|
HC STUMP SOCK SINGLE PLY AK EACH
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
CPT L8480
|
| Hospital Charge Code |
905358480
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$7.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cigna of CA HMO |
$24.50
|
| Rate for Payer: Cigna of CA PPO |
$24.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.00
|
| Rate for Payer: EPIC Health Plan Senior |
$14.00
|
| Rate for Payer: Galaxy Health WC |
$29.75
|
| Rate for Payer: Global Benefits Group Commercial |
$21.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.40
|
| Rate for Payer: Multiplan Commercial |
$28.00
|
| Rate for Payer: Networks By Design Commercial |
$17.50
|
| Rate for Payer: Prime Health Services Commercial |
$29.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.14
|
| Rate for Payer: United Healthcare All Other HMO |
$12.79
|
| Rate for Payer: United Healthcare HMO Rider |
$12.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.46
|
|
|
HC STUMP SOCK SINGLE PLY BK EACH
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
CPT L8470
|
| Hospital Charge Code |
915358470
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna of CA HMO |
$25.20
|
| Rate for Payer: Cigna of CA PPO |
$25.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.40
|
| Rate for Payer: EPIC Health Plan Senior |
$14.40
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.64
|
| Rate for Payer: Multiplan Commercial |
$28.80
|
| Rate for Payer: Networks By Design Commercial |
$18.00
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.51
|
| Rate for Payer: United Healthcare All Other HMO |
$13.15
|
| Rate for Payer: United Healthcare HMO Rider |
$12.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.79
|
|
|
HC STUMP SOCK SINGLE PLY BK EACH
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
CPT L8470
|
| Hospital Charge Code |
905358470
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7.53 |
| Max. Negotiated Rate |
$27.20 |
| Rate for Payer: Adventist Health Commercial |
$13.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.53
|
| Rate for Payer: Blue Shield of California Commercial |
$23.62
|
| Rate for Payer: Blue Shield of California EPN |
$15.55
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna of CA HMO |
$22.40
|
| Rate for Payer: Cigna of CA PPO |
$22.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.80
|
| Rate for Payer: EPIC Health Plan Senior |
$12.80
|
| Rate for Payer: Galaxy Health WC |
$27.20
|
| Rate for Payer: Global Benefits Group Commercial |
$19.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.40
|
| Rate for Payer: Multiplan Commercial |
$25.60
|
| Rate for Payer: Networks By Design Commercial |
$16.00
|
| Rate for Payer: Prime Health Services Commercial |
$27.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.01
|
| Rate for Payer: United Healthcare All Other HMO |
$11.69
|
| Rate for Payer: United Healthcare HMO Rider |
$11.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.20
|
| Rate for Payer: Vantage Medical Group Senior |
$27.20
|
|
|
HC STUMP SOCK SINGLE PLY BK EACH
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT L8470
|
| Hospital Charge Code |
915358470
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7.53 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Adventist Health Commercial |
$14.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.85
|
| Rate for Payer: Blue Shield of California Commercial |
$26.57
|
| 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: Cigna of CA HMO |
$25.20
|
| Rate for Payer: Cigna of CA PPO |
$25.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.40
|
| Rate for Payer: EPIC Health Plan Senior |
$14.40
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.20
|
| Rate for Payer: Multiplan Commercial |
$28.80
|
| Rate for Payer: Networks By Design Commercial |
$18.00
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
| 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 |
$13.51
|
| Rate for Payer: United Healthcare All Other HMO |
$13.15
|
| Rate for Payer: United Healthcare HMO Rider |
$12.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.60
|
| Rate for Payer: Vantage Medical Group Senior |
$30.60
|
|
|
HC STUMP SOCK SINGLE PLY BK EACH
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
CPT L8470
|
| Hospital Charge Code |
905358470
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$6.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna of CA HMO |
$22.40
|
| Rate for Payer: Cigna of CA PPO |
$22.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.80
|
| Rate for Payer: EPIC Health Plan Senior |
$12.80
|
| Rate for Payer: Galaxy Health WC |
$27.20
|
| Rate for Payer: Global Benefits Group Commercial |
$19.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.68
|
| Rate for Payer: Multiplan Commercial |
$25.60
|
| Rate for Payer: Networks By Design Commercial |
$16.00
|
| Rate for Payer: Prime Health Services Commercial |
$27.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.01
|
| Rate for Payer: United Healthcare All Other HMO |
$11.69
|
| Rate for Payer: United Healthcare HMO Rider |
$11.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.48
|
|
|
HC STUMP SOCK SNGLE PLY UPPER LMB
|
Facility
|
IP
|
$47.00
|
|
|
Service Code
|
CPT L8485
|
| Hospital Charge Code |
915358485
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$9.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$9.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$21.15
|
| Rate for Payer: Cash Price |
$21.15
|
| Rate for Payer: Cigna of CA HMO |
$32.90
|
| Rate for Payer: Cigna of CA PPO |
$32.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.80
|
| Rate for Payer: EPIC Health Plan Senior |
$18.80
|
| Rate for Payer: Galaxy Health WC |
$39.95
|
| Rate for Payer: Global Benefits Group Commercial |
$28.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.28
|
| Rate for Payer: Multiplan Commercial |
$37.60
|
| Rate for Payer: Networks By Design Commercial |
$23.50
|
| Rate for Payer: Prime Health Services Commercial |
$39.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.64
|
| Rate for Payer: United Healthcare All Other HMO |
$17.17
|
| Rate for Payer: United Healthcare HMO Rider |
$16.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.39
|
|
|
HC STUMP SOCK SNGLE PLY UPPER LMB
|
Facility
|
IP
|
$47.00
|
|
|
Service Code
|
CPT L8485
|
| Hospital Charge Code |
905358485
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$9.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$9.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$21.15
|
| Rate for Payer: Cash Price |
$21.15
|
| Rate for Payer: Cigna of CA HMO |
$32.90
|
| Rate for Payer: Cigna of CA PPO |
$32.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.80
|
| Rate for Payer: EPIC Health Plan Senior |
$18.80
|
| Rate for Payer: Galaxy Health WC |
$39.95
|
| Rate for Payer: Global Benefits Group Commercial |
$28.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.28
|
| Rate for Payer: Multiplan Commercial |
$37.60
|
| Rate for Payer: Networks By Design Commercial |
$23.50
|
| Rate for Payer: Prime Health Services Commercial |
$39.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.64
|
| Rate for Payer: United Healthcare All Other HMO |
$17.17
|
| Rate for Payer: United Healthcare HMO Rider |
$16.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.39
|
|
|
HC STUMP SOCK SNGLE PLY UPPER LMB
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
CPT L8485
|
| Hospital Charge Code |
915358485
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$11.28 |
| Max. Negotiated Rate |
$39.95 |
| Rate for Payer: Adventist Health Commercial |
$19.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$39.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.22
|
| Rate for Payer: Blue Shield of California Commercial |
$34.69
|
| Rate for Payer: Blue Shield of California EPN |
$22.84
|
| Rate for Payer: Cash Price |
$21.15
|
| Rate for Payer: Cash Price |
$21.15
|
| Rate for Payer: Cigna of CA HMO |
$32.90
|
| Rate for Payer: Cigna of CA PPO |
$32.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$39.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$39.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.80
|
| Rate for Payer: EPIC Health Plan Senior |
$18.80
|
| Rate for Payer: Galaxy Health WC |
$39.95
|
| Rate for Payer: Global Benefits Group Commercial |
$28.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$15.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.90
|
| Rate for Payer: Multiplan Commercial |
$37.60
|
| Rate for Payer: Networks By Design Commercial |
$23.50
|
| Rate for Payer: Prime Health Services Commercial |
$39.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.64
|
| Rate for Payer: United Healthcare All Other HMO |
$17.17
|
| Rate for Payer: United Healthcare HMO Rider |
$16.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$39.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39.95
|
| Rate for Payer: Vantage Medical Group Senior |
$39.95
|
|
|
HC STUMP SOCK SNGLE PLY UPPER LMB
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
CPT L8485
|
| Hospital Charge Code |
905358485
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$11.28 |
| Max. Negotiated Rate |
$39.95 |
| Rate for Payer: Adventist Health Commercial |
$19.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$39.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.22
|
| Rate for Payer: Blue Shield of California Commercial |
$34.69
|
| Rate for Payer: Blue Shield of California EPN |
$22.84
|
| Rate for Payer: Cash Price |
$21.15
|
| Rate for Payer: Cash Price |
$21.15
|
| Rate for Payer: Cigna of CA HMO |
$32.90
|
| Rate for Payer: Cigna of CA PPO |
$32.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$39.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$39.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.80
|
| Rate for Payer: EPIC Health Plan Senior |
$18.80
|
| Rate for Payer: Galaxy Health WC |
$39.95
|
| Rate for Payer: Global Benefits Group Commercial |
$28.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$15.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.90
|
| Rate for Payer: Multiplan Commercial |
$37.60
|
| Rate for Payer: Networks By Design Commercial |
$23.50
|
| Rate for Payer: Prime Health Services Commercial |
$39.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.64
|
| Rate for Payer: United Healthcare All Other HMO |
$17.17
|
| Rate for Payer: United Healthcare HMO Rider |
$16.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$39.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39.95
|
| Rate for Payer: Vantage Medical Group Senior |
$39.95
|
|
|
HC STYE INCISION OF LID MARGIN
|
Facility
|
IP
|
$2,346.00
|
|
|
Service Code
|
CPT 67830
|
| Hospital Charge Code |
900501664
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$469.20 |
| Max. Negotiated Rate |
$1,994.10 |
| Rate for Payer: Adventist Health Commercial |
$469.20
|
| Rate for Payer: Cash Price |
$1,055.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$938.40
|
| Rate for Payer: EPIC Health Plan Senior |
$938.40
|
| Rate for Payer: Galaxy Health WC |
$1,994.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,407.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,564.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$893.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,452.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$563.04
|
| Rate for Payer: Multiplan Commercial |
$1,876.80
|
| Rate for Payer: Networks By Design Commercial |
$1,524.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,994.10
|
|
|
HC STYE INCISION OF LID MARGIN
|
Facility
|
OP
|
$2,346.00
|
|
|
Service Code
|
CPT 67830
|
| Hospital Charge Code |
900501664
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$469.20 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$469.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,845.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,353.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,230.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$1,055.70
|
| Rate for Payer: Cash Price |
$1,055.70
|
| Rate for Payer: Cash Price |
$1,055.70
|
| Rate for Payer: Cigna of CA HMO |
$1,501.44
|
| Rate for Payer: Cigna of CA PPO |
$1,736.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,845.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,353.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,230.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,661.35
|
| Rate for Payer: EPIC Health Plan Senior |
$1,230.63
|
| Rate for Payer: Galaxy Health WC |
$1,994.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,407.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,018.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,230.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,564.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$582.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,230.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$563.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,550.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,649.04
|
| Rate for Payer: Multiplan Commercial |
$1,876.80
|
| Rate for Payer: Multiplan WC |
$1,960.77
|
| Rate for Payer: Networks By Design Commercial |
$1,524.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,994.10
|
| Rate for Payer: Prime Health Services WC |
$1,940.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,407.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,173.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,173.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,173.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,173.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,230.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,845.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,353.69
|
| Rate for Payer: Vantage Medical Group Senior |
$1,230.63
|
|
|
HC STYLET INTUBATION 12FR
|
Facility
|
IP
|
$19.43
|
|
|
Service Code
|
CPT A4212
|
| Hospital Charge Code |
901698672
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.89 |
| Max. Negotiated Rate |
$16.52 |
| Rate for Payer: Adventist Health Commercial |
$3.89
|
| Rate for Payer: Cash Price |
$8.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.77
|
| Rate for Payer: EPIC Health Plan Senior |
$7.77
|
| Rate for Payer: Galaxy Health WC |
$16.52
|
| Rate for Payer: Global Benefits Group Commercial |
$11.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.66
|
| Rate for Payer: Multiplan Commercial |
$15.54
|
| Rate for Payer: Networks By Design Commercial |
$12.63
|
| Rate for Payer: Prime Health Services Commercial |
$16.52
|
|
|
HC STYLET INTUBATION 12FR
|
Facility
|
OP
|
$19.43
|
|
|
Service Code
|
CPT A4212
|
| Hospital Charge Code |
901698672
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.89 |
| Max. Negotiated Rate |
$16.52 |
| Rate for Payer: Adventist Health Commercial |
$3.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.93
|
| Rate for Payer: Cash Price |
$8.74
|
| Rate for Payer: Cigna of CA HMO |
$12.44
|
| Rate for Payer: Cigna of CA PPO |
$14.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.77
|
| Rate for Payer: EPIC Health Plan Senior |
$7.77
|
| Rate for Payer: Galaxy Health WC |
$16.52
|
| Rate for Payer: Global Benefits Group Commercial |
$11.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.60
|
| Rate for Payer: Multiplan Commercial |
$15.54
|
| Rate for Payer: Networks By Design Commercial |
$12.63
|
| Rate for Payer: Prime Health Services Commercial |
$16.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.71
|
| Rate for Payer: United Healthcare All Other HMO |
$9.71
|
| Rate for Payer: United Healthcare HMO Rider |
$9.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.52
|
| Rate for Payer: Vantage Medical Group Senior |
$16.52
|
|
|
HC STYLET, INTUBATION, 14FR
|
Facility
|
OP
|
$13.69
|
|
|
Service Code
|
CPT A4212
|
| Hospital Charge Code |
901607910
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.74 |
| Max. Negotiated Rate |
$11.64 |
| Rate for Payer: Adventist Health Commercial |
$2.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.41
|
| Rate for Payer: Cash Price |
$6.16
|
| Rate for Payer: Cigna of CA HMO |
$8.76
|
| Rate for Payer: Cigna of CA PPO |
$10.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.48
|
| Rate for Payer: EPIC Health Plan Senior |
$5.48
|
| Rate for Payer: Galaxy Health WC |
$11.64
|
| Rate for Payer: Global Benefits Group Commercial |
$8.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.58
|
| Rate for Payer: Multiplan Commercial |
$10.95
|
| Rate for Payer: Networks By Design Commercial |
$8.90
|
| Rate for Payer: Prime Health Services Commercial |
$11.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.84
|
| Rate for Payer: United Healthcare All Other HMO |
$6.84
|
| Rate for Payer: United Healthcare HMO Rider |
$6.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.64
|
| Rate for Payer: Vantage Medical Group Senior |
$11.64
|
|
|
HC STYLET, INTUBATION, 14FR
|
Facility
|
IP
|
$13.69
|
|
|
Service Code
|
CPT A4212
|
| Hospital Charge Code |
901607910
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.74 |
| Max. Negotiated Rate |
$11.64 |
| Rate for Payer: Adventist Health Commercial |
$2.74
|
| Rate for Payer: Cash Price |
$6.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.48
|
| Rate for Payer: EPIC Health Plan Senior |
$5.48
|
| Rate for Payer: Galaxy Health WC |
$11.64
|
| Rate for Payer: Global Benefits Group Commercial |
$8.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.29
|
| Rate for Payer: Multiplan Commercial |
$10.95
|
| Rate for Payer: Networks By Design Commercial |
$8.90
|
| Rate for Payer: Prime Health Services Commercial |
$11.64
|
|
|
HC STYLET INTUBATION 2.5-4.5MM
|
Facility
|
IP
|
$23.12
|
|
|
Service Code
|
CPT A4212
|
| Hospital Charge Code |
901607806
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.62 |
| Max. Negotiated Rate |
$19.65 |
| Rate for Payer: Adventist Health Commercial |
$4.62
|
| Rate for Payer: Cash Price |
$10.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.25
|
| Rate for Payer: EPIC Health Plan Senior |
$9.25
|
| Rate for Payer: Galaxy Health WC |
$19.65
|
| Rate for Payer: Global Benefits Group Commercial |
$13.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.55
|
| Rate for Payer: Multiplan Commercial |
$18.50
|
| Rate for Payer: Networks By Design Commercial |
$15.03
|
| Rate for Payer: Prime Health Services Commercial |
$19.65
|
|
|
HC STYLET INTUBATION 2.5-4.5MM
|
Facility
|
OP
|
$23.12
|
|
|
Service Code
|
CPT A4212
|
| Hospital Charge Code |
901607806
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.62 |
| Max. Negotiated Rate |
$19.65 |
| Rate for Payer: Adventist Health Commercial |
$4.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.20
|
| Rate for Payer: Cash Price |
$10.40
|
| Rate for Payer: Cigna of CA HMO |
$14.80
|
| Rate for Payer: Cigna of CA PPO |
$17.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.25
|
| Rate for Payer: EPIC Health Plan Senior |
$9.25
|
| Rate for Payer: Galaxy Health WC |
$19.65
|
| Rate for Payer: Global Benefits Group Commercial |
$13.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.18
|
| Rate for Payer: Multiplan Commercial |
$18.50
|
| Rate for Payer: Networks By Design Commercial |
$15.03
|
| Rate for Payer: Prime Health Services Commercial |
$19.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.56
|
| Rate for Payer: United Healthcare All Other HMO |
$11.56
|
| Rate for Payer: United Healthcare HMO Rider |
$11.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.65
|
| Rate for Payer: Vantage Medical Group Senior |
$19.65
|
|
|
HC STYLET INTUBATION 5.0-7.5MM
|
Facility
|
OP
|
$22.71
|
|
|
Service Code
|
CPT A4212
|
| Hospital Charge Code |
901607807
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.54 |
| Max. Negotiated Rate |
$19.30 |
| Rate for Payer: Adventist Health Commercial |
$4.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.95
|
| Rate for Payer: Cash Price |
$10.22
|
| Rate for Payer: Cigna of CA HMO |
$14.53
|
| Rate for Payer: Cigna of CA PPO |
$16.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.08
|
| Rate for Payer: EPIC Health Plan Senior |
$9.08
|
| Rate for Payer: Galaxy Health WC |
$19.30
|
| Rate for Payer: Global Benefits Group Commercial |
$13.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.90
|
| Rate for Payer: Multiplan Commercial |
$18.17
|
| Rate for Payer: Networks By Design Commercial |
$14.76
|
| Rate for Payer: Prime Health Services Commercial |
$19.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.36
|
| Rate for Payer: United Healthcare All Other HMO |
$11.36
|
| Rate for Payer: United Healthcare HMO Rider |
$11.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.30
|
| Rate for Payer: Vantage Medical Group Senior |
$19.30
|
|
|
HC STYLET INTUBATION 5.0-7.5MM
|
Facility
|
IP
|
$22.71
|
|
|
Service Code
|
CPT A4212
|
| Hospital Charge Code |
901607807
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.54 |
| Max. Negotiated Rate |
$19.30 |
| Rate for Payer: Adventist Health Commercial |
$4.54
|
| Rate for Payer: Cash Price |
$10.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.08
|
| Rate for Payer: EPIC Health Plan Senior |
$9.08
|
| Rate for Payer: Galaxy Health WC |
$19.30
|
| Rate for Payer: Global Benefits Group Commercial |
$13.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.45
|
| Rate for Payer: Multiplan Commercial |
$18.17
|
| Rate for Payer: Networks By Design Commercial |
$14.76
|
| Rate for Payer: Prime Health Services Commercial |
$19.30
|
|
|
HC STYLET INTUBATION 6FR
|
Facility
|
IP
|
$19.19
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901698734
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.84 |
| Max. Negotiated Rate |
$16.31 |
| Rate for Payer: Adventist Health Commercial |
$3.84
|
| Rate for Payer: Cash Price |
$8.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.68
|
| Rate for Payer: EPIC Health Plan Senior |
$7.68
|
| Rate for Payer: Galaxy Health WC |
$16.31
|
| Rate for Payer: Global Benefits Group Commercial |
$11.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.61
|
| Rate for Payer: Multiplan Commercial |
$15.35
|
| Rate for Payer: Networks By Design Commercial |
$12.47
|
| Rate for Payer: Prime Health Services Commercial |
$16.31
|
|
|
HC STYLET INTUBATION 6FR
|
Facility
|
OP
|
$19.19
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901698734
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.84 |
| Max. Negotiated Rate |
$16.31 |
| Rate for Payer: Adventist Health Commercial |
$3.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.78
|
| Rate for Payer: Cash Price |
$8.64
|
| Rate for Payer: Cigna of CA HMO |
$12.28
|
| Rate for Payer: Cigna of CA PPO |
$14.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.68
|
| Rate for Payer: EPIC Health Plan Senior |
$7.68
|
| Rate for Payer: Galaxy Health WC |
$16.31
|
| Rate for Payer: Global Benefits Group Commercial |
$11.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.43
|
| Rate for Payer: Multiplan Commercial |
$15.35
|
| Rate for Payer: Networks By Design Commercial |
$12.47
|
| Rate for Payer: Prime Health Services Commercial |
$16.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.60
|
| Rate for Payer: United Healthcare All Other HMO |
$9.60
|
| Rate for Payer: United Healthcare HMO Rider |
$9.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.31
|
| Rate for Payer: Vantage Medical Group Senior |
$16.31
|
|
|
HC STYLET INTUBATION 6FR LUBR
|
Facility
|
IP
|
$2,300.00
|
|
|
Service Code
|
CPT A4212
|
| Hospital Charge Code |
901698670
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$1,955.00 |
| Rate for Payer: Adventist Health Commercial |
$460.00
|
| Rate for Payer: Cash Price |
$1,035.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$920.00
|
| Rate for Payer: EPIC Health Plan Senior |
$920.00
|
| Rate for Payer: Galaxy Health WC |
$1,955.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,380.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,534.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$876.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,423.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$552.00
|
| Rate for Payer: Multiplan Commercial |
$1,840.00
|
| Rate for Payer: Networks By Design Commercial |
$1,495.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,955.00
|
|
|
HC STYLET INTUBATION 6FR LUBR
|
Facility
|
OP
|
$2,300.00
|
|
|
Service Code
|
CPT A4212
|
| Hospital Charge Code |
901698670
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$1,955.00 |
| Rate for Payer: Adventist Health Commercial |
$460.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,508.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,265.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,725.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,412.43
|
| Rate for Payer: Cash Price |
$1,035.00
|
| Rate for Payer: Cigna of CA HMO |
$1,472.00
|
| Rate for Payer: Cigna of CA PPO |
$1,702.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,955.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,955.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$920.00
|
| Rate for Payer: EPIC Health Plan Senior |
$920.00
|
| Rate for Payer: Galaxy Health WC |
$1,955.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,380.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,534.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$876.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,423.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$552.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,610.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,610.00
|
| Rate for Payer: Multiplan Commercial |
$1,840.00
|
| Rate for Payer: Networks By Design Commercial |
$1,495.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,955.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,380.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,380.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,150.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,150.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,150.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,150.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,955.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,955.00
|
|
|
HC STYLET INTUBATION 7.5-9.5MM
|
Facility
|
OP
|
$23.21
|
|
|
Service Code
|
CPT A4212
|
| Hospital Charge Code |
901607808
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.64 |
| Max. Negotiated Rate |
$19.73 |
| Rate for Payer: Adventist Health Commercial |
$4.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.25
|
| Rate for Payer: Cash Price |
$10.44
|
| Rate for Payer: Cigna of CA HMO |
$14.85
|
| Rate for Payer: Cigna of CA PPO |
$17.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.28
|
| Rate for Payer: EPIC Health Plan Senior |
$9.28
|
| Rate for Payer: Galaxy Health WC |
$19.73
|
| Rate for Payer: Global Benefits Group Commercial |
$13.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.25
|
| Rate for Payer: Multiplan Commercial |
$18.57
|
| Rate for Payer: Networks By Design Commercial |
$15.09
|
| Rate for Payer: Prime Health Services Commercial |
$19.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.61
|
| Rate for Payer: United Healthcare All Other HMO |
$11.61
|
| Rate for Payer: United Healthcare HMO Rider |
$11.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.73
|
| Rate for Payer: Vantage Medical Group Senior |
$19.73
|
|
|
HC STYLET INTUBATION 7.5-9.5MM
|
Facility
|
IP
|
$23.21
|
|
|
Service Code
|
CPT A4212
|
| Hospital Charge Code |
901607808
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.64 |
| Max. Negotiated Rate |
$19.73 |
| Rate for Payer: Adventist Health Commercial |
$4.64
|
| Rate for Payer: Cash Price |
$10.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.28
|
| Rate for Payer: EPIC Health Plan Senior |
$9.28
|
| Rate for Payer: Galaxy Health WC |
$19.73
|
| Rate for Payer: Global Benefits Group Commercial |
$13.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.57
|
| Rate for Payer: Multiplan Commercial |
$18.57
|
| Rate for Payer: Networks By Design Commercial |
$15.09
|
| Rate for Payer: Prime Health Services Commercial |
$19.73
|
|
