PPO |
$376.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$432.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$432.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$432.62
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$356.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$203.59
|
| Rate for Payer: EPIC Health Plan Senior |
$203.59
|
| Rate for Payer: Galaxy Health WC |
$432.62
|
| Rate for Payer: Global Benefits Group Commercial |
$305.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$458.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$323.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$184.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$300.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$356.28
|
| Rate for Payer: Multiplan Commercial |
$381.73
|
| Rate for Payer: Networks By Design Commercial |
$330.83
|
| Rate for Payer: Prime Health Services Commercial |
$432.62
|
| Rate for Payer: Riverside University Health System MISP |
$203.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$305.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$305.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$254.49
|
| Rate for Payer: United Healthcare All Other HMO |
$254.49
|
| Rate for Payer: United Healthcare HMO Rider |
$254.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$254.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$432.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$432.62
|
| Rate for Payer: Vantage Medical Group Senior |
$432.62
|
|
|
HC PACEMAKER INSERTION KIT
|
Facility
|
IP
|
$508.97
|
|
| Hospital Charge Code |
901698281
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.79 |
| Max. Negotiated Rate |
$458.07 |
| Rate for Payer: Adventist Health Commercial |
$101.79
|
| Rate for Payer: Cash Price |
$229.04
|
| Rate for Payer: Central Health Plan Commercial |
$407.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$356.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$203.59
|
| Rate for Payer: EPIC Health Plan Senior |
$203.59
|
| Rate for Payer: Galaxy Health WC |
$432.62
|
| Rate for Payer: Global Benefits Group Commercial |
$305.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$458.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$323.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$300.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.79
|
| Rate for Payer: Multiplan Commercial |
$381.73
|
| Rate for Payer: Networks By Design Commercial |
$330.83
|
| Rate for Payer: Prime Health Services Commercial |
$432.62
|
|
|
HC PACE MAKER MODEL KIT
|
Facility
|
OP
|
$265.44
|
|
| Hospital Charge Code |
901698277
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.09 |
| Max. Negotiated Rate |
$238.90 |
| Rate for Payer: Adventist Health Commercial |
$53.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$161.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$225.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$145.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$199.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$128.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$154.41
|
| Rate for Payer: Blue Shield of California Commercial |
$168.29
|
| Rate for Payer: Blue Shield of California EPN |
$105.91
|
| Rate for Payer: Cash Price |
$119.45
|
| Rate for Payer: Central Health Plan Commercial |
$212.35
|
| Rate for Payer: Cigna of CA HMO |
$169.88
|
| Rate for Payer: Cigna of CA PPO |
$196.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$225.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.62
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$185.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.18
|
| Rate for Payer: EPIC Health Plan Senior |
$106.18
|
| Rate for Payer: Galaxy Health WC |
$225.62
|
| Rate for Payer: Global Benefits Group Commercial |
$159.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$238.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$168.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$96.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$185.81
|
| Rate for Payer: Multiplan Commercial |
$199.08
|
| Rate for Payer: Networks By Design Commercial |
$172.54
|
| Rate for Payer: Prime Health Services Commercial |
$225.62
|
| Rate for Payer: Riverside University Health System MISP |
$106.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$159.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$159.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$132.72
|
| Rate for Payer: United Healthcare All Other HMO |
$132.72
|
| Rate for Payer: United Healthcare HMO Rider |
$132.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$225.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$225.62
|
| Rate for Payer: Vantage Medical Group Senior |
$225.62
|
|
|
HC PACE MAKER MODEL KIT
|
Facility
|
IP
|
$265.44
|
|
| Hospital Charge Code |
901698277
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.09 |
| Max. Negotiated Rate |
$238.90 |
| Rate for Payer: Adventist Health Commercial |
$53.09
|
| Rate for Payer: Cash Price |
$119.45
|
| Rate for Payer: Central Health Plan Commercial |
$212.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$185.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.18
|
| Rate for Payer: EPIC Health Plan Senior |
$106.18
|
| Rate for Payer: Galaxy Health WC |
$225.62
|
| Rate for Payer: Global Benefits Group Commercial |
$159.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$238.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$168.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.09
|
| Rate for Payer: Multiplan Commercial |
$199.08
|
| Rate for Payer: Networks By Design Commercial |
$172.54
|
| Rate for Payer: Prime Health Services Commercial |
$225.62
|
|
|
HC PACE MED MICRA TC SYS MC1VRO1
|
Facility
|
IP
|
$25,000.00
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
906813823
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,000.00 |
| Max. Negotiated Rate |
$22,500.00 |
| Rate for Payer: Adventist Health Commercial |
$5,000.00
|
| Rate for Payer: Blue Shield of California Commercial |
$20,050.00
|
| Rate for Payer: Blue Shield of California EPN |
$12,600.00
|
| Rate for Payer: Cash Price |
$11,250.00
|
| Rate for Payer: Central Health Plan Commercial |
$20,000.00
|
| Rate for Payer: Cigna of CA HMO |
$17,500.00
|
| Rate for Payer: Cigna of CA PPO |
$17,500.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17,500.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,000.00
|
| Rate for Payer: Galaxy Health WC |
$21,250.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,000.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,500.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15,875.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14,750.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,000.00
|
| Rate for Payer: Multiplan Commercial |
$18,750.00
|
| Rate for Payer: Networks By Design Commercial |
$12,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,250.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,382.50
|
| Rate for Payer: United Healthcare All Other HMO |
$9,132.50
|
| Rate for Payer: United Healthcare HMO Rider |
$8,935.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,187.50
|
|
|
HC PACE MED MICRA TC SYS MC1VRO1
|
Facility
|
OP
|
$25,000.00
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
906813823
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,000.00 |
| Max. Negotiated Rate |
$22,500.00 |
| Rate for Payer: Adventist Health Commercial |
$5,000.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,750.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18,750.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12,105.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,542.50
|
| Rate for Payer: Blue Shield of California Commercial |
$20,050.00
|
| Rate for Payer: Blue Shield of California EPN |
$12,600.00
|
| Rate for Payer: Cash Price |
$11,250.00
|
| Rate for Payer: Central Health Plan Commercial |
$20,000.00
|
| Rate for Payer: Cigna of CA HMO |
$17,500.00
|
| Rate for Payer: Cigna of CA PPO |
$17,500.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$21,250.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21,250.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17,500.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,000.00
|
| Rate for Payer: Galaxy Health WC |
$21,250.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,000.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,500.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15,875.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14,750.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,000.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17,500.00
|
| Rate for Payer: Multiplan Commercial |
$18,750.00
|
| Rate for Payer: Networks By Design Commercial |
$12,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,250.00
|
| Rate for Payer: Riverside University Health System MISP |
$10,000.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,000.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,382.50
|
| Rate for Payer: United Healthcare All Other HMO |
$9,132.50
|
| Rate for Payer: United Healthcare HMO Rider |
$8,935.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,187.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21,250.00
|
| Rate for Payer: Vantage Medical Group Senior |
$21,250.00
|
|
