|
HC PIV KIT W/STNDR BORE EXT SET
|
Facility
|
OP
|
$22.06
|
|
| Hospital Charge Code |
901698435
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.41 |
| Max. Negotiated Rate |
$19.85 |
| Rate for Payer: Adventist Health Commercial |
$4.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.96
|
| Rate for Payer: Blue Shield of California Commercial |
$13.48
|
| Rate for Payer: Blue Shield of California EPN |
$8.80
|
| Rate for Payer: Cash Price |
$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 Medi-Cal |
$18.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.82
|
| Rate for Payer: EPIC Health Plan Senior |
$8.82
|
| Rate for Payer: Galaxy Health WC |
$18.75
|
| Rate for Payer: Global Benefits Group Commercial |
$13.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.85
|
| Rate for Payer: InnovAge PACE Commercial |
$11.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.44
|
| Rate for Payer: Multiplan Commercial |
$16.55
|
| Rate for Payer: Networks By Design Commercial |
$14.34
|
| Rate for Payer: Prime Health Services Commercial |
$18.75
|
| Rate for Payer: Riverside University Health System MISP |
$8.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.03
|
| Rate for Payer: United Healthcare All Other HMO |
$11.03
|
| Rate for Payer: United Healthcare HMO Rider |
$11.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.75
|
| Rate for Payer: Vantage Medical Group Senior |
$18.75
|
|
|
HC PIV OUTPT START KIT
|
Facility
|
IP
|
$8.28
|
|
| Hospital Charge Code |
901698365
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.66 |
| Max. Negotiated Rate |
$7.45 |
| Rate for Payer: Adventist Health Commercial |
$1.66
|
| Rate for Payer: Cash Price |
$3.73
|
| Rate for Payer: Central Health Plan Commercial |
$6.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.31
|
| Rate for Payer: EPIC Health Plan Senior |
$3.31
|
| Rate for Payer: Galaxy Health WC |
$7.04
|
| Rate for Payer: Global Benefits Group Commercial |
$4.97
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.66
|
| Rate for Payer: Multiplan Commercial |
$6.21
|
| Rate for Payer: Networks By Design Commercial |
$5.38
|
| Rate for Payer: Prime Health Services Commercial |
$7.04
|
|
|
HC PIV OUTPT START KIT
|
Facility
|
OP
|
$8.28
|
|
| Hospital Charge Code |
901698365
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.66 |
| Max. Negotiated Rate |
$7.45 |
| Rate for Payer: Adventist Health Commercial |
$1.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.86
|
| Rate for Payer: Blue Shield of California Commercial |
$5.06
|
| Rate for Payer: Blue Shield of California EPN |
$3.30
|
| Rate for Payer: Cash Price |
$3.73
|
| Rate for Payer: Central Health Plan Commercial |
$6.62
|
| Rate for Payer: Cigna of CA HMO |
$5.30
|
| Rate for Payer: Cigna of CA PPO |
$6.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.31
|
| Rate for Payer: EPIC Health Plan Senior |
$3.31
|
| Rate for Payer: Galaxy Health WC |
$7.04
|
| Rate for Payer: Global Benefits Group Commercial |
$4.97
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.45
|
| Rate for Payer: InnovAge PACE Commercial |
$4.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.80
|
| Rate for Payer: Multiplan Commercial |
$6.21
|
| Rate for Payer: Networks By Design Commercial |
$5.38
|
| Rate for Payer: Prime Health Services Commercial |
$7.04
|
| Rate for Payer: Riverside University Health System MISP |
$3.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.97
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.14
|
| Rate for Payer: United Healthcare All Other HMO |
$4.14
|
| Rate for Payer: United Healthcare HMO Rider |
$4.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.04
|
| Rate for Payer: Vantage Medical Group Senior |
$7.04
|
|
|
HC PLACEMENT OF IVC FILTER
|
Facility
|
IP
|
$20,172.00
|
|
|
Service Code
|
CPT 37191
|
| Hospital Charge Code |
906820197
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,034.40 |
| Max. Negotiated Rate |
$18,154.80 |
| Rate for Payer: Adventist Health Commercial |
$4,034.40
|
| Rate for Payer: Cash Price |
$9,077.40
|
| Rate for Payer: Central Health Plan Commercial |
$16,137.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,068.80
|
| Rate for Payer: EPIC Health Plan Senior |
$8,068.80
|
| Rate for Payer: Galaxy Health WC |
$17,146.20
|
| Rate for Payer: Global Benefits Group Commercial |
$12,103.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$18,154.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,454.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,685.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,486.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,034.40
|
| Rate for Payer: Multiplan Commercial |
$15,129.00
|
| Rate for Payer: Networks By Design Commercial |
$13,111.80
|
| Rate for Payer: Prime Health Services Commercial |
$17,146.20
|
|
|
HC PLACEMENT OF IVC FILTER
|
Facility
|
OP
|
$23,198.00
|
|
|
Service Code
|
CPT 37191
|
| Hospital Charge Code |
909081666
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$337.46 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$4,639.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$6,868.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,868.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$10,943.70
|
| Rate for Payer: Blue Shield of California Commercial |
$4,245.30
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$10,439.10
|
| Rate for Payer: Cash Price |
$10,439.10
|
| Rate for Payer: Cash Price |
$10,439.10
|
| Rate for Payer: Central Health Plan Commercial |
$18,558.40
|
| Rate for Payer: Cigna of CA HMO |
$14,846.72
|
| Rate for Payer: Cigna of CA PPO |
$17,166.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,555.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,868.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,272.45
|
| Rate for Payer: EPIC Health Plan Senior |
$6,868.48
|
| Rate for Payer: Galaxy Health WC |
$19,718.30
|
| Rate for Payer: Global Benefits Group Commercial |
$13,918.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$20,878.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,264.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$337.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,868.48
|
| Rate for Payer: InnovAge PACE Commercial |
$10,302.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,473.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$372.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,868.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,639.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,203.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,203.76
|
| Rate for Payer: Multiplan Commercial |
$17,398.50
|
| Rate for Payer: Multiplan WC |
$10,943.70
|
| Rate for Payer: Networks By Design Commercial |
$15,078.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6,868.48
|
| Rate for Payer: Preferred Health Network WC |
$11,167.04
|
| Rate for Payer: Prime Health Services Commercial |
$19,718.30
|
| Rate for Payer: Prime Health Services Medicare |
$7,280.59
|
| Rate for Payer: Prime Health Services WC |
$10,832.03
|
| Rate for Payer: Riverside University Health System MISP |
$7,555.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13,918.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$6,868.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Vantage Medical Group Senior |
$6,868.48
|
|
|
HC PLACEMENT OF IVC FILTER
|
Facility
|
OP
|
$20,172.00
|
|
|
Service Code
|
CPT 37191
|
| Hospital Charge Code |
906820197
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$337.46 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$4,034.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$6,868.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,868.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$10,943.70
|
| Rate for Payer: Blue Shield of California Commercial |
$4,245.30
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$9,077.40
|
| Rate for Payer: Cash Price |
$9,077.40
|
| Rate for Payer: Cash Price |
$9,077.40
|
| Rate for Payer: Central Health Plan Commercial |
$16,137.60
|
| Rate for Payer: Cigna of CA HMO |
$12,910.08
|
| Rate for Payer: Cigna of CA PPO |
$14,927.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,555.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,868.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,272.45
|
| Rate for Payer: EPIC Health Plan Senior |
$6,868.48
|
| Rate for Payer: Galaxy Health WC |
$17,146.20
|
| Rate for Payer: Global Benefits Group Commercial |
$12,103.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$18,154.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,264.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$337.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,868.48
|
| Rate for Payer: InnovAge PACE Commercial |
$10,302.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,454.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$372.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,868.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,034.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,203.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,203.76
|
| Rate for Payer: Multiplan Commercial |
$15,129.00
|
| Rate for Payer: Multiplan WC |
$10,943.70
|
| Rate for Payer: Networks By Design Commercial |
$13,111.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6,868.48
|
| Rate for Payer: Preferred Health Network WC |
$11,167.04
|
| Rate for Payer: Prime Health Services Commercial |
$17,146.20
|
| Rate for Payer: Prime Health Services Medicare |
$7,280.59
|
| Rate for Payer: Prime Health Services WC |
$10,832.03
|
| Rate for Payer: Riverside University Health System MISP |
$7,555.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12,103.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$6,868.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Vantage Medical Group Senior |
$6,868.48
|
|
|
HC PLACEMENT OF IVC FILTER
|
Facility
|
IP
|
$23,198.00
|
|
|
Service Code
|
CPT 37191
|
| Hospital Charge Code |
909081666
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,639.60 |
| Max. Negotiated Rate |
$20,878.20 |
| Rate for Payer: Adventist Health Commercial |
$4,639.60
|
| Rate for Payer: Cash Price |
$10,439.10
|
| Rate for Payer: Central Health Plan Commercial |
$18,558.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,279.20
|
| Rate for Payer: EPIC Health Plan Senior |
$9,279.20
|
| Rate for Payer: Galaxy Health WC |
$19,718.30
|
| Rate for Payer: Global Benefits Group Commercial |
$13,918.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$20,878.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,473.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,838.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,359.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,639.60
|
| Rate for Payer: Multiplan Commercial |
$17,398.50
|
| Rate for Payer: Networks By Design Commercial |
$15,078.70
|
| Rate for Payer: Prime Health Services Commercial |
$19,718.30
|
|
|
HC PLACENTAL ALPHA MICROGLOB-1POC
|
Facility
|
IP
|
$960.00
|
|
|
Service Code
|
CPT 84112
|
| Hospital Charge Code |
900912139
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$192.00 |
| Max. Negotiated Rate |
$864.00 |
| Rate for Payer: Adventist Health Commercial |
$192.00
|
| Rate for Payer: Cash Price |
$432.00
|
| Rate for Payer: Central Health Plan Commercial |
$768.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$384.00
|
| Rate for Payer: EPIC Health Plan Senior |
$384.00
|
| Rate for Payer: Galaxy Health WC |
$816.00
|
| Rate for Payer: Global Benefits Group Commercial |
$576.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$864.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$640.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$365.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$594.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$192.00
|
| Rate for Payer: Multiplan Commercial |
$720.00
|
| Rate for Payer: Networks By Design Commercial |
$624.00
|
| Rate for Payer: Prime Health Services Commercial |
$816.00
|
|
|
HC PLACENTAL ALPHA MICROGLOB-1POC
|
Facility
|
OP
|
$272.00
|
|
|
Service Code
|
CPT 84112
|
| Hospital Charge Code |
900912139
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$54.40 |
| Max. Negotiated Rate |
$371.54 |
| Rate for Payer: Adventist Health Commercial |
$54.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$98.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$165.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$147.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$107.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$98.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$371.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$75.40
|
| Rate for Payer: Blue Shield of California Commercial |
$165.10
|
| Rate for Payer: Blue Shield of California EPN |
$107.98
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Central Health Plan Commercial |
$217.60
|
| Rate for Payer: Cigna of CA HMO |
$174.08
|
| Rate for Payer: Cigna of CA PPO |
$201.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$147.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$107.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$98.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$132.45
|
| Rate for Payer: EPIC Health Plan Senior |
$98.11
|
| Rate for Payer: Galaxy Health WC |
$231.20
|
| Rate for Payer: Global Benefits Group Commercial |
$163.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$244.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$160.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$98.11
|
| Rate for Payer: InnovAge PACE Commercial |
$147.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$181.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$103.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$98.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$131.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$131.47
|
| Rate for Payer: Multiplan Commercial |
$204.00
|
| Rate for Payer: Networks By Design Commercial |
$176.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$98.11
|
| Rate for Payer: Prime Health Services Commercial |
$231.20
|
| Rate for Payer: Prime Health Services Medicare |
$104.00
|
| Rate for Payer: Riverside University Health System MISP |
$107.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$163.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$163.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$79.47
|
| Rate for Payer: United Healthcare All Other HMO |
$79.47
|
| Rate for Payer: United Healthcare HMO Rider |
$79.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$79.47
|
| Rate for Payer: Upland Medical Group Pediatric |
$98.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$147.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$107.92
|
| Rate for Payer: Vantage Medical Group Senior |
$98.11
|
|
|
HC PLASMA IRON TURNOVER
|
Facility
|
OP
|
$1,047.00
|
|
| Hospital Charge Code |
909301337
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$209.40 |
| Max. Negotiated Rate |
$942.30 |
| Rate for Payer: Adventist Health Commercial |
$209.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$635.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$889.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$785.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$506.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$614.90
|
| Rate for Payer: Blue Shield of California Commercial |
$635.53
|
| Rate for Payer: Blue Shield of California EPN |
$415.66
|
| Rate for Payer: Cash Price |
$471.15
|
| Rate for Payer: Central Health Plan Commercial |
$837.60
|
| Rate for Payer: Cigna of CA HMO |
$670.08
|
| Rate for Payer: Cigna of CA PPO |
$774.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$889.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$889.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$889.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$418.80
|
| Rate for Payer: EPIC Health Plan Senior |
$418.80
|
| Rate for Payer: Galaxy Health WC |
$889.95
|
| Rate for Payer: Global Benefits Group Commercial |
$628.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$942.30
|
| Rate for Payer: InnovAge PACE Commercial |
$523.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$698.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$398.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$648.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$209.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$732.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$732.90
|
| Rate for Payer: Multiplan Commercial |
$785.25
|
| Rate for Payer: Networks By Design Commercial |
$680.55
|
| Rate for Payer: Prime Health Services Commercial |
$889.95
|
| Rate for Payer: Riverside University Health System MISP |
$418.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$628.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$628.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$523.50
|
| Rate for Payer: United Healthcare All Other HMO |
$523.50
|
| Rate for Payer: United Healthcare HMO Rider |
$523.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$523.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$889.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$889.95
|
| Rate for Payer: Vantage Medical Group Senior |
$889.95
|
|
|
HC PLASMA IRON TURNOVER
|
Facility
|
IP
|
$1,047.00
|
|
| Hospital Charge Code |
909301337
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$209.40 |
| Max. Negotiated Rate |
$942.30 |
| Rate for Payer: Adventist Health Commercial |
$209.40
|
| Rate for Payer: Cash Price |
$471.15
|
| Rate for Payer: Central Health Plan Commercial |
$837.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$418.80
|
| Rate for Payer: EPIC Health Plan Senior |
$418.80
|
| Rate for Payer: Galaxy Health WC |
$889.95
|
| Rate for Payer: Global Benefits Group Commercial |
$628.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$942.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$698.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$398.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$648.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$209.40
|
| Rate for Payer: Multiplan Commercial |
$785.25
|
| Rate for Payer: Networks By Design Commercial |
$680.55
|
| Rate for Payer: Prime Health Services Commercial |
$889.95
|
|
|
HC PLASTIC REPAIR OF CANALICULI
|
Facility
|
IP
|
$10,307.00
|
|
|
Service Code
|
CPT 68700
|
| Hospital Charge Code |
900501395
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$2,061.40 |
| Max. Negotiated Rate |
$9,276.30 |
| Rate for Payer: Adventist Health Commercial |
$2,061.40
|
| Rate for Payer: Cash Price |
$4,638.15
|
| Rate for Payer: Central Health Plan Commercial |
$8,245.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,122.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,122.80
|
| Rate for Payer: Galaxy Health WC |
$8,760.95
|
| Rate for Payer: Global Benefits Group Commercial |
$6,184.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,276.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,874.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,926.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,380.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,061.40
|
| Rate for Payer: Multiplan Commercial |
$7,730.25
|
| Rate for Payer: Networks By Design Commercial |
$6,699.55
|
| Rate for Payer: Prime Health Services Commercial |
$8,760.95
|
|
|
HC PLASTIC REPAIR OF CANALICULI
|
Facility
|
IP
|
$10,307.00
|
|
|
Service Code
|
CPT 68700
|
| Hospital Charge Code |
900501395
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,061.40 |
| Max. Negotiated Rate |
$9,276.30 |
| Rate for Payer: Adventist Health Commercial |
$2,061.40
|
| Rate for Payer: Cash Price |
$4,638.15
|
| Rate for Payer: Central Health Plan Commercial |
$8,245.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,122.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,122.80
|
| Rate for Payer: Galaxy Health WC |
$8,760.95
|
| Rate for Payer: Global Benefits Group Commercial |
$6,184.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,276.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,874.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,926.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,380.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,061.40
|
| Rate for Payer: Multiplan Commercial |
$7,730.25
|
| Rate for Payer: Networks By Design Commercial |
$6,699.55
|
| Rate for Payer: Prime Health Services Commercial |
$8,760.95
|
|
|
HC PLASTIC REPAIR OF CANALICULI
|
Facility
|
OP
|
$10,307.00
|
|
|
Service Code
|
CPT 68700
|
| Hospital Charge Code |
900501395
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$9,276.30 |
| Rate for Payer: Adventist Health Commercial |
$4,225.87
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,446.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,260.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,964.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$4,723.01
|
| Rate for Payer: Cash Price |
$4,638.15
|
| Rate for Payer: Cash Price |
$4,638.15
|
| Rate for Payer: Cash Price |
$4,638.15
|
| Rate for Payer: Cash Price |
$4,638.15
|
| Rate for Payer: Central Health Plan Commercial |
$8,245.60
|
| Rate for Payer: Cigna of CA HMO |
$6,596.48
|
| Rate for Payer: Cigna of CA PPO |
$7,627.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,446.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,260.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,964.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,001.75
|
| Rate for Payer: EPIC Health Plan Senior |
$2,964.26
|
| Rate for Payer: Galaxy Health WC |
$8,760.95
|
| Rate for Payer: Global Benefits Group Commercial |
$6,184.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,276.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,861.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,964.26
|
| Rate for Payer: InnovAge PACE Commercial |
$4,446.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,874.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,576.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,964.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,061.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,972.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,972.11
|
| Rate for Payer: Multiplan Commercial |
$7,730.25
|
| Rate for Payer: Multiplan WC |
$4,723.01
|
| Rate for Payer: Networks By Design Commercial |
$6,699.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,964.26
|
| Rate for Payer: Preferred Health Network WC |
$4,819.40
|
| Rate for Payer: Prime Health Services Commercial |
$8,760.95
|
| Rate for Payer: Prime Health Services Medicare |
$3,142.12
|
| Rate for Payer: Prime Health Services WC |
$4,674.82
|
| Rate for Payer: Riverside University Health System MISP |
$3,260.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,184.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,184.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,964.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,446.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,260.69
|
| Rate for Payer: Vantage Medical Group Senior |
$2,964.26
|
|
|
HC PLASTIC REPAIR OF CANALICULI
|
Facility
|
OP
|
$10,307.00
|
|
|
Service Code
|
CPT 68700
|
| Hospital Charge Code |
900501395
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$9,276.30 |
| Rate for Payer: Adventist Health Commercial |
$2,061.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,446.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,260.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,964.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$4,723.01
|
| Rate for Payer: Cash Price |
$4,638.15
|
| Rate for Payer: Cash Price |
$4,638.15
|
| Rate for Payer: Cash Price |
$4,638.15
|
| Rate for Payer: Cash Price |
$4,638.15
|
| Rate for Payer: Central Health Plan Commercial |
$8,245.60
|
| Rate for Payer: Cigna of CA HMO |
$6,596.48
|
| Rate for Payer: Cigna of CA PPO |
$7,627.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,446.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,260.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,964.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,001.75
|
| Rate for Payer: EPIC Health Plan Senior |
$2,964.26
|
| Rate for Payer: Galaxy Health WC |
$8,760.95
|
| Rate for Payer: Global Benefits Group Commercial |
$6,184.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,276.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,861.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,964.26
|
| Rate for Payer: InnovAge PACE Commercial |
$4,446.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,874.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,576.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,964.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,061.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,972.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,972.11
|
| Rate for Payer: Multiplan Commercial |
$7,730.25
|
| Rate for Payer: Multiplan WC |
$4,723.01
|
| Rate for Payer: Networks By Design Commercial |
$6,699.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,964.26
|
| Rate for Payer: Preferred Health Network WC |
$4,819.40
|
| Rate for Payer: Prime Health Services Commercial |
$8,760.95
|
| Rate for Payer: Prime Health Services Medicare |
$3,142.12
|
| Rate for Payer: Prime Health Services WC |
$4,674.82
|
| Rate for Payer: Riverside University Health System MISP |
$3,260.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,184.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,153.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5,153.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5,153.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,153.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,964.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,446.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,260.69
|
| Rate for Payer: Vantage Medical Group Senior |
$2,964.26
|
|
|
HC PLASTY BALLOON/ACCENT
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909081210
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Adventist Health Commercial |
$60.00
|
| Rate for Payer: Blue Shield of California Commercial |
$231.90
|
| Rate for Payer: Blue Shield of California EPN |
$151.20
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Central Health Plan Commercial |
$240.00
|
| Rate for Payer: Cigna of CA HMO |
$210.00
|
| Rate for Payer: Cigna of CA PPO |
$210.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.00
|
| Rate for Payer: EPIC Health Plan Senior |
$120.00
|
| Rate for Payer: Galaxy Health WC |
$255.00
|
| Rate for Payer: Global Benefits Group Commercial |
$180.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$270.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$200.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$185.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Multiplan Commercial |
$225.00
|
| Rate for Payer: Networks By Design Commercial |
$150.00
|
| Rate for Payer: Prime Health Services Commercial |
$255.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$112.59
|
| Rate for Payer: United Healthcare All Other HMO |
$109.59
|
| Rate for Payer: United Healthcare HMO Rider |
$107.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$98.25
|
|
|
HC PLASTY BALLOON/ACCENT
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909081210
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Adventist Health Commercial |
$60.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$255.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$165.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$136.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$166.11
|
| Rate for Payer: Blue Shield of California Commercial |
$231.90
|
| Rate for Payer: Blue Shield of California EPN |
$151.20
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Central Health Plan Commercial |
$240.00
|
| Rate for Payer: Cigna of CA HMO |
$210.00
|
| Rate for Payer: Cigna of CA PPO |
$210.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$255.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$255.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$255.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.00
|
| Rate for Payer: EPIC Health Plan Senior |
$120.00
|
| Rate for Payer: Galaxy Health WC |
$255.00
|
| Rate for Payer: Global Benefits Group Commercial |
$180.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$270.00
|
| Rate for Payer: InnovAge PACE Commercial |
$150.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$200.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$185.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$210.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$210.00
|
| Rate for Payer: Multiplan Commercial |
$225.00
|
| Rate for Payer: Networks By Design Commercial |
$150.00
|
| Rate for Payer: Prime Health Services Commercial |
$255.00
|
| Rate for Payer: Riverside University Health System MISP |
$120.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$180.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$180.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$112.59
|
| Rate for Payer: United Healthcare All Other HMO |
$109.59
|
| Rate for Payer: United Healthcare HMO Rider |
$107.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$98.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$255.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$255.00
|
| Rate for Payer: Vantage Medical Group Senior |
$255.00
|
|
|
HC PLASTY BALLOON/LP/PF+ CORDIS
|
Facility
|
OP
|
$720.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909081212
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$144.00 |
| Max. Negotiated Rate |
$648.00 |
| Rate for Payer: Adventist Health Commercial |
$144.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$612.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$396.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$540.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$328.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$398.66
|
| Rate for Payer: Blue Shield of California Commercial |
$556.56
|
| Rate for Payer: Blue Shield of California EPN |
$362.88
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Central Health Plan Commercial |
$576.00
|
| Rate for Payer: Cigna of CA HMO |
$504.00
|
| Rate for Payer: Cigna of CA PPO |
$504.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$612.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$612.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$612.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$288.00
|
| Rate for Payer: EPIC Health Plan Senior |
$288.00
|
| Rate for Payer: Galaxy Health WC |
$612.00
|
| Rate for Payer: Global Benefits Group Commercial |
$432.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$648.00
|
| Rate for Payer: InnovAge PACE Commercial |
$360.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$480.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$274.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$445.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$144.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$504.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$504.00
|
| Rate for Payer: Multiplan Commercial |
$540.00
|
| Rate for Payer: Networks By Design Commercial |
$360.00
|
| Rate for Payer: Prime Health Services Commercial |
$612.00
|
| Rate for Payer: Riverside University Health System MISP |
$288.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$432.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$432.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$270.22
|
| Rate for Payer: United Healthcare All Other HMO |
$263.02
|
| Rate for Payer: United Healthcare HMO Rider |
$257.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$235.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$612.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$612.00
|
| Rate for Payer: Vantage Medical Group Senior |
$612.00
|
|
|
HC PLASTY BALLOON/LP/PF+ CORDIS
|
Facility
|
IP
|
$720.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909081212
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$144.00 |
| Max. Negotiated Rate |
$648.00 |
| Rate for Payer: Adventist Health Commercial |
$144.00
|
| Rate for Payer: Blue Shield of California Commercial |
$556.56
|
| Rate for Payer: Blue Shield of California EPN |
$362.88
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Central Health Plan Commercial |
$576.00
|
| Rate for Payer: Cigna of CA HMO |
$504.00
|
| Rate for Payer: Cigna of CA PPO |
$504.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$288.00
|
| Rate for Payer: EPIC Health Plan Senior |
$288.00
|
| Rate for Payer: Galaxy Health WC |
$612.00
|
| Rate for Payer: Global Benefits Group Commercial |
$432.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$648.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$480.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$274.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$445.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$144.00
|
| Rate for Payer: Multiplan Commercial |
$540.00
|
| Rate for Payer: Networks By Design Commercial |
$360.00
|
| Rate for Payer: Prime Health Services Commercial |
$612.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$270.22
|
| Rate for Payer: United Healthcare All Other HMO |
$263.02
|
| Rate for Payer: United Healthcare HMO Rider |
$257.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$235.80
|
|
|
HC PLASTY BALLOON/XXL/MAXI
|
Facility
|
IP
|
$1,150.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909081287
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$230.00 |
| Max. Negotiated Rate |
$1,035.00 |
| Rate for Payer: Adventist Health Commercial |
$230.00
|
| Rate for Payer: Blue Shield of California Commercial |
$888.95
|
| Rate for Payer: Blue Shield of California EPN |
$579.60
|
| Rate for Payer: Cash Price |
$517.50
|
| Rate for Payer: Central Health Plan Commercial |
$920.00
|
| Rate for Payer: Cigna of CA HMO |
$805.00
|
| Rate for Payer: Cigna of CA PPO |
$805.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$460.00
|
| Rate for Payer: EPIC Health Plan Senior |
$460.00
|
| Rate for Payer: Galaxy Health WC |
$977.50
|
| Rate for Payer: Global Benefits Group Commercial |
$690.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,035.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$767.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$438.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$711.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$230.00
|
| Rate for Payer: Multiplan Commercial |
$862.50
|
| Rate for Payer: Networks By Design Commercial |
$575.00
|
| Rate for Payer: Prime Health Services Commercial |
$977.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$431.60
|
| Rate for Payer: United Healthcare All Other HMO |
$420.10
|
| Rate for Payer: United Healthcare HMO Rider |
$411.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$376.62
|
|
|
HC PLASTY BALLOON/XXL/MAXI
|
Facility
|
OP
|
$1,150.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909081287
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$230.00 |
| Max. Negotiated Rate |
$1,035.00 |
| Rate for Payer: Adventist Health Commercial |
$230.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$977.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$632.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$862.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$525.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$636.75
|
| Rate for Payer: Blue Shield of California Commercial |
$888.95
|
| Rate for Payer: Blue Shield of California EPN |
$579.60
|
| Rate for Payer: Cash Price |
$517.50
|
| Rate for Payer: Central Health Plan Commercial |
$920.00
|
| Rate for Payer: Cigna of CA HMO |
$805.00
|
| Rate for Payer: Cigna of CA PPO |
$805.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$977.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$977.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$977.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$460.00
|
| Rate for Payer: EPIC Health Plan Senior |
$460.00
|
| Rate for Payer: Galaxy Health WC |
$977.50
|
| Rate for Payer: Global Benefits Group Commercial |
$690.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,035.00
|
| Rate for Payer: InnovAge PACE Commercial |
$575.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$767.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$438.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$711.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$230.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$805.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$805.00
|
| Rate for Payer: Multiplan Commercial |
$862.50
|
| Rate for Payer: Networks By Design Commercial |
$575.00
|
| Rate for Payer: Prime Health Services Commercial |
$977.50
|
| Rate for Payer: Riverside University Health System MISP |
$460.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$690.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$690.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$431.60
|
| Rate for Payer: United Healthcare All Other HMO |
$420.10
|
| Rate for Payer: United Healthcare HMO Rider |
$411.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$376.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$977.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$977.50
|
| Rate for Payer: Vantage Medical Group Senior |
$977.50
|
|
|
HC PLATELET AGGREGATION ASA
|
Facility
|
IP
|
$313.00
|
|
|
Service Code
|
CPT 85576 QW,91
|
| Hospital Charge Code |
900912034
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$62.60 |
| Max. Negotiated Rate |
$281.70 |
| Rate for Payer: Adventist Health Commercial |
$62.60
|
| Rate for Payer: Cash Price |
$140.85
|
| Rate for Payer: Central Health Plan Commercial |
$250.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.20
|
| Rate for Payer: EPIC Health Plan Senior |
$125.20
|
| Rate for Payer: Galaxy Health WC |
$266.05
|
| Rate for Payer: Global Benefits Group Commercial |
$187.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$281.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$208.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$119.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$193.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.60
|
| Rate for Payer: Multiplan Commercial |
$234.75
|
| Rate for Payer: Networks By Design Commercial |
$203.45
|
| Rate for Payer: Prime Health Services Commercial |
$266.05
|
|
|
HC PLATELET AGGREGATION ASA
|
Facility
|
OP
|
$223.00
|
|
|
Service Code
|
CPT 85576 QW,91
|
| Hospital Charge Code |
900912034
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$20.18 |
| Max. Negotiated Rate |
$200.70 |
| Rate for Payer: Adventist Health Commercial |
$44.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$135.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$189.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$122.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$167.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$132.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.95
|
| Rate for Payer: Blue Shield of California Commercial |
$135.36
|
| Rate for Payer: Blue Shield of California EPN |
$88.53
|
| Rate for Payer: Cash Price |
$100.35
|
| Rate for Payer: Cash Price |
$100.35
|
| Rate for Payer: Central Health Plan Commercial |
$178.40
|
| Rate for Payer: Cigna of CA HMO |
$142.72
|
| Rate for Payer: Cigna of CA PPO |
$165.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$189.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$189.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$189.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.20
|
| Rate for Payer: EPIC Health Plan Senior |
$89.20
|
| Rate for Payer: Galaxy Health WC |
$189.55
|
| Rate for Payer: Global Benefits Group Commercial |
$133.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$200.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.47
|
| Rate for Payer: InnovAge PACE Commercial |
$111.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$148.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$138.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$156.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$156.10
|
| Rate for Payer: Multiplan Commercial |
$167.25
|
| Rate for Payer: Networks By Design Commercial |
$144.95
|
| Rate for Payer: Prime Health Services Commercial |
$189.55
|
| Rate for Payer: Riverside University Health System MISP |
$89.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$133.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$133.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.18
|
| Rate for Payer: United Healthcare All Other HMO |
$20.18
|
| Rate for Payer: United Healthcare HMO Rider |
$20.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$189.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$189.55
|
| Rate for Payer: Vantage Medical Group Senior |
$189.55
|
|
|
HC PLATELET AGGREGATION PRU P2Y12
|
Facility
|
IP
|
$416.00
|
|
|
Service Code
|
CPT 85576 91
|
| Hospital Charge Code |
900912033
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$83.20 |
| Max. Negotiated Rate |
$374.40 |
| Rate for Payer: Adventist Health Commercial |
$83.20
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Central Health Plan Commercial |
$332.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$166.40
|
| Rate for Payer: EPIC Health Plan Senior |
$166.40
|
| Rate for Payer: Galaxy Health WC |
$353.60
|
| Rate for Payer: Global Benefits Group Commercial |
$249.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$374.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$277.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$158.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$257.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.20
|
| Rate for Payer: Multiplan Commercial |
$312.00
|
| Rate for Payer: Networks By Design Commercial |
$270.40
|
| Rate for Payer: Prime Health Services Commercial |
$353.60
|
|
|
HC PLATELET AGGREGATION PRU P2Y12
|
Facility
|
OP
|
$309.00
|
|
|
Service Code
|
CPT 85576 91
|
| Hospital Charge Code |
900912033
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$20.18 |
| Max. Negotiated Rate |
$278.10 |
| Rate for Payer: Adventist Health Commercial |
$61.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$187.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$262.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$169.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$231.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$132.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.95
|
| Rate for Payer: Blue Shield of California Commercial |
$187.56
|
| Rate for Payer: Blue Shield of California EPN |
$122.67
|
| Rate for Payer: Cash Price |
$139.05
|
| Rate for Payer: Cash Price |
$139.05
|
| Rate for Payer: Central Health Plan Commercial |
$247.20
|
| Rate for Payer: Cigna of CA HMO |
$197.76
|
| Rate for Payer: Cigna of CA PPO |
$228.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$262.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$262.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$262.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$123.60
|
| Rate for Payer: EPIC Health Plan Senior |
$123.60
|
| Rate for Payer: Galaxy Health WC |
$262.65
|
| Rate for Payer: Global Benefits Group Commercial |
$185.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$278.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.47
|
| Rate for Payer: InnovAge PACE Commercial |
$154.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$206.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$191.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$216.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$216.30
|
| Rate for Payer: Multiplan Commercial |
$231.75
|
| Rate for Payer: Networks By Design Commercial |
$200.85
|
| Rate for Payer: Prime Health Services Commercial |
$262.65
|
| Rate for Payer: Riverside University Health System MISP |
$123.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$185.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$185.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.18
|
| Rate for Payer: United Healthcare All Other HMO |
$20.18
|
| Rate for Payer: United Healthcare HMO Rider |
$20.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$262.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$262.65
|
| Rate for Payer: Vantage Medical Group Senior |
$262.65
|
|
