|
HC PICO SNGLE-USE NPWT 6IN X 12IN
|
Facility
OP
|
$1,113.20
|
|
| Hospital Charge Code |
901698268
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$222.64 |
| Max. Negotiated Rate |
$1,001.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$676.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$946.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$612.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$612.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$539.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$657.68
|
| Rate for Payer: BCBS Transplant Transplant |
$667.92
|
| Rate for Payer: Blue Shield of California Commercial |
$700.20
|
| Rate for Payer: Blue Shield of California EPN |
$544.35
|
| Rate for Payer: Cash Price |
$500.94
|
| Rate for Payer: Central Health Plan Commercial |
$890.56
|
| Rate for Payer: Cigna of CA HMO |
$712.45
|
| Rate for Payer: Cigna of CA PPO |
$823.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$946.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$445.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$445.28
|
| Rate for Payer: Galaxy Health WC |
$946.22
|
| Rate for Payer: Global Benefits Group Commercial |
$667.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,001.88
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$834.90
|
| Rate for Payer: IEHP medi-cal |
$389.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$742.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$222.64
|
| Rate for Payer: Multiplan Commercial |
$834.90
|
| Rate for Payer: Networks By Design Commercial |
$723.58
|
| Rate for Payer: Prime Health Services Commercial |
$946.22
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$667.92
|
| Rate for Payer: Riverside University Health MISP |
$445.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$667.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$667.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$556.60
|
| Rate for Payer: United Healthcare All Other HMO |
$556.60
|
| Rate for Payer: United Healthcare HMO Rider |
$556.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$556.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$946.22
|
| Rate for Payer: Vantage Medical Group Senior |
$946.22
|
|
|
HC PICU BACK TRANSPORT PER HOUR
|
Facility
IP
|
$3,587.00
|
|
| Hospital Charge Code |
905200103
|
|
Hospital Revenue Code
|
220
|
| Min. Negotiated Rate |
$215.00 |
| Max. Negotiated Rate |
$7,975.00 |
| Rate for Payer: Blue Shield of California Commercial |
$7,975.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,714.00
|
| Rate for Payer: Cash Price |
$1,614.15
|
| Rate for Payer: Cash Price |
$1,614.15
|
| Rate for Payer: Cash Price |
$1,614.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,869.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,434.80
|
| Rate for Payer: Galaxy Health WC |
$3,048.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,152.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,228.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$215.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,392.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$717.40
|
| Rate for Payer: Multiplan Commercial |
$2,690.25
|
| Rate for Payer: Networks By Design Commercial |
$2,331.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,048.95
|
|
|
HC PICU TRANSPORT CASE RATE
|
Facility
IP
|
$2,068.00
|
|
| Hospital Charge Code |
905200104
|
|
Hospital Revenue Code
|
220
|
| Min. Negotiated Rate |
$215.00 |
| Max. Negotiated Rate |
$7,975.00 |
| Rate for Payer: Blue Shield of California Commercial |
$7,975.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,714.00
|
| Rate for Payer: Cash Price |
$930.60
|
| Rate for Payer: Cash Price |
$930.60
|
| Rate for Payer: Cash Price |
$930.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,654.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$827.20
|
| Rate for Payer: Galaxy Health WC |
$1,757.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,240.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,861.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$215.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,379.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$413.60
|
| Rate for Payer: Multiplan Commercial |
$1,551.00
|
| Rate for Payer: Networks By Design Commercial |
$1,344.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,757.80
|
|
|
HC PICU TRANSPORT PER HOUR
|
Facility
IP
|
$2,985.00
|
|
| Hospital Charge Code |
905200100
|
|
Hospital Revenue Code
|
220
|
| Min. Negotiated Rate |
$215.00 |
| Max. Negotiated Rate |
$7,975.00 |
| Rate for Payer: Blue Shield of California Commercial |
$7,975.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,714.00
|
| Rate for Payer: Cash Price |
$1,343.25
|
| Rate for Payer: Cash Price |
$1,343.25
|
| Rate for Payer: Cash Price |
$1,343.25
|
| Rate for Payer: Central Health Plan Commercial |
$2,388.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,194.00
|
| Rate for Payer: Galaxy Health WC |
$2,537.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,791.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,686.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$215.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,991.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$597.00
|
| Rate for Payer: Multiplan Commercial |
$2,238.75
|
| Rate for Payer: Networks By Design Commercial |
$1,940.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,537.25
|
|
|
HC PID
|
Facility
OP
|
$23.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900913005
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.60 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$8.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.27
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$58.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$71.63
|
| Rate for Payer: BCBS Transplant Transplant |
$13.80
|
| Rate for Payer: Blue Shield of California Commercial |
$14.21
|
| Rate for Payer: Blue Shield of California EPN |
$11.18
|
| Rate for Payer: Caremore Medicare Advantage |
$8.08
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Central Health Plan Commercial |
$18.40
|
| Rate for Payer: Cigna of CA HMO |
$14.72
|
| Rate for Payer: Cigna of CA PPO |
$17.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.08
|
| Rate for Payer: Galaxy Health WC |
$19.55
|
| Rate for Payer: Global Benefits Group Commercial |
$13.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$17.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.25
|
| Rate for Payer: IEHP medi-cal |
$13.33
|
| Rate for Payer: IEHP Medicare Advantage |
$8.08
|
| Rate for Payer: Innovage PACE Commercial |
$12.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.83
|
| Rate for Payer: Multiplan Commercial |
$17.25
|
| Rate for Payer: Networks By Design Commercial |
$14.95
|
| Rate for Payer: Prime Health Services Commercial |
$19.55
|
| Rate for Payer: Prime Health Services Medicare |
$8.56
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: Riverside University Health MISP |
$8.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.54
|
| Rate for Payer: United Healthcare All Other HMO |
$6.54
|
| Rate for Payer: United Healthcare HMO Rider |
$6.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
HC PID
|
Facility
IP
|
$23.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900913005
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.60 |
| Max. Negotiated Rate |
$20.70 |
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Central Health Plan Commercial |
$18.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.20
|
| Rate for Payer: Galaxy Health WC |
$19.55
|
| Rate for Payer: Global Benefits Group Commercial |
$13.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.60
|
| Rate for Payer: Multiplan Commercial |
$17.25
|
| Rate for Payer: Networks By Design Commercial |
$14.95
|
| Rate for Payer: Prime Health Services Commercial |
$19.55
|
|
|
HC PI-LINKD AG, FLOW 1ST MRKR WBC
|
Facility
IP
|
$451.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
900914174
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$90.20 |
| Max. Negotiated Rate |
$405.90 |
| Rate for Payer: Cash Price |
$202.95
|
| Rate for Payer: Central Health Plan Commercial |
$360.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$180.40
|
| Rate for Payer: Galaxy Health WC |
$383.35
|
| Rate for Payer: Global Benefits Group Commercial |
$270.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$405.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$300.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.20
|
| Rate for Payer: Multiplan Commercial |
$338.25
|
| Rate for Payer: Networks By Design Commercial |
$293.15
|
| Rate for Payer: Prime Health Services Commercial |
$383.35
|
|
|
HC PI-LINKD AG, FLOW 1ST MRKR WBC
|
Facility
OP
|
$451.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
900914174
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$90.20 |
| Max. Negotiated Rate |
$741.03 |
| Rate for Payer: Adventist Health Medi-Cal |
$449.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$470.85
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$673.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$494.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$449.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$283.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$346.13
|
| Rate for Payer: BCBS Transplant Transplant |
$270.60
|
| Rate for Payer: Blue Shield of California Commercial |
$278.72
|
| Rate for Payer: Blue Shield of California EPN |
$219.19
|
| Rate for Payer: Caremore Medicare Advantage |
$449.11
|
| Rate for Payer: Cash Price |
$202.95
|
| Rate for Payer: Cash Price |
$202.95
|
| Rate for Payer: Central Health Plan Commercial |
$360.80
|
| Rate for Payer: Cigna of CA HMO |
$288.64
|
| Rate for Payer: Cigna of CA PPO |
$333.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$606.30
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$449.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$449.11
|
| Rate for Payer: Galaxy Health WC |
$383.35
|
| Rate for Payer: Global Benefits Group Commercial |
$270.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$405.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$338.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$736.54
|
| Rate for Payer: IEHP medi-cal |
$741.03
|
| Rate for Payer: IEHP Medicare Advantage |
$449.11
|
| Rate for Payer: Innovage PACE Commercial |
$673.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$300.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$449.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$601.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$601.81
|
| Rate for Payer: Multiplan Commercial |
$338.25
|
| Rate for Payer: Networks By Design Commercial |
$293.15
|
| Rate for Payer: Prime Health Services Commercial |
$383.35
|
| Rate for Payer: Prime Health Services Medicare |
$476.06
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$270.60
|
| Rate for Payer: Riverside University Health MISP |
$494.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$270.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$270.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$240.94
|
| Rate for Payer: United Healthcare All Other HMO |
$240.94
|
| Rate for Payer: United Healthcare HMO Rider |
$240.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$240.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$494.02
|
| Rate for Payer: Vantage Medical Group Senior |
$449.11
|
|
|
HC PI-LINKD AG,FLOW ADD'L MRKR,WBC
|
Facility
IP
|
$36.00
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
900914175
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$32.40 |
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Central Health Plan Commercial |
$28.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.40
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
| Rate for Payer: Networks By Design Commercial |
$23.40
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
|
|
HC PI-LINKD AG,FLOW ADD'L MRKR,WBC
|
Facility
OP
|
$36.00
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
900914175
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$281.75 |
| Rate for Payer: Aetna of CA HMO/PPO |
$281.75
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$30.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$19.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$139.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.08
|
| Rate for Payer: BCBS Transplant Transplant |
$21.60
|
| Rate for Payer: Blue Shield of California Commercial |
$22.25
|
| Rate for Payer: Blue Shield of California EPN |
$17.50
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Central Health Plan Commercial |
$28.80
|
| Rate for Payer: Cigna of CA HMO |
$23.04
|
| Rate for Payer: Cigna of CA PPO |
$26.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.40
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$27.00
|
| Rate for Payer: IEHP medi-cal |
$12.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
| Rate for Payer: Networks By Design Commercial |
$23.40
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$21.60
|
| Rate for Payer: Riverside University Health MISP |
$14.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.95
|
| Rate for Payer: United Healthcare All Other HMO |
$17.95
|
| Rate for Payer: United Healthcare HMO Rider |
$17.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.60
|
| Rate for Payer: Vantage Medical Group Senior |
$30.60
|
|
|
HC PIN WORM PREP
|
Facility
OP
|
$20.00
|
|
|
Service Code
|
CPT 87172
|
| Hospital Charge Code |
900911636
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$37.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$4.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.88
|
| Rate for Payer: BCBS Transplant Transplant |
$12.00
|
| Rate for Payer: Blue Shield of California Commercial |
$12.36
|
| Rate for Payer: Blue Shield of California EPN |
$9.72
|
| Rate for Payer: Caremore Medicare Advantage |
$4.27
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Central Health Plan Commercial |
$16.00
|
| Rate for Payer: Cigna of CA HMO |
$12.80
|
| Rate for Payer: Cigna of CA PPO |
$14.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4.27
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.27
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$15.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.00
|
| Rate for Payer: IEHP medi-cal |
$7.05
|
| Rate for Payer: IEHP Medicare Advantage |
$4.27
|
| Rate for Payer: Innovage PACE Commercial |
$6.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.72
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Prime Health Services Medicare |
$4.53
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: Riverside University Health MISP |
$4.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.46
|
| Rate for Payer: United Healthcare All Other HMO |
$3.46
|
| Rate for Payer: United Healthcare HMO Rider |
$3.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4.27
|
|
|
HC PIN WORM PREP
|
Facility
IP
|
$115.00
|
|
|
Service Code
|
CPT 87172
|
| Hospital Charge Code |
900911636
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$103.50 |
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: Central Health Plan Commercial |
$92.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.00
|
| Rate for Payer: Galaxy Health WC |
$97.75
|
| Rate for Payer: Global Benefits Group Commercial |
$69.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$103.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.00
|
| Rate for Payer: Multiplan Commercial |
$86.25
|
| Rate for Payer: Networks By Design Commercial |
$74.75
|
| Rate for Payer: Prime Health Services Commercial |
$97.75
|
|
|
HC PIPERACILLIN/TAZOBACTAM E TEST
|
Facility
IP
|
$105.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
900912422
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Central Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.00
|
| Rate for Payer: Galaxy Health WC |
$89.25
|
| Rate for Payer: Global Benefits Group Commercial |
$63.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$94.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.00
|
| Rate for Payer: Multiplan Commercial |
$78.75
|
| Rate for Payer: Networks By Design Commercial |
$68.25
|
| Rate for Payer: Prime Health Services Commercial |
$89.25
|
|
|
HC PIPERACILLIN/TAZOBACTAM E TEST
|
Facility
OP
|
$18.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
900912422
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$20.01 |
| Rate for Payer: Adventist Health Medi-Cal |
$4.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.96
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$16.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.01
|
| Rate for Payer: BCBS Transplant Transplant |
$10.80
|
| Rate for Payer: Blue Shield of California Commercial |
$11.12
|
| Rate for Payer: Blue Shield of California EPN |
$8.75
|
| Rate for Payer: Caremore Medicare Advantage |
$4.75
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Central Health Plan Commercial |
$14.40
|
| Rate for Payer: Cigna of CA HMO |
$11.52
|
| Rate for Payer: Cigna of CA PPO |
$13.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.41
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4.75
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.75
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$13.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.79
|
| Rate for Payer: IEHP medi-cal |
$7.84
|
| Rate for Payer: IEHP Medicare Advantage |
$4.75
|
| Rate for Payer: Innovage PACE Commercial |
$7.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.36
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
| Rate for Payer: Networks By Design Commercial |
$11.70
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: Prime Health Services Medicare |
$5.04
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$10.80
|
| Rate for Payer: Riverside University Health MISP |
$5.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.85
|
| Rate for Payer: United Healthcare All Other HMO |
$3.85
|
| Rate for Payer: United Healthcare HMO Rider |
$3.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Vantage Medical Group Senior |
$4.75
|
|
|
HC PIV ADULT IV START KIT
|
Facility
IP
|
$133.84
|
|
| Hospital Charge Code |
901698428
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.77 |
| Max. Negotiated Rate |
$120.46 |
| Rate for Payer: Cash Price |
$60.23
|
| Rate for Payer: Central Health Plan Commercial |
$107.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.54
|
| Rate for Payer: Galaxy Health WC |
$113.76
|
| Rate for Payer: Global Benefits Group Commercial |
$80.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$120.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$89.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.77
|
| Rate for Payer: Multiplan Commercial |
$100.38
|
| Rate for Payer: Networks By Design Commercial |
$87.00
|
| Rate for Payer: Prime Health Services Commercial |
$113.76
|
|
|
HC PIV ADULT IV START KIT
|
Facility
OP
|
$133.84
|
|
| Hospital Charge Code |
901698428
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.77 |
| Max. Negotiated Rate |
$120.46 |
| Rate for Payer: Aetna of CA HMO/PPO |
$81.28
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$113.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$73.61
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$73.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$64.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.07
|
| Rate for Payer: BCBS Transplant Transplant |
$80.30
|
| Rate for Payer: Blue Shield of California Commercial |
$84.19
|
| Rate for Payer: Blue Shield of California EPN |
$65.45
|
| Rate for Payer: Cash Price |
$60.23
|
| Rate for Payer: Central Health Plan Commercial |
$107.07
|
| Rate for Payer: Cigna of CA HMO |
$85.66
|
| Rate for Payer: Cigna of CA PPO |
$99.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$53.54
|
| Rate for Payer: Galaxy Health WC |
$113.76
|
| Rate for Payer: Global Benefits Group Commercial |
$80.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$120.46
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$100.38
|
| Rate for Payer: IEHP medi-cal |
$46.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$89.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.77
|
| Rate for Payer: Multiplan Commercial |
$100.38
|
| Rate for Payer: Networks By Design Commercial |
$87.00
|
| Rate for Payer: Prime Health Services Commercial |
$113.76
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$80.30
|
| Rate for Payer: Riverside University Health MISP |
$53.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$80.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$80.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$66.92
|
| Rate for Payer: United Healthcare All Other HMO |
$66.92
|
| Rate for Payer: United Healthcare HMO Rider |
$66.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$66.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$113.76
|
| Rate for Payer: Vantage Medical Group Senior |
$113.76
|
|
|
HC PIV DRESSING CHANGE KIT
|
Facility
IP
|
$62.16
|
|
| Hospital Charge Code |
901698273
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.43 |
| Max. Negotiated Rate |
$55.94 |
| Rate for Payer: Cash Price |
$27.97
|
| Rate for Payer: Central Health Plan Commercial |
$49.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.86
|
| Rate for Payer: Galaxy Health WC |
$52.84
|
| Rate for Payer: Global Benefits Group Commercial |
$37.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$55.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$41.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.43
|
| Rate for Payer: Multiplan Commercial |
$46.62
|
| Rate for Payer: Networks By Design Commercial |
$40.40
|
| Rate for Payer: Prime Health Services Commercial |
$52.84
|
|
|
HC PIV DRESSING CHANGE KIT
|
Facility
OP
|
$62.16
|
|
| Hospital Charge Code |
901698273
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.43 |
| Max. Negotiated Rate |
$55.94 |
| Rate for Payer: Aetna of CA HMO/PPO |
$37.75
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$52.84
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$34.19
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$34.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$30.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.72
|
| Rate for Payer: BCBS Transplant Transplant |
$37.30
|
| Rate for Payer: Blue Shield of California Commercial |
$39.10
|
| Rate for Payer: Blue Shield of California EPN |
$30.40
|
| Rate for Payer: Cash Price |
$27.97
|
| Rate for Payer: Central Health Plan Commercial |
$49.73
|
| Rate for Payer: Cigna of CA HMO |
$39.78
|
| Rate for Payer: Cigna of CA PPO |
$46.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.86
|
| Rate for Payer: EPIC Health Plan Transplant |
$24.86
|
| Rate for Payer: Galaxy Health WC |
$52.84
|
| Rate for Payer: Global Benefits Group Commercial |
$37.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$55.94
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$46.62
|
| Rate for Payer: IEHP medi-cal |
$21.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$41.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.43
|
| Rate for Payer: Multiplan Commercial |
$46.62
|
| Rate for Payer: Networks By Design Commercial |
$40.40
|
| Rate for Payer: Prime Health Services Commercial |
$52.84
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$37.30
|
| Rate for Payer: Riverside University Health MISP |
$24.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$37.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$37.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.08
|
| Rate for Payer: United Healthcare All Other HMO |
$31.08
|
| Rate for Payer: United Healthcare HMO Rider |
$31.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.84
|
| Rate for Payer: Vantage Medical Group Senior |
$52.84
|
|
|
HC PIV EXTND DWELL 2FR 22GA
|
Facility
OP
|
$238.00
|
|
| Hospital Charge Code |
901698220
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$214.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$144.54
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$202.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$130.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$130.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$115.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$140.61
|
| Rate for Payer: BCBS Transplant Transplant |
$142.80
|
| Rate for Payer: Blue Shield of California Commercial |
$149.70
|
| Rate for Payer: Blue Shield of California EPN |
$116.38
|
| Rate for Payer: Cash Price |
$107.10
|
| Rate for Payer: Central Health Plan Commercial |
$190.40
|
| Rate for Payer: Cigna of CA HMO |
$152.32
|
| Rate for Payer: Cigna of CA PPO |
$176.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$95.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$95.20
|
| Rate for Payer: Galaxy Health WC |
$202.30
|
| Rate for Payer: Global Benefits Group Commercial |
$142.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$214.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$178.50
|
| Rate for Payer: IEHP medi-cal |
$83.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$158.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.60
|
| Rate for Payer: Multiplan Commercial |
$178.50
|
| Rate for Payer: Networks By Design Commercial |
$154.70
|
| Rate for Payer: Prime Health Services Commercial |
$202.30
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$142.80
|
| Rate for Payer: Riverside University Health MISP |
$95.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$142.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$142.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$119.00
|
| Rate for Payer: United Healthcare All Other HMO |
$119.00
|
| Rate for Payer: United Healthcare HMO Rider |
$119.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$119.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$202.30
|
| Rate for Payer: Vantage Medical Group Senior |
$202.30
|
|
|
HC PIV EXTND DWELL 2FR 22GA
|
Facility
IP
|
$238.00
|
|
| Hospital Charge Code |
901698220
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$214.20 |
| Rate for Payer: Cash Price |
$107.10
|
| Rate for Payer: Central Health Plan Commercial |
$190.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$95.20
|
| Rate for Payer: Galaxy Health WC |
$202.30
|
| Rate for Payer: Global Benefits Group Commercial |
$142.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$214.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$158.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.60
|
| Rate for Payer: Multiplan Commercial |
$178.50
|
| Rate for Payer: Networks By Design Commercial |
$154.70
|
| Rate for Payer: Prime Health Services Commercial |
$202.30
|
|
|
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: Aetna of CA HMO/PPO |
$13.40
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$12.13
|
| Rate for Payer: AlphaCare 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: BCBS Transplant 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: 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 Transplant Other |
$16.54
|
| Rate for Payer: IEHP medi-cal |
$7.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.71
|
| 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: Redlands Yucaipa Medical Group Commercial/Senior |
$13.24
|
| Rate for Payer: Riverside University Health 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 PIV KIT W/STNDR BORE EXT SET
|
Facility
IP
|
$22.06
|
|
| Hospital Charge Code |
901698435
|
|
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: 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 PIV OUTPT START KIT
|
Facility
IP
|
$75.52
|
|
| Hospital Charge Code |
901698365
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.10 |
| Max. Negotiated Rate |
$67.97 |
| Rate for Payer: Cash Price |
$33.98
|
| Rate for Payer: Central Health Plan Commercial |
$60.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.21
|
| Rate for Payer: Galaxy Health WC |
$64.19
|
| Rate for Payer: Global Benefits Group Commercial |
$45.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$67.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.10
|
| Rate for Payer: Multiplan Commercial |
$56.64
|
| Rate for Payer: Networks By Design Commercial |
$49.09
|
| Rate for Payer: Prime Health Services Commercial |
$64.19
|
|
|
HC PIV OUTPT START KIT
|
Facility
OP
|
$75.52
|
|
| Hospital Charge Code |
901698365
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.10 |
| Max. Negotiated Rate |
$67.97 |
| Rate for Payer: Aetna of CA HMO/PPO |
$45.86
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$64.19
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$41.54
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$41.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$36.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.62
|
| Rate for Payer: BCBS Transplant Transplant |
$45.31
|
| Rate for Payer: Blue Shield of California Commercial |
$47.50
|
| Rate for Payer: Blue Shield of California EPN |
$36.93
|
| Rate for Payer: Cash Price |
$33.98
|
| Rate for Payer: Central Health Plan Commercial |
$60.42
|
| Rate for Payer: Cigna of CA HMO |
$48.33
|
| Rate for Payer: Cigna of CA PPO |
$55.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$30.21
|
| Rate for Payer: Galaxy Health WC |
$64.19
|
| Rate for Payer: Global Benefits Group Commercial |
$45.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$67.97
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$56.64
|
| Rate for Payer: IEHP medi-cal |
$26.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.10
|
| Rate for Payer: Multiplan Commercial |
$56.64
|
| Rate for Payer: Networks By Design Commercial |
$49.09
|
| Rate for Payer: Prime Health Services Commercial |
$64.19
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$45.31
|
| Rate for Payer: Riverside University Health MISP |
$30.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.76
|
| Rate for Payer: United Healthcare All Other HMO |
$37.76
|
| Rate for Payer: United Healthcare HMO Rider |
$37.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$37.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.19
|
| Rate for Payer: Vantage Medical Group Senior |
$64.19
|
|
|
HC PLACEMENT OF IVC FILTER
|
Facility
OP
|
$17,541.00
|
|
|
Service Code
|
CPT 37191
|
| Hospital Charge Code |
909081666
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,960.28 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,866.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6,866.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: BCBS Transplant Transplant |
$10,524.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4,121.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,960.28
|
| Rate for Payer: Caremore Medicare Advantage |
$6,866.07
|
| Rate for Payer: Cash Price |
$7,893.45
|
| Rate for Payer: Cash Price |
$7,893.45
|
| Rate for Payer: Central Health Plan Commercial |
$14,032.80
|
| Rate for Payer: Cigna of CA PPO |
$12,980.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,299.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,269.19
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6,866.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,866.07
|
| Rate for Payer: Galaxy Health WC |
$14,909.85
|
| Rate for Payer: Global Benefits Group Commercial |
$10,524.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,786.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$13,155.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,260.35
|
| Rate for Payer: IEHP medi-cal |
$11,329.02
|
| Rate for Payer: IEHP Medicare Advantage |
$6,866.07
|
| Rate for Payer: Innovage PACE Commercial |
$10,299.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,699.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,866.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,508.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,200.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,200.53
|
| Rate for Payer: Multiplan Commercial |
$13,155.75
|
| Rate for Payer: Networks By Design Commercial |
$11,401.65
|
| Rate for Payer: Prime Health Services Commercial |
$14,909.85
|
| Rate for Payer: Prime Health Services Medicare |
$7,278.03
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$10,524.60
|
| Rate for Payer: Riverside University Health MISP |
$7,552.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,524.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Vantage Medical Group Senior |
$6,866.07
|
|
