|
HC NUTR THER-RE EVAL 30 MN MCAL
|
Facility
|
OP
|
$136.00
|
|
| Hospital Charge Code |
902000207
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$785.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$82.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$115.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$74.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$65.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$80.35
|
| Rate for Payer: Blue Distinction Transplant |
$81.60
|
| Rate for Payer: Blue Shield of California Commercial |
$85.54
|
| Rate for Payer: Blue Shield of California EPN |
$66.50
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Central Health Plan Commercial |
$108.80
|
| Rate for Payer: Cigna of CA HMO |
$87.04
|
| Rate for Payer: Cigna of CA PPO |
$100.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$115.60
|
| Rate for Payer: Dignity Health Media |
$115.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$115.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$54.40
|
| Rate for Payer: Galaxy Health WC |
$115.60
|
| Rate for Payer: Global Benefits Group Commercial |
$81.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$122.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$102.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$47.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$90.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.20
|
| Rate for Payer: Multiplan Commercial |
$102.00
|
| Rate for Payer: Networks By Design Commercial |
$88.40
|
| Rate for Payer: Prime Health Services Commercial |
$115.60
|
| Rate for Payer: Riverside University Health System MISP |
$54.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$602.00
|
| Rate for Payer: United Healthcare All Other HMO |
$785.00
|
| Rate for Payer: United Healthcare HMO Rider |
$593.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$115.60
|
| Rate for Payer: Vantage Medical Group Senior |
$115.60
|
|
|
HC O2/CO2 EXHALED AIR ANALYSIS RSPC
|
Facility
|
IP
|
$964.00
|
|
|
Service Code
|
CPT 94681
|
| Hospital Charge Code |
900894681
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$192.80 |
| Max. Negotiated Rate |
$867.60 |
| Rate for Payer: Cash Price |
$433.80
|
| Rate for Payer: Central Health Plan Commercial |
$771.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$385.60
|
| Rate for Payer: Galaxy Health WC |
$819.40
|
| Rate for Payer: Global Benefits Group Commercial |
$578.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$867.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$642.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$367.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$192.80
|
| Rate for Payer: Multiplan Commercial |
$723.00
|
| Rate for Payer: Networks By Design Commercial |
$626.60
|
| Rate for Payer: Prime Health Services Commercial |
$819.40
|
|
|
HC O2/CO2 EXHALED AIR ANALYSIS RSPC
|
Facility
|
OP
|
$964.00
|
|
|
Service Code
|
CPT 94681
|
| Hospital Charge Code |
900894681
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$155.80 |
| Max. Negotiated Rate |
$867.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$392.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$288.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$313.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$569.53
|
| Rate for Payer: Blue Distinction Transplant |
$578.40
|
| Rate for Payer: Blue Shield of California Commercial |
$595.75
|
| Rate for Payer: Blue Shield of California EPN |
$468.50
|
| Rate for Payer: Caremore Medicare Advantage |
$392.17
|
| Rate for Payer: Cash Price |
$433.80
|
| Rate for Payer: Cash Price |
$433.80
|
| Rate for Payer: Cash Price |
$433.80
|
| Rate for Payer: Central Health Plan Commercial |
$771.20
|
| Rate for Payer: Cigna of CA HMO |
$616.96
|
| Rate for Payer: Cigna of CA PPO |
$713.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$588.26
|
| Rate for Payer: Dignity Health Media |
$392.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$529.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$392.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$392.17
|
| Rate for Payer: Galaxy Health WC |
$819.40
|
| Rate for Payer: Global Benefits Group Commercial |
$578.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$867.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$723.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$643.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$647.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$392.17
|
| Rate for Payer: InnovAge PACE Commercial |
$588.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$642.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$155.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$392.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$192.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$525.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$525.51
|
| Rate for Payer: Multiplan Commercial |
$723.00
|
| Rate for Payer: Networks By Design Commercial |
$626.60
|
| Rate for Payer: Prime Health Services Commercial |
$819.40
|
| Rate for Payer: Prime Health Services Medicare |
$415.70
|
| Rate for Payer: Riverside University Health System MISP |
$431.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$578.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$578.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$725.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$696.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$636.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Vantage Medical Group Senior |
$392.17
|
|
|
HC O2 UPTAKE REST EXERCISE
|
Facility
|
IP
|
$542.00
|
|
|
Service Code
|
CPT 94680
|
| Hospital Charge Code |
900801032
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$108.40 |
| Max. Negotiated Rate |
$487.80 |
| Rate for Payer: Cash Price |
$243.90
|
| Rate for Payer: Central Health Plan Commercial |
$433.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$216.80
|
| Rate for Payer: Galaxy Health WC |
$460.70
|
| Rate for Payer: Global Benefits Group Commercial |
$325.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$487.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$361.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$206.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.40
|
| Rate for Payer: Multiplan Commercial |
$406.50
|
| Rate for Payer: Networks By Design Commercial |
$352.30
|
| Rate for Payer: Prime Health Services Commercial |
$460.70
|
|
|
HC O2 UPTAKE REST EXERCISE
|
Facility
|
OP
|
$542.00
|
|
|
Service Code
|
CPT 94680
|
| Hospital Charge Code |
900801032
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$77.90 |
| Max. Negotiated Rate |
$725.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$195.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$280.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$195.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$141.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$320.21
|
| Rate for Payer: Blue Distinction Transplant |
$325.20
|
| Rate for Payer: Blue Shield of California Commercial |
$334.96
|
| Rate for Payer: Blue Shield of California EPN |
$263.41
|
| Rate for Payer: Caremore Medicare Advantage |
$195.17
|
| Rate for Payer: Cash Price |
$243.90
|
| Rate for Payer: Cash Price |
$243.90
|
| Rate for Payer: Cash Price |
$243.90
|
| Rate for Payer: Central Health Plan Commercial |
$433.60
|
| Rate for Payer: Cigna of CA HMO |
$346.88
|
| Rate for Payer: Cigna of CA PPO |
$401.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$292.76
|
| Rate for Payer: Dignity Health Media |
$195.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$214.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$263.48
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$195.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$195.17
|
| Rate for Payer: Galaxy Health WC |
$460.70
|
| Rate for Payer: Global Benefits Group Commercial |
$325.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$487.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$406.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$320.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$322.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$195.17
|
| Rate for Payer: InnovAge PACE Commercial |
$292.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$361.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$195.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$261.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$261.53
|
| Rate for Payer: Multiplan Commercial |
$406.50
|
| Rate for Payer: Networks By Design Commercial |
$352.30
|
| Rate for Payer: Prime Health Services Commercial |
$460.70
|
| Rate for Payer: Prime Health Services Medicare |
$206.88
|
| Rate for Payer: Riverside University Health System MISP |
$214.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$325.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$325.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$725.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$696.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$636.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Vantage Medical Group Senior |
$195.17
|
|
|
HC OB AIRWAY PRIMARY KIT
|
Facility
|
OP
|
$4.92
|
|
| Hospital Charge Code |
901698560
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$4.43 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.91
|
| Rate for Payer: Blue Distinction Transplant |
$2.95
|
| Rate for Payer: Blue Shield of California Commercial |
$3.09
|
| Rate for Payer: Blue Shield of California EPN |
$2.41
|
| Rate for Payer: Cash Price |
$2.21
|
| Rate for Payer: Central Health Plan Commercial |
$3.94
|
| Rate for Payer: Cigna of CA HMO |
$3.15
|
| Rate for Payer: Cigna of CA PPO |
$3.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.18
|
| Rate for Payer: Dignity Health Media |
$4.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.97
|
| Rate for Payer: Galaxy Health WC |
$4.18
|
| Rate for Payer: Global Benefits Group Commercial |
$2.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.43
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.98
|
| Rate for Payer: Multiplan Commercial |
$3.69
|
| Rate for Payer: Networks By Design Commercial |
$3.20
|
| Rate for Payer: Prime Health Services Commercial |
$4.18
|
| Rate for Payer: Riverside University Health System MISP |
$1.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.46
|
| Rate for Payer: United Healthcare All Other HMO |
$2.46
|
| Rate for Payer: United Healthcare HMO Rider |
$2.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.18
|
| Rate for Payer: Vantage Medical Group Senior |
$4.18
|
|
|
HC OB AIRWAY PRIMARY KIT
|
Facility
|
IP
|
$4.92
|
|
| Hospital Charge Code |
901698560
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$4.43 |
| Rate for Payer: Cash Price |
$2.21
|
| Rate for Payer: Central Health Plan Commercial |
$3.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.97
|
| Rate for Payer: Galaxy Health WC |
$4.18
|
| Rate for Payer: Global Benefits Group Commercial |
$2.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.98
|
| Rate for Payer: Multiplan Commercial |
$3.69
|
| Rate for Payer: Networks By Design Commercial |
$3.20
|
| Rate for Payer: Prime Health Services Commercial |
$4.18
|
|
|
HC OB AIRWAY SECONDARY KIT
|
Facility
|
IP
|
$22.06
|
|
| Hospital Charge Code |
901698561
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.41 |
| Max. Negotiated Rate |
$19.85 |
| Rate for Payer: Cash Price |
$9.93
|
| Rate for Payer: Central Health Plan Commercial |
$17.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.82
|
| Rate for Payer: Galaxy Health WC |
$18.75
|
| Rate for Payer: Global Benefits Group Commercial |
$13.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.41
|
| Rate for Payer: Multiplan Commercial |
$16.54
|
| Rate for Payer: Networks By Design Commercial |
$14.34
|
| Rate for Payer: Prime Health Services Commercial |
$18.75
|
|
|
HC OB AIRWAY SECONDARY KIT
|
Facility
|
OP
|
$22.06
|
|
| Hospital Charge Code |
901698561
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.41 |
| Max. Negotiated Rate |
$19.85 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.03
|
| Rate for Payer: Blue Distinction Transplant |
$13.24
|
| Rate for Payer: Blue Shield of California Commercial |
$13.88
|
| Rate for Payer: Blue Shield of California EPN |
$10.79
|
| Rate for Payer: Cash Price |
$9.93
|
| Rate for Payer: Central Health Plan Commercial |
$17.65
|
| Rate for Payer: Cigna of CA HMO |
$14.12
|
| Rate for Payer: Cigna of CA PPO |
$16.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.75
|
| Rate for Payer: Dignity Health Media |
$18.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.82
|
| Rate for Payer: Galaxy Health WC |
$18.75
|
| Rate for Payer: Global Benefits Group Commercial |
$13.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.85
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$16.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.41
|
| Rate for Payer: Multiplan Commercial |
$16.54
|
| Rate for Payer: Networks By Design Commercial |
$14.34
|
| Rate for Payer: Prime Health Services Commercial |
$18.75
|
| Rate for Payer: Riverside University Health System MISP |
$8.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.03
|
| Rate for Payer: United Healthcare All Other HMO |
$11.03
|
| Rate for Payer: United Healthcare HMO Rider |
$11.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.75
|
| Rate for Payer: Vantage Medical Group Senior |
$18.75
|
|
|
HC OBSTETRIC PANEL
|
Facility
|
IP
|
$304.00
|
|
|
Service Code
|
CPT 80055
|
| Hospital Charge Code |
900913621
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.80 |
| Max. Negotiated Rate |
$273.60 |
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Central Health Plan Commercial |
$243.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.60
|
| Rate for Payer: Galaxy Health WC |
$258.40
|
| Rate for Payer: Global Benefits Group Commercial |
$182.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$273.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$202.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.80
|
| Rate for Payer: Multiplan Commercial |
$228.00
|
| Rate for Payer: Networks By Design Commercial |
$197.60
|
| Rate for Payer: Prime Health Services Commercial |
$258.40
|
|
|
HC OBSTETRIC PANEL
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
CPT 80055
|
| Hospital Charge Code |
900913621
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.60 |
| Max. Negotiated Rate |
$332.37 |
| Rate for Payer: Adventist Health Medi-Cal |
$47.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$332.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$71.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$47.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$119.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$146.12
|
| Rate for Payer: Blue Distinction Transplant |
$76.80
|
| Rate for Payer: Blue Shield of California Commercial |
$79.10
|
| Rate for Payer: Blue Shield of California EPN |
$62.21
|
| Rate for Payer: Caremore Medicare Advantage |
$47.81
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Central Health Plan Commercial |
$102.40
|
| Rate for Payer: Cigna of CA HMO |
$81.92
|
| Rate for Payer: Cigna of CA PPO |
$94.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$71.72
|
| Rate for Payer: Dignity Health Media |
$47.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.54
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$47.81
|
| Rate for Payer: EPIC Health Plan Transplant |
$47.81
|
| Rate for Payer: Galaxy Health WC |
$108.80
|
| Rate for Payer: Global Benefits Group Commercial |
$76.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$115.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$96.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$78.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$78.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$47.81
|
| Rate for Payer: InnovAge PACE Commercial |
$71.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$85.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$64.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$64.07
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Networks By Design Commercial |
$83.20
|
| Rate for Payer: Prime Health Services Commercial |
$108.80
|
| Rate for Payer: Prime Health Services Medicare |
$50.68
|
| Rate for Payer: Riverside University Health System MISP |
$52.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$76.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$76.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$38.73
|
| Rate for Payer: United Healthcare All Other HMO |
$38.73
|
| Rate for Payer: United Healthcare HMO Rider |
$38.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$38.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$71.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.59
|
| Rate for Payer: Vantage Medical Group Senior |
$47.81
|
|
|
HC OBTURATOR CAP, HEMOSTSIS 8FR
|
Facility
|
IP
|
$20.91
|
|
| Hospital Charge Code |
901698235
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.18 |
| Max. Negotiated Rate |
$18.82 |
| Rate for Payer: Cash Price |
$9.41
|
| Rate for Payer: Central Health Plan Commercial |
$16.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.36
|
| Rate for Payer: Galaxy Health WC |
$17.77
|
| Rate for Payer: Global Benefits Group Commercial |
$12.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.18
|
| Rate for Payer: Multiplan Commercial |
$15.68
|
| Rate for Payer: Networks By Design Commercial |
$13.59
|
| Rate for Payer: Prime Health Services Commercial |
$17.77
|
|
|
HC OBTURATOR CAP, HEMOSTSIS 8FR
|
Facility
|
OP
|
$20.91
|
|
| Hospital Charge Code |
901698235
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.18 |
| Max. Negotiated Rate |
$18.82 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.35
|
| Rate for Payer: Blue Distinction Transplant |
$12.55
|
| Rate for Payer: Blue Shield of California Commercial |
$13.15
|
| Rate for Payer: Blue Shield of California EPN |
$10.22
|
| Rate for Payer: Cash Price |
$9.41
|
| Rate for Payer: Central Health Plan Commercial |
$16.73
|
| Rate for Payer: Cigna of CA HMO |
$13.38
|
| Rate for Payer: Cigna of CA PPO |
$15.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.77
|
| Rate for Payer: Dignity Health Media |
$17.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.36
|
| Rate for Payer: Galaxy Health WC |
$17.77
|
| Rate for Payer: Global Benefits Group Commercial |
$12.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.82
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$15.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.18
|
| Rate for Payer: Multiplan Commercial |
$15.68
|
| Rate for Payer: Networks By Design Commercial |
$13.59
|
| Rate for Payer: Prime Health Services Commercial |
$17.77
|
| Rate for Payer: Riverside University Health System MISP |
$8.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.46
|
| Rate for Payer: United Healthcare All Other HMO |
$10.46
|
| Rate for Payer: United Healthcare HMO Rider |
$10.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.77
|
| Rate for Payer: Vantage Medical Group Senior |
$17.77
|
|
|
HC OB ULTRASOUND RPT/FOLLOW-UP ADDL FETUS
|
Facility
|
IP
|
$1,832.00
|
|
|
Service Code
|
CPT 76816
|
| Hospital Charge Code |
906601320
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$366.40 |
| Max. Negotiated Rate |
$1,648.80 |
| Rate for Payer: Cash Price |
$824.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,465.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$732.80
|
| Rate for Payer: Galaxy Health WC |
$1,557.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,099.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,648.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,221.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$697.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$366.40
|
| Rate for Payer: Multiplan Commercial |
$1,374.00
|
| Rate for Payer: Networks By Design Commercial |
$1,190.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,557.20
|
|
|
HC OB ULTRASOUND RPT/FOLLOW-UP ADDL FETUS
|
Facility
|
OP
|
$1,832.00
|
|
|
Service Code
|
CPT 76816
|
| Hospital Charge Code |
906601320
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$1,648.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$137.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$348.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$199.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,082.35
|
| Rate for Payer: Blue Distinction Transplant |
$1,099.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,132.18
|
| Rate for Payer: Blue Shield of California EPN |
$890.35
|
| Rate for Payer: Caremore Medicare Advantage |
$137.36
|
| Rate for Payer: Cash Price |
$824.40
|
| Rate for Payer: Cash Price |
$824.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,465.60
|
| Rate for Payer: Cigna of CA HMO |
$1,172.48
|
| Rate for Payer: Cigna of CA PPO |
$1,355.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$1,557.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,099.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,648.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,374.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$226.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: InnovAge PACE Commercial |
$206.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,221.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$196.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$366.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$1,374.00
|
| Rate for Payer: Networks By Design Commercial |
$1,190.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,557.20
|
| Rate for Payer: Prime Health Services Medicare |
$145.60
|
| Rate for Payer: Riverside University Health System MISP |
$151.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,099.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,099.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$161.07
|
| Rate for Payer: United Healthcare All Other HMO |
$161.07
|
| Rate for Payer: United Healthcare HMO Rider |
$161.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$161.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC OB ULTRASOUND RPT/FOLLOW-UP SINGLE FETUS
|
Facility
|
IP
|
$1,832.00
|
|
|
Service Code
|
CPT 76816
|
| Hospital Charge Code |
906601311
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$366.40 |
| Max. Negotiated Rate |
$1,648.80 |
| Rate for Payer: Cash Price |
$824.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,465.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$732.80
|
| Rate for Payer: Galaxy Health WC |
$1,557.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,099.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,648.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,221.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$697.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$366.40
|
| Rate for Payer: Multiplan Commercial |
$1,374.00
|
| Rate for Payer: Networks By Design Commercial |
$1,190.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,557.20
|
|
|
HC OB ULTRASOUND RPT/FOLLOW-UP SINGLE FETUS
|
Facility
|
OP
|
$1,832.00
|
|
|
Service Code
|
CPT 76816
|
| Hospital Charge Code |
906601311
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$1,648.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$137.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$348.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$199.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,082.35
|
| Rate for Payer: Blue Distinction Transplant |
$1,099.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,132.18
|
| Rate for Payer: Blue Shield of California EPN |
$890.35
|
| Rate for Payer: Caremore Medicare Advantage |
$137.36
|
| Rate for Payer: Cash Price |
$824.40
|
| Rate for Payer: Cash Price |
$824.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,465.60
|
| Rate for Payer: Cigna of CA HMO |
$1,172.48
|
| Rate for Payer: Cigna of CA PPO |
$1,355.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$1,557.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,099.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,648.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,374.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$226.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: InnovAge PACE Commercial |
$206.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,221.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$196.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$366.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$1,374.00
|
| Rate for Payer: Networks By Design Commercial |
$1,190.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,557.20
|
| Rate for Payer: Prime Health Services Medicare |
$145.60
|
| Rate for Payer: Riverside University Health System MISP |
$151.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,099.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,099.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$161.07
|
| Rate for Payer: United Healthcare All Other HMO |
$161.07
|
| Rate for Payer: United Healthcare HMO Rider |
$161.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$161.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC OB US AFI LMTD 1 OR MORE FETUS
|
Facility
|
OP
|
$1,502.00
|
|
|
Service Code
|
CPT 76815
|
| Hospital Charge Code |
910400110
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$119.60 |
| Max. Negotiated Rate |
$1,351.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$137.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$337.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$283.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$887.38
|
| Rate for Payer: Blue Distinction Transplant |
$901.20
|
| Rate for Payer: Blue Shield of California Commercial |
$928.24
|
| Rate for Payer: Blue Shield of California EPN |
$729.97
|
| Rate for Payer: Caremore Medicare Advantage |
$137.36
|
| Rate for Payer: Cash Price |
$675.90
|
| Rate for Payer: Cash Price |
$675.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,201.60
|
| Rate for Payer: Cigna of CA HMO |
$961.28
|
| Rate for Payer: Cigna of CA PPO |
$1,111.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$1,276.70
|
| Rate for Payer: Global Benefits Group Commercial |
$901.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,351.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,126.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$226.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: InnovAge PACE Commercial |
$206.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,001.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$119.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$300.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$1,126.50
|
| Rate for Payer: Networks By Design Commercial |
$976.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,276.70
|
| Rate for Payer: Prime Health Services Medicare |
$145.60
|
| Rate for Payer: Riverside University Health System MISP |
$151.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$901.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$901.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$161.07
|
| Rate for Payer: United Healthcare All Other HMO |
$161.07
|
| Rate for Payer: United Healthcare HMO Rider |
$161.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$161.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC OB US AFI LMTD 1 OR MORE FETUS
|
Facility
|
IP
|
$1,502.00
|
|
|
Service Code
|
CPT 76815
|
| Hospital Charge Code |
910400110
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$300.40 |
| Max. Negotiated Rate |
$1,351.80 |
| Rate for Payer: Cash Price |
$675.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,201.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$600.80
|
| Rate for Payer: Galaxy Health WC |
$1,276.70
|
| Rate for Payer: Global Benefits Group Commercial |
$901.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,351.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,001.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$572.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$300.40
|
| Rate for Payer: Multiplan Commercial |
$1,126.50
|
| Rate for Payer: Networks By Design Commercial |
$976.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,276.70
|
|
|
HC OCA1 81479 SOUMN
|
Facility
|
IP
|
$1,181.68
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914802
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$236.34 |
| Max. Negotiated Rate |
$1,063.51 |
| Rate for Payer: Cash Price |
$531.76
|
| Rate for Payer: Central Health Plan Commercial |
$945.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$472.67
|
| Rate for Payer: Galaxy Health WC |
$1,004.43
|
| Rate for Payer: Global Benefits Group Commercial |
$709.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,063.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$788.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$450.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$236.34
|
| Rate for Payer: Multiplan Commercial |
$886.26
|
| Rate for Payer: Networks By Design Commercial |
$768.09
|
| Rate for Payer: Prime Health Services Commercial |
$1,004.43
|
|
|
HC OCA1 81479 SOUMN
|
Facility
|
OP
|
$1,181.68
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914802
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$236.34 |
| Max. Negotiated Rate |
$1,063.51 |
| Rate for Payer: Aetna of CA HMO/PPO |
$276.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,004.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$649.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$649.92
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$572.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$698.14
|
| Rate for Payer: Blue Distinction Transplant |
$709.01
|
| Rate for Payer: Blue Shield of California Commercial |
$730.28
|
| Rate for Payer: Blue Shield of California EPN |
$574.30
|
| Rate for Payer: Cash Price |
$531.76
|
| Rate for Payer: Cash Price |
$531.76
|
| Rate for Payer: Central Health Plan Commercial |
$945.34
|
| Rate for Payer: Cigna of CA HMO |
$756.28
|
| Rate for Payer: Cigna of CA PPO |
$874.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,004.43
|
| Rate for Payer: Dignity Health Media |
$1,004.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,004.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$472.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$472.67
|
| Rate for Payer: Galaxy Health WC |
$1,004.43
|
| Rate for Payer: Global Benefits Group Commercial |
$709.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,063.51
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$886.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$413.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$788.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$236.34
|
| Rate for Payer: Multiplan Commercial |
$886.26
|
| Rate for Payer: Networks By Design Commercial |
$768.09
|
| Rate for Payer: Prime Health Services Commercial |
$1,004.43
|
| Rate for Payer: Riverside University Health System MISP |
$472.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$709.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$709.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$590.84
|
| Rate for Payer: United Healthcare All Other HMO |
$590.84
|
| Rate for Payer: United Healthcare HMO Rider |
$590.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$590.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,004.43
|
| Rate for Payer: Vantage Medical Group Senior |
$1,004.43
|
|
|
HC OCCLUSION CATHETER
|
Facility
|
OP
|
$595.00
|
|
|
Service Code
|
CPT C2628
|
| Hospital Charge Code |
909081214
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$119.00 |
| Max. Negotiated Rate |
$2,309.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,309.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$505.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$327.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$327.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$288.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$351.53
|
| Rate for Payer: Blue Distinction Transplant |
$357.00
|
| Rate for Payer: Blue Shield of California Commercial |
$374.26
|
| Rate for Payer: Blue Shield of California EPN |
$290.96
|
| Rate for Payer: Cash Price |
$267.75
|
| Rate for Payer: Cash Price |
$267.75
|
| Rate for Payer: Central Health Plan Commercial |
$476.00
|
| Rate for Payer: Cigna of CA HMO |
$380.80
|
| Rate for Payer: Cigna of CA PPO |
$440.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$505.75
|
| Rate for Payer: Dignity Health Media |
$505.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$505.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$238.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$238.00
|
| Rate for Payer: Galaxy Health WC |
$505.75
|
| Rate for Payer: Global Benefits Group Commercial |
$357.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$535.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$446.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$208.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$396.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$226.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.00
|
| Rate for Payer: Multiplan Commercial |
$446.25
|
| Rate for Payer: Networks By Design Commercial |
$386.75
|
| Rate for Payer: Prime Health Services Commercial |
$505.75
|
| Rate for Payer: Riverside University Health System MISP |
$238.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$357.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$357.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$297.50
|
| Rate for Payer: United Healthcare All Other HMO |
$297.50
|
| Rate for Payer: United Healthcare HMO Rider |
$297.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$505.75
|
| Rate for Payer: Vantage Medical Group Senior |
$505.75
|
|
|
HC OCCLUSION CATHETER
|
Facility
|
IP
|
$595.00
|
|
|
Service Code
|
CPT C2628
|
| Hospital Charge Code |
909081214
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$119.00 |
| Max. Negotiated Rate |
$535.50 |
| Rate for Payer: Cash Price |
$267.75
|
| Rate for Payer: Central Health Plan Commercial |
$476.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$238.00
|
| Rate for Payer: Galaxy Health WC |
$505.75
|
| Rate for Payer: Global Benefits Group Commercial |
$357.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$535.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$396.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$226.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.00
|
| Rate for Payer: Multiplan Commercial |
$446.25
|
| Rate for Payer: Networks By Design Commercial |
$386.75
|
| Rate for Payer: Prime Health Services Commercial |
$505.75
|
|
|
HC OCCLUSIVE DEVICE IN VEIN ART
|
Facility
|
IP
|
$1,074.00
|
|
|
Service Code
|
CPT G0269
|
| Hospital Charge Code |
906820128
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$214.80 |
| Max. Negotiated Rate |
$966.60 |
| Rate for Payer: Cash Price |
$483.30
|
| Rate for Payer: Central Health Plan Commercial |
$859.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$429.60
|
| Rate for Payer: Galaxy Health WC |
$912.90
|
| Rate for Payer: Global Benefits Group Commercial |
$644.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$966.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$716.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$409.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$214.80
|
| Rate for Payer: Multiplan Commercial |
$805.50
|
| Rate for Payer: Networks By Design Commercial |
$698.10
|
| Rate for Payer: Prime Health Services Commercial |
$912.90
|
|
|
HC OCCLUSIVE DEVICE IN VEIN ART
|
Facility
|
OP
|
$1,074.00
|
|
|
Service Code
|
CPT G0269
|
| Hospital Charge Code |
906811384
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$214.80 |
| Max. Negotiated Rate |
$16,537.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$16,537.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$912.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$590.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$590.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$644.40
|
| 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 |
$483.30
|
| Rate for Payer: Cash Price |
$483.30
|
| Rate for Payer: Cash Price |
$483.30
|
| Rate for Payer: Central Health Plan Commercial |
$859.20
|
| Rate for Payer: Cigna of CA PPO |
$794.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$912.90
|
| Rate for Payer: Dignity Health Media |
$912.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$912.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$429.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$429.60
|
| Rate for Payer: Galaxy Health WC |
$912.90
|
| Rate for Payer: Global Benefits Group Commercial |
$644.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$966.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$805.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$375.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$716.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$409.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$214.80
|
| Rate for Payer: Multiplan Commercial |
$805.50
|
| Rate for Payer: Networks By Design Commercial |
$698.10
|
| Rate for Payer: Prime Health Services Commercial |
$912.90
|
| Rate for Payer: Riverside University Health System MISP |
$429.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$644.40
|
| 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 |
$912.90
|
| Rate for Payer: Vantage Medical Group Senior |
$912.90
|
|
