|
HC TRAY CATH SLCN DRAIN BAG 18FR
|
Facility
|
OP
|
$123.35
|
|
| Hospital Charge Code |
901608087
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.67 |
| Max. Negotiated Rate |
$104.85 |
| Rate for Payer: Cigna of CA PPO |
$91.28
|
| Rate for Payer: Adventist Health Commercial |
$24.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$80.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$104.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$67.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$92.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$75.75
|
| Rate for Payer: Cash Price |
$67.84
|
| Rate for Payer: Cigna of CA HMO |
$78.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$104.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$104.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$104.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.34
|
| Rate for Payer: EPIC Health Plan Senior |
$49.34
|
| Rate for Payer: Galaxy Health WC |
$104.85
|
| Rate for Payer: Global Benefits Group Commercial |
$74.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$82.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$86.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$86.34
|
| Rate for Payer: Multiplan Commercial |
$98.68
|
| Rate for Payer: Networks By Design Commercial |
$80.18
|
| Rate for Payer: Prime Health Services Commercial |
$104.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$74.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$74.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$61.67
|
| Rate for Payer: United Healthcare All Other HMO |
$61.67
|
| Rate for Payer: United Healthcare HMO Rider |
$61.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$61.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$104.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$104.85
|
| Rate for Payer: Vantage Medical Group Senior |
$104.85
|
|
|
HC TRAY CATH SLCN URN METER 16FR
|
Facility
|
IP
|
$112.25
|
|
| Hospital Charge Code |
901608088
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.45 |
| Max. Negotiated Rate |
$95.41 |
| Rate for Payer: Adventist Health Commercial |
$22.45
|
| Rate for Payer: Cash Price |
$61.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.90
|
| Rate for Payer: EPIC Health Plan Senior |
$44.90
|
| Rate for Payer: Galaxy Health WC |
$95.41
|
| Rate for Payer: Global Benefits Group Commercial |
$67.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$74.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$69.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.94
|
| Rate for Payer: Multiplan Commercial |
$89.80
|
| Rate for Payer: Networks By Design Commercial |
$72.96
|
| Rate for Payer: Prime Health Services Commercial |
$95.41
|
|
|
HC TRAY CATH SLCN URN METER 16FR
|
Facility
|
OP
|
$112.25
|
|
| Hospital Charge Code |
901608088
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.45 |
| Max. Negotiated Rate |
$95.41 |
| Rate for Payer: Adventist Health Commercial |
$22.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$73.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$95.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$61.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$84.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$68.93
|
| Rate for Payer: Cash Price |
$61.74
|
| Rate for Payer: Cigna of CA HMO |
$71.84
|
| Rate for Payer: Cigna of CA PPO |
$83.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$95.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$95.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$95.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.90
|
| Rate for Payer: EPIC Health Plan Senior |
$44.90
|
| Rate for Payer: Galaxy Health WC |
$95.41
|
| Rate for Payer: Global Benefits Group Commercial |
$67.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$74.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$69.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$78.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$78.58
|
| Rate for Payer: Multiplan Commercial |
$89.80
|
| Rate for Payer: Networks By Design Commercial |
$72.96
|
| Rate for Payer: Prime Health Services Commercial |
$95.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.12
|
| Rate for Payer: United Healthcare All Other HMO |
$56.12
|
| Rate for Payer: United Healthcare HMO Rider |
$56.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$56.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$95.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$95.41
|
| Rate for Payer: Vantage Medical Group Senior |
$95.41
|
|
|
HC TRAY CATH SLCN URN METER 18FR
|
Facility
|
IP
|
$119.09
|
|
| Hospital Charge Code |
901608085
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.82 |
| Max. Negotiated Rate |
$101.23 |
| Rate for Payer: Adventist Health Commercial |
$23.82
|
| Rate for Payer: Cash Price |
$65.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.64
|
| Rate for Payer: EPIC Health Plan Senior |
$47.64
|
| Rate for Payer: Galaxy Health WC |
$101.23
|
| Rate for Payer: Global Benefits Group Commercial |
$71.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$79.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$73.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.58
|
| Rate for Payer: Multiplan Commercial |
$95.27
|
| Rate for Payer: Networks By Design Commercial |
$77.41
|
| Rate for Payer: Prime Health Services Commercial |
$101.23
|
|
|
HC TRAY CATH SLCN URN METER 18FR
|
Facility
|
OP
|
$119.09
|
|
| Hospital Charge Code |
901608085
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.82 |
| Max. Negotiated Rate |
$101.23 |
| Rate for Payer: Adventist Health Commercial |
$23.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$78.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$101.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$65.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$89.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$73.13
|
| Rate for Payer: Cash Price |
$65.50
|
| Rate for Payer: Cigna of CA HMO |
$76.22
|
| Rate for Payer: Cigna of CA PPO |
$88.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$101.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$101.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$101.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.64
|
| Rate for Payer: EPIC Health Plan Senior |
$47.64
|
| Rate for Payer: Galaxy Health WC |
$101.23
|
| Rate for Payer: Global Benefits Group Commercial |
$71.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$79.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$73.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$83.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$83.36
|
| Rate for Payer: Multiplan Commercial |
$95.27
|
| Rate for Payer: Networks By Design Commercial |
$77.41
|
| Rate for Payer: Prime Health Services Commercial |
$101.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$71.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$71.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$59.55
|
| Rate for Payer: United Healthcare All Other HMO |
$59.55
|
| Rate for Payer: United Healthcare HMO Rider |
$59.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$101.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$101.23
|
| Rate for Payer: Vantage Medical Group Senior |
$101.23
|
|
|
HC TRAY CATH URETHRAL 14FR
|
Facility
|
IP
|
$24.52
|
|
| Hospital Charge Code |
901607380
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$20.84 |
| Rate for Payer: Adventist Health Commercial |
$4.90
|
| Rate for Payer: Cash Price |
$13.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.81
|
| Rate for Payer: EPIC Health Plan Senior |
$9.81
|
| Rate for Payer: Galaxy Health WC |
$20.84
|
| Rate for Payer: Global Benefits Group Commercial |
$14.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.88
|
| Rate for Payer: Multiplan Commercial |
$19.62
|
| Rate for Payer: Networks By Design Commercial |
$15.94
|
| Rate for Payer: Prime Health Services Commercial |
$20.84
|
|
|
HC TRAY CATH URETHRAL 14FR
|
Facility
|
OP
|
$24.52
|
|
| Hospital Charge Code |
901607380
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$20.84 |
| Rate for Payer: Adventist Health Commercial |
$4.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.06
|
| Rate for Payer: Cash Price |
$13.49
|
| Rate for Payer: Cigna of CA HMO |
$15.69
|
| Rate for Payer: Cigna of CA PPO |
$18.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.81
|
| Rate for Payer: EPIC Health Plan Senior |
$9.81
|
| Rate for Payer: Galaxy Health WC |
$20.84
|
| Rate for Payer: Global Benefits Group Commercial |
$14.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.16
|
| Rate for Payer: Multiplan Commercial |
$19.62
|
| Rate for Payer: Networks By Design Commercial |
$15.94
|
| Rate for Payer: Prime Health Services Commercial |
$20.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.26
|
| Rate for Payer: United Healthcare All Other HMO |
$12.26
|
| Rate for Payer: United Healthcare HMO Rider |
$12.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.84
|
| Rate for Payer: Vantage Medical Group Senior |
$20.84
|
|
|
HC TRAY CATH URN METER 14FR SLCN
|
Facility
|
IP
|
$120.38
|
|
| Hospital Charge Code |
901607613
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.08 |
| Max. Negotiated Rate |
$102.32 |
| Rate for Payer: Adventist Health Commercial |
$24.08
|
| Rate for Payer: Cash Price |
$66.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.15
|
| Rate for Payer: EPIC Health Plan Senior |
$48.15
|
| Rate for Payer: Galaxy Health WC |
$102.32
|
| Rate for Payer: Global Benefits Group Commercial |
$72.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$74.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.89
|
| Rate for Payer: Multiplan Commercial |
$96.30
|
| Rate for Payer: Networks By Design Commercial |
$78.25
|
| Rate for Payer: Prime Health Services Commercial |
$102.32
|
|
|
HC TRAY CATH URN METER 14FR SLCN
|
Facility
|
OP
|
$120.38
|
|
| Hospital Charge Code |
901607613
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.08 |
| Max. Negotiated Rate |
$102.32 |
| Rate for Payer: Adventist Health Commercial |
$24.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$78.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$102.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$73.93
|
| Rate for Payer: Cash Price |
$66.21
|
| Rate for Payer: Cigna of CA HMO |
$77.04
|
| Rate for Payer: Cigna of CA PPO |
$89.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$102.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$102.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.15
|
| Rate for Payer: EPIC Health Plan Senior |
$48.15
|
| Rate for Payer: Galaxy Health WC |
$102.32
|
| Rate for Payer: Global Benefits Group Commercial |
$72.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$74.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$84.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$84.27
|
| Rate for Payer: Multiplan Commercial |
$96.30
|
| Rate for Payer: Networks By Design Commercial |
$78.25
|
| Rate for Payer: Prime Health Services Commercial |
$102.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.19
|
| Rate for Payer: United Healthcare All Other HMO |
$60.19
|
| Rate for Payer: United Healthcare HMO Rider |
$60.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$60.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$102.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$102.32
|
| Rate for Payer: Vantage Medical Group Senior |
$102.32
|
|
|
HC TRAY FOLEY INS PVP 10CC SYR
|
Facility
|
IP
|
$12.87
|
|
|
Service Code
|
CPT A4310
|
| Hospital Charge Code |
901698655
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.57 |
| Max. Negotiated Rate |
$10.94 |
| Rate for Payer: Adventist Health Commercial |
$2.57
|
| Rate for Payer: Cash Price |
$7.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.15
|
| Rate for Payer: EPIC Health Plan Senior |
$5.15
|
| Rate for Payer: Galaxy Health WC |
$10.94
|
| Rate for Payer: Global Benefits Group Commercial |
$7.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.09
|
| Rate for Payer: Multiplan Commercial |
$10.30
|
| Rate for Payer: Networks By Design Commercial |
$8.37
|
| Rate for Payer: Prime Health Services Commercial |
$10.94
|
|
|
HC TRAY FOLEY INS PVP 10CC SYR
|
Facility
|
OP
|
$12.87
|
|
|
Service Code
|
CPT A4310
|
| Hospital Charge Code |
901698655
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.57 |
| Max. Negotiated Rate |
$10.94 |
| Rate for Payer: Adventist Health Commercial |
$2.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.90
|
| Rate for Payer: Cash Price |
$7.08
|
| Rate for Payer: Cigna of CA HMO |
$8.24
|
| Rate for Payer: Cigna of CA PPO |
$9.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.15
|
| Rate for Payer: EPIC Health Plan Senior |
$5.15
|
| Rate for Payer: Galaxy Health WC |
$10.94
|
| Rate for Payer: Global Benefits Group Commercial |
$7.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.01
|
| Rate for Payer: Multiplan Commercial |
$10.30
|
| Rate for Payer: Networks By Design Commercial |
$8.37
|
| Rate for Payer: Prime Health Services Commercial |
$10.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.43
|
| Rate for Payer: United Healthcare All Other HMO |
$6.43
|
| Rate for Payer: United Healthcare HMO Rider |
$6.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.94
|
| Rate for Payer: Vantage Medical Group Senior |
$10.94
|
|
|
HC TRAY FOLEY INS PVP 10ML SYR
|
Facility
|
OP
|
$21.24
|
|
|
Service Code
|
CPT A4310
|
| Hospital Charge Code |
901698656
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.25 |
| Max. Negotiated Rate |
$18.05 |
| Rate for Payer: Adventist Health Commercial |
$4.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.04
|
| Rate for Payer: Cash Price |
$11.68
|
| Rate for Payer: Cigna of CA HMO |
$13.59
|
| Rate for Payer: Cigna of CA PPO |
$15.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.50
|
| Rate for Payer: EPIC Health Plan Senior |
$8.50
|
| Rate for Payer: Galaxy Health WC |
$18.05
|
| Rate for Payer: Global Benefits Group Commercial |
$12.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.87
|
| Rate for Payer: Multiplan Commercial |
$16.99
|
| Rate for Payer: Networks By Design Commercial |
$13.81
|
| Rate for Payer: Prime Health Services Commercial |
$18.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.62
|
| Rate for Payer: United Healthcare All Other HMO |
$10.62
|
| Rate for Payer: United Healthcare HMO Rider |
$10.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.05
|
| Rate for Payer: Vantage Medical Group Senior |
$18.05
|
|
|
HC TRAY FOLEY INS PVP 10ML SYR
|
Facility
|
IP
|
$21.24
|
|
|
Service Code
|
CPT A4310
|
| Hospital Charge Code |
901698656
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.25 |
| Max. Negotiated Rate |
$18.05 |
| Rate for Payer: Adventist Health Commercial |
$4.25
|
| Rate for Payer: Cash Price |
$11.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.50
|
| Rate for Payer: EPIC Health Plan Senior |
$8.50
|
| Rate for Payer: Galaxy Health WC |
$18.05
|
| Rate for Payer: Global Benefits Group Commercial |
$12.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.10
|
| Rate for Payer: Multiplan Commercial |
$16.99
|
| Rate for Payer: Networks By Design Commercial |
$13.81
|
| Rate for Payer: Prime Health Services Commercial |
$18.05
|
|
|
HC TRAY FOLEY INS W 30ML SYR PVP
|
Facility
|
OP
|
$15.17
|
|
|
Service Code
|
CPT A4338
|
| Hospital Charge Code |
901607398
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.03 |
| Max. Negotiated Rate |
$12.89 |
| Rate for Payer: Adventist Health Commercial |
$3.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.32
|
| Rate for Payer: Cash Price |
$8.34
|
| Rate for Payer: Cigna of CA HMO |
$9.71
|
| Rate for Payer: Cigna of CA PPO |
$11.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.07
|
| Rate for Payer: EPIC Health Plan Senior |
$6.07
|
| Rate for Payer: Galaxy Health WC |
$12.89
|
| Rate for Payer: Global Benefits Group Commercial |
$9.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.62
|
| Rate for Payer: Multiplan Commercial |
$12.14
|
| Rate for Payer: Networks By Design Commercial |
$9.86
|
| Rate for Payer: Prime Health Services Commercial |
$12.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.58
|
| Rate for Payer: United Healthcare All Other HMO |
$7.58
|
| Rate for Payer: United Healthcare HMO Rider |
$7.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.89
|
| Rate for Payer: Vantage Medical Group Senior |
$12.89
|
|
|
HC TRAY FOLEY INS W 30ML SYR PVP
|
Facility
|
IP
|
$15.17
|
|
|
Service Code
|
CPT A4338
|
| Hospital Charge Code |
901607398
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.03 |
| Max. Negotiated Rate |
$12.89 |
| Rate for Payer: Adventist Health Commercial |
$3.03
|
| Rate for Payer: Cash Price |
$8.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.07
|
| Rate for Payer: EPIC Health Plan Senior |
$6.07
|
| Rate for Payer: Galaxy Health WC |
$12.89
|
| Rate for Payer: Global Benefits Group Commercial |
$9.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.64
|
| Rate for Payer: Multiplan Commercial |
$12.14
|
| Rate for Payer: Networks By Design Commercial |
$9.86
|
| Rate for Payer: Prime Health Services Commercial |
$12.89
|
|
|
HC TRAY FOLEY URN MTR NO CATH
|
Facility
|
OP
|
$140.75
|
|
|
Service Code
|
CPT A4354
|
| Hospital Charge Code |
901698796
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.15 |
| Max. Negotiated Rate |
$119.64 |
| Rate for Payer: Adventist Health Commercial |
$28.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$92.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$119.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$77.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$105.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$86.43
|
| Rate for Payer: Cash Price |
$77.41
|
| Rate for Payer: Cigna of CA HMO |
$90.08
|
| Rate for Payer: Cigna of CA PPO |
$104.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$119.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$119.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$119.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.30
|
| Rate for Payer: EPIC Health Plan Senior |
$56.30
|
| Rate for Payer: Galaxy Health WC |
$119.64
|
| Rate for Payer: Global Benefits Group Commercial |
$84.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$93.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$87.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$98.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$98.53
|
| Rate for Payer: Multiplan Commercial |
$112.60
|
| Rate for Payer: Networks By Design Commercial |
$91.49
|
| Rate for Payer: Prime Health Services Commercial |
$119.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$84.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$84.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$70.38
|
| Rate for Payer: United Healthcare All Other HMO |
$70.38
|
| Rate for Payer: United Healthcare HMO Rider |
$70.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$70.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$119.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$119.64
|
| Rate for Payer: Vantage Medical Group Senior |
$119.64
|
|
|
HC TRAY FOLEY URN MTR NO CATH
|
Facility
|
IP
|
$140.75
|
|
|
Service Code
|
CPT A4354
|
| Hospital Charge Code |
901698796
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.15 |
| Max. Negotiated Rate |
$119.64 |
| Rate for Payer: Adventist Health Commercial |
$28.15
|
| Rate for Payer: Cash Price |
$77.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.30
|
| Rate for Payer: EPIC Health Plan Senior |
$56.30
|
| Rate for Payer: Galaxy Health WC |
$119.64
|
| Rate for Payer: Global Benefits Group Commercial |
$84.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$93.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$87.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.78
|
| Rate for Payer: Multiplan Commercial |
$112.60
|
| Rate for Payer: Networks By Design Commercial |
$91.49
|
| Rate for Payer: Prime Health Services Commercial |
$119.64
|
|
|
HC TRAY LEADER FLEX INSERTION
|
Facility
|
IP
|
$4.42
|
|
| Hospital Charge Code |
901698221
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$3.76 |
| Rate for Payer: Adventist Health Commercial |
$0.88
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.77
|
| Rate for Payer: EPIC Health Plan Senior |
$1.77
|
| Rate for Payer: Galaxy Health WC |
$3.76
|
| Rate for Payer: Global Benefits Group Commercial |
$2.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.06
|
| Rate for Payer: Multiplan Commercial |
$3.54
|
| Rate for Payer: Networks By Design Commercial |
$2.87
|
| Rate for Payer: Prime Health Services Commercial |
$3.76
|
|
|
HC TRAY LEADER FLEX INSERTION
|
Facility
|
OP
|
$4.42
|
|
| Hospital Charge Code |
901698221
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$3.76 |
| Rate for Payer: Adventist Health Commercial |
$0.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.71
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cigna of CA HMO |
$2.83
|
| Rate for Payer: Cigna of CA PPO |
$3.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.77
|
| Rate for Payer: EPIC Health Plan Senior |
$1.77
|
| Rate for Payer: Galaxy Health WC |
$3.76
|
| Rate for Payer: Global Benefits Group Commercial |
$2.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.09
|
| Rate for Payer: Multiplan Commercial |
$3.54
|
| Rate for Payer: Networks By Design Commercial |
$2.87
|
| Rate for Payer: Prime Health Services Commercial |
$3.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.21
|
| Rate for Payer: United Healthcare All Other HMO |
$2.21
|
| Rate for Payer: United Healthcare HMO Rider |
$2.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.76
|
| Rate for Payer: Vantage Medical Group Senior |
$3.76
|
|
|
HC TRAY NICU PICC
|
Facility
|
IP
|
$5.74
|
|
| Hospital Charge Code |
901698414
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$4.88 |
| Rate for Payer: Adventist Health Commercial |
$1.15
|
| Rate for Payer: Cash Price |
$3.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.30
|
| Rate for Payer: EPIC Health Plan Senior |
$2.30
|
| Rate for Payer: Galaxy Health WC |
$4.88
|
| Rate for Payer: Global Benefits Group Commercial |
$3.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.38
|
| Rate for Payer: Multiplan Commercial |
$4.59
|
| Rate for Payer: Networks By Design Commercial |
$3.73
|
| Rate for Payer: Prime Health Services Commercial |
$4.88
|
|
|
HC TRAY NICU PICC
|
Facility
|
OP
|
$5.74
|
|
| Hospital Charge Code |
901698414
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$4.88 |
| Rate for Payer: Adventist Health Commercial |
$1.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.52
|
| Rate for Payer: Cash Price |
$3.16
|
| Rate for Payer: Cigna of CA HMO |
$3.67
|
| Rate for Payer: Cigna of CA PPO |
$4.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.30
|
| Rate for Payer: EPIC Health Plan Senior |
$2.30
|
| Rate for Payer: Galaxy Health WC |
$4.88
|
| Rate for Payer: Global Benefits Group Commercial |
$3.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.02
|
| Rate for Payer: Multiplan Commercial |
$4.59
|
| Rate for Payer: Networks By Design Commercial |
$3.73
|
| Rate for Payer: Prime Health Services Commercial |
$4.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.87
|
| Rate for Payer: United Healthcare All Other HMO |
$2.87
|
| Rate for Payer: United Healthcare HMO Rider |
$2.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.88
|
| Rate for Payer: Vantage Medical Group Senior |
$4.88
|
|
|
HC TRAY, RADIAL ARTERY CATH 2.5FR
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698160
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$229.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$214.94
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$175.00
|
| Rate for Payer: United Healthcare All Other HMO |
$175.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$175.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC TRAY, RADIAL ARTERY CATH 2.5FR
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698160
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
|
|
HC TREAT FOOT DISLOCATION W/ANEST
|
Facility
|
IP
|
$1,214.00
|
|
|
Service Code
|
CPT 28605
|
| Hospital Charge Code |
902890262
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$242.80 |
| Max. Negotiated Rate |
$1,031.90 |
| Rate for Payer: Adventist Health Commercial |
$242.80
|
| Rate for Payer: Cash Price |
$667.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$485.60
|
| Rate for Payer: EPIC Health Plan Senior |
$485.60
|
| Rate for Payer: Galaxy Health WC |
$1,031.90
|
| Rate for Payer: Global Benefits Group Commercial |
$728.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$809.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$462.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$751.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$291.36
|
| Rate for Payer: Multiplan Commercial |
$971.20
|
| Rate for Payer: Networks By Design Commercial |
$789.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,031.90
|
|
|
HC TREAT FOOT DISLOCATION W/ANEST
|
Facility
|
OP
|
$1,214.00
|
|
|
Service Code
|
CPT 28605
|
| Hospital Charge Code |
902890262
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$242.80 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$242.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$667.70
|
| Rate for Payer: Cash Price |
$667.70
|
| Rate for Payer: Cash Price |
$667.70
|
| Rate for Payer: Cigna of CA HMO |
$776.96
|
| Rate for Payer: Cigna of CA PPO |
$898.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$411.47
|
| Rate for Payer: EPIC Health Plan Senior |
$304.79
|
| Rate for Payer: Galaxy Health WC |
$1,031.90
|
| Rate for Payer: Global Benefits Group Commercial |
$728.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$499.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$809.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$293.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$291.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$384.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.42
|
| Rate for Payer: Multiplan Commercial |
$971.20
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$789.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,031.90
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$728.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$607.00
|
| Rate for Payer: United Healthcare All Other HMO |
$607.00
|
| Rate for Payer: United Healthcare HMO Rider |
$607.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$607.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$304.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Vantage Medical Group Senior |
$304.79
|
|
