|
HC TRACH SHILEY PEDS 5.5 UNCUFF
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
901698499
|
|
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 |
$135.36
|
| 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 |
$224.59
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$127.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| 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 TRACH TUBE CHANGE
|
Facility
|
OP
|
$1,476.00
|
|
|
Service Code
|
CPT 31502
|
| Hospital Charge Code |
900800523
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$100.08 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$295.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$218.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$456.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Cash Price |
$664.20
|
| Rate for Payer: Cash Price |
$664.20
|
| Rate for Payer: Cash Price |
$664.20
|
| Rate for Payer: Cash Price |
$664.20
|
| Rate for Payer: Cigna of CA HMO |
$944.64
|
| Rate for Payer: Cigna of CA PPO |
$1,092.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$456.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,033.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$502.64
|
| Rate for Payer: EPIC Health Plan Senior |
$335.09
|
| Rate for Payer: Galaxy Health WC |
$1,254.60
|
| Rate for Payer: Global Benefits Group Commercial |
$885.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$499.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$100.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$937.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$113.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$426.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$354.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$383.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.20
|
| Rate for Payer: Multiplan Commercial |
$1,180.80
|
| Rate for Payer: Networks By Design Commercial |
$959.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,254.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$885.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$885.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$304.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$456.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.09
|
| Rate for Payer: Vantage Medical Group Senior |
$304.63
|
|
|
HC TRACH TUBE CHANGE
|
Facility
|
OP
|
$1,476.00
|
|
|
Service Code
|
CPT 31502
|
| Hospital Charge Code |
900800523
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$113.18 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$605.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$218.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$456.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$664.20
|
| Rate for Payer: Cash Price |
$664.20
|
| Rate for Payer: Cash Price |
$664.20
|
| Rate for Payer: Cigna of CA HMO |
$944.64
|
| Rate for Payer: Cigna of CA PPO |
$1,092.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$456.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,033.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$502.64
|
| Rate for Payer: EPIC Health Plan Senior |
$335.09
|
| Rate for Payer: Galaxy Health WC |
$1,254.60
|
| Rate for Payer: Global Benefits Group Commercial |
$885.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$499.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$937.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$113.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$327.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$354.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$383.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.20
|
| Rate for Payer: Multiplan Commercial |
$1,180.80
|
| Rate for Payer: Multiplan WC |
$470.13
|
| Rate for Payer: Networks By Design Commercial |
$959.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,254.60
|
| Rate for Payer: Prime Health Services WC |
$465.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$885.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$885.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$304.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$456.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.09
|
| Rate for Payer: Vantage Medical Group Senior |
$304.63
|
|
|
HC TRACH TUBE CHANGE
|
Facility
|
OP
|
$1,476.00
|
|
|
Service Code
|
CPT 31502
|
| Hospital Charge Code |
900800523
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$113.18 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$295.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$456.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$664.20
|
| Rate for Payer: Cash Price |
$664.20
|
| Rate for Payer: Cash Price |
$664.20
|
| Rate for Payer: Cigna of CA HMO |
$944.64
|
| Rate for Payer: Cigna of CA PPO |
$1,092.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$456.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,033.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$502.64
|
| Rate for Payer: EPIC Health Plan Senior |
$335.09
|
| Rate for Payer: Galaxy Health WC |
$1,254.60
|
| Rate for Payer: Global Benefits Group Commercial |
$885.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$499.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$937.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$113.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$327.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$354.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$383.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.20
|
| Rate for Payer: Multiplan Commercial |
$1,180.80
|
| Rate for Payer: Multiplan WC |
$470.13
|
| Rate for Payer: Networks By Design Commercial |
$959.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,254.60
|
| Rate for Payer: Prime Health Services WC |
$465.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$885.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$738.00
|
| Rate for Payer: United Healthcare All Other HMO |
$738.00
|
| Rate for Payer: United Healthcare HMO Rider |
$738.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$738.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$304.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$456.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.09
|
| Rate for Payer: Vantage Medical Group Senior |
$304.63
|
|
|
HC TRACH TUBE CHANGE
|
Facility
|
IP
|
$1,476.00
|
|
|
Service Code
|
CPT 31502
|
| Hospital Charge Code |
900800523
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$295.20 |
| Max. Negotiated Rate |
$1,254.60 |
| Rate for Payer: Adventist Health Commercial |
$295.20
|
| Rate for Payer: Cash Price |
$664.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,033.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$590.40
|
| Rate for Payer: EPIC Health Plan Senior |
$590.40
|
| Rate for Payer: Galaxy Health WC |
$1,254.60
|
| Rate for Payer: Global Benefits Group Commercial |
$885.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$937.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$870.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$354.24
|
| Rate for Payer: Multiplan Commercial |
$1,180.80
|
| Rate for Payer: Networks By Design Commercial |
$959.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,254.60
|
|
|
HC TRACH TUBE CHANGE
|
Facility
|
IP
|
$1,476.00
|
|
|
Service Code
|
CPT 31502
|
| Hospital Charge Code |
900800523
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$295.20 |
| Max. Negotiated Rate |
$1,254.60 |
| Rate for Payer: Adventist Health Commercial |
$295.20
|
| Rate for Payer: Cash Price |
$664.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,033.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$590.40
|
| Rate for Payer: EPIC Health Plan Senior |
$590.40
|
| Rate for Payer: Galaxy Health WC |
$1,254.60
|
| Rate for Payer: Global Benefits Group Commercial |
$885.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$937.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$870.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$354.24
|
| Rate for Payer: Multiplan Commercial |
$1,180.80
|
| Rate for Payer: Networks By Design Commercial |
$959.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,254.60
|
|
|
HC TRACH TUBE CHANGE
|
Facility
|
IP
|
$1,476.00
|
|
|
Service Code
|
CPT 31502
|
| Hospital Charge Code |
900800523
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$295.20 |
| Max. Negotiated Rate |
$1,254.60 |
| Rate for Payer: Adventist Health Commercial |
$295.20
|
| Rate for Payer: Cash Price |
$664.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,033.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$590.40
|
| Rate for Payer: EPIC Health Plan Senior |
$590.40
|
| Rate for Payer: Galaxy Health WC |
$1,254.60
|
| Rate for Payer: Global Benefits Group Commercial |
$885.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$937.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$870.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$354.24
|
| Rate for Payer: Multiplan Commercial |
$1,180.80
|
| Rate for Payer: Networks By Design Commercial |
$959.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,254.60
|
|
|
HC TRACH TUBE HOLDER 1 SZ
|
Facility
|
IP
|
$15.33
|
|
|
Service Code
|
CPT A7526
|
| Hospital Charge Code |
901698588
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.07 |
| Max. Negotiated Rate |
$13.03 |
| Rate for Payer: Adventist Health Commercial |
$3.07
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.13
|
| Rate for Payer: EPIC Health Plan Senior |
$6.13
|
| Rate for Payer: Galaxy Health WC |
$13.03
|
| Rate for Payer: Global Benefits Group Commercial |
$9.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.68
|
| Rate for Payer: Multiplan Commercial |
$12.26
|
| Rate for Payer: Networks By Design Commercial |
$9.96
|
| Rate for Payer: Prime Health Services Commercial |
$13.03
|
|
|
HC TRACH TUBE HOLDER 1 SZ
|
Facility
|
OP
|
$15.33
|
|
|
Service Code
|
CPT A7526
|
| Hospital Charge Code |
901698588
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.07 |
| Max. Negotiated Rate |
$13.03 |
| Rate for Payer: Adventist Health Commercial |
$3.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.84
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cigna of CA HMO |
$9.81
|
| Rate for Payer: Cigna of CA PPO |
$11.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.13
|
| Rate for Payer: EPIC Health Plan Senior |
$6.13
|
| Rate for Payer: Galaxy Health WC |
$13.03
|
| Rate for Payer: Global Benefits Group Commercial |
$9.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.73
|
| Rate for Payer: Multiplan Commercial |
$12.26
|
| Rate for Payer: Networks By Design Commercial |
$9.96
|
| Rate for Payer: Prime Health Services Commercial |
$13.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.67
|
| Rate for Payer: United Healthcare All Other HMO |
$7.67
|
| Rate for Payer: United Healthcare HMO Rider |
$7.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.03
|
| Rate for Payer: Vantage Medical Group Senior |
$13.03
|
|
|
HC TRACKER CATH
|
Facility
|
IP
|
$930.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909081237
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$186.00 |
| Max. Negotiated Rate |
$790.50 |
| Rate for Payer: Adventist Health Commercial |
$186.00
|
| Rate for Payer: Cash Price |
$418.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$651.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.00
|
| Rate for Payer: EPIC Health Plan Senior |
$372.00
|
| Rate for Payer: Galaxy Health WC |
$790.50
|
| Rate for Payer: Global Benefits Group Commercial |
$558.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$590.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$548.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.20
|
| Rate for Payer: Multiplan Commercial |
$744.00
|
| Rate for Payer: Networks By Design Commercial |
$604.50
|
| Rate for Payer: Prime Health Services Commercial |
$790.50
|
|
|
HC TRACKER CATH
|
Facility
|
OP
|
$930.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909081237
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$186.00 |
| Max. Negotiated Rate |
$790.50 |
| Rate for Payer: Adventist Health Commercial |
$186.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$213.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$790.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$511.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$697.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$596.78
|
| Rate for Payer: Cash Price |
$418.50
|
| Rate for Payer: Cash Price |
$418.50
|
| Rate for Payer: Cigna of CA HMO |
$595.20
|
| Rate for Payer: Cigna of CA PPO |
$688.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$790.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$790.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$790.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$651.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.00
|
| Rate for Payer: EPIC Health Plan Senior |
$372.00
|
| Rate for Payer: Galaxy Health WC |
$790.50
|
| Rate for Payer: Global Benefits Group Commercial |
$558.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$590.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$337.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$548.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$651.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$651.00
|
| Rate for Payer: Multiplan Commercial |
$744.00
|
| Rate for Payer: Networks By Design Commercial |
$604.50
|
| Rate for Payer: Prime Health Services Commercial |
$790.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$558.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$558.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$465.00
|
| Rate for Payer: United Healthcare All Other HMO |
$465.00
|
| Rate for Payer: United Healthcare HMO Rider |
$465.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$465.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$790.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$790.50
|
| Rate for Payer: Vantage Medical Group Senior |
$790.50
|
|
|
HC TRACKER - GUIDEWIRE
|
Facility
|
IP
|
$606.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081224
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.20 |
| Max. Negotiated Rate |
$515.10 |
| Rate for Payer: Adventist Health Commercial |
$121.20
|
| Rate for Payer: Cash Price |
$272.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$424.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$242.40
|
| Rate for Payer: EPIC Health Plan Senior |
$242.40
|
| Rate for Payer: Galaxy Health WC |
$515.10
|
| Rate for Payer: Global Benefits Group Commercial |
$363.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$384.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$357.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.44
|
| Rate for Payer: Multiplan Commercial |
$484.80
|
| Rate for Payer: Networks By Design Commercial |
$393.90
|
| Rate for Payer: Prime Health Services Commercial |
$515.10
|
|
|
HC TRACKER - GUIDEWIRE
|
Facility
|
OP
|
$606.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081224
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.20 |
| Max. Negotiated Rate |
$515.10 |
| Rate for Payer: Adventist Health Commercial |
$121.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$449.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$515.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$333.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$454.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$388.87
|
| Rate for Payer: Cash Price |
$272.70
|
| Rate for Payer: Cash Price |
$272.70
|
| Rate for Payer: Cigna of CA HMO |
$387.84
|
| Rate for Payer: Cigna of CA PPO |
$448.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$515.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$515.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$515.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$424.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$242.40
|
| Rate for Payer: EPIC Health Plan Senior |
$242.40
|
| Rate for Payer: Galaxy Health WC |
$515.10
|
| Rate for Payer: Global Benefits Group Commercial |
$363.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$384.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$219.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$357.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$424.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$424.20
|
| Rate for Payer: Multiplan Commercial |
$484.80
|
| Rate for Payer: Networks By Design Commercial |
$393.90
|
| Rate for Payer: Prime Health Services Commercial |
$515.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$363.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$363.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$303.00
|
| Rate for Payer: United Healthcare All Other HMO |
$303.00
|
| Rate for Payer: United Healthcare HMO Rider |
$303.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$303.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$515.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$515.10
|
| Rate for Payer: Vantage Medical Group Senior |
$515.10
|
|
|
HC TRACKER INFUSION KIT
|
Facility
|
IP
|
$1,148.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909081220
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$229.60 |
| Max. Negotiated Rate |
$975.80 |
| Rate for Payer: Adventist Health Commercial |
$229.60
|
| Rate for Payer: Cash Price |
$516.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$803.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$459.20
|
| Rate for Payer: EPIC Health Plan Senior |
$459.20
|
| Rate for Payer: Galaxy Health WC |
$975.80
|
| Rate for Payer: Global Benefits Group Commercial |
$688.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$728.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$677.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$275.52
|
| Rate for Payer: Multiplan Commercial |
$918.40
|
| Rate for Payer: Networks By Design Commercial |
$746.20
|
| Rate for Payer: Prime Health Services Commercial |
$975.80
|
|
|
HC TRACKER INFUSION KIT
|
Facility
|
OP
|
$1,148.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909081220
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$213.43 |
| Max. Negotiated Rate |
$975.80 |
| Rate for Payer: Adventist Health Commercial |
$229.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$213.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$975.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$631.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$861.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$736.67
|
| Rate for Payer: Cash Price |
$516.60
|
| Rate for Payer: Cash Price |
$516.60
|
| Rate for Payer: Cigna of CA HMO |
$734.72
|
| Rate for Payer: Cigna of CA PPO |
$849.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$975.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$975.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$975.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$803.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$459.20
|
| Rate for Payer: EPIC Health Plan Senior |
$459.20
|
| Rate for Payer: Galaxy Health WC |
$975.80
|
| Rate for Payer: Global Benefits Group Commercial |
$688.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$728.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$416.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$677.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$275.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$803.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$803.60
|
| Rate for Payer: Multiplan Commercial |
$918.40
|
| Rate for Payer: Networks By Design Commercial |
$746.20
|
| Rate for Payer: Prime Health Services Commercial |
$975.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$688.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$688.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$574.00
|
| Rate for Payer: United Healthcare All Other HMO |
$574.00
|
| Rate for Payer: United Healthcare HMO Rider |
$574.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$574.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$975.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$975.80
|
| Rate for Payer: Vantage Medical Group Senior |
$975.80
|
|
|
HC TRACTION MECHANICAL MCAL
|
Facility
|
OP
|
$232.00
|
|
|
Service Code
|
CPT 97012
|
| Hospital Charge Code |
900400025
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$22.14 |
| Max. Negotiated Rate |
$478.00 |
| Rate for Payer: Adventist Health Commercial |
$95.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$76.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$197.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$127.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$174.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cigna of CA HMO |
$148.48
|
| Rate for Payer: Cigna of CA PPO |
$171.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$197.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$197.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$197.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$162.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.80
|
| Rate for Payer: EPIC Health Plan Senior |
$92.80
|
| Rate for Payer: Galaxy Health WC |
$197.20
|
| Rate for Payer: Global Benefits Group Commercial |
$139.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$147.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$136.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$162.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$162.40
|
| Rate for Payer: Multiplan Commercial |
$185.60
|
| Rate for Payer: Networks By Design Commercial |
$150.80
|
| Rate for Payer: Prime Health Services Commercial |
$197.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$139.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$139.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$197.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$197.20
|
| Rate for Payer: Vantage Medical Group Senior |
$197.20
|
|
|
HC TRACTION MECHANICAL MCAL
|
Facility
|
IP
|
$232.00
|
|
|
Service Code
|
CPT 97012
|
| Hospital Charge Code |
900400025
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$46.40 |
| Max. Negotiated Rate |
$197.20 |
| Rate for Payer: Adventist Health Commercial |
$46.40
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$162.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.80
|
| Rate for Payer: EPIC Health Plan Senior |
$92.80
|
| Rate for Payer: Galaxy Health WC |
$197.20
|
| Rate for Payer: Global Benefits Group Commercial |
$139.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$147.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$136.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.68
|
| Rate for Payer: Multiplan Commercial |
$185.60
|
| Rate for Payer: Networks By Design Commercial |
$150.80
|
| Rate for Payer: Prime Health Services Commercial |
$197.20
|
|
|
HC TRACTION MECHANICAL MCARE COMM
|
Facility
|
OP
|
$232.00
|
|
|
Service Code
|
CPT 97012
|
| Hospital Charge Code |
900407037
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$22.14 |
| Max. Negotiated Rate |
$478.00 |
| Rate for Payer: Cigna of CA PPO |
$171.68
|
| Rate for Payer: Adventist Health Commercial |
$95.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$76.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$197.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$127.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$174.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cigna of CA HMO |
$148.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$197.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$197.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$197.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$162.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.80
|
| Rate for Payer: EPIC Health Plan Senior |
$92.80
|
| Rate for Payer: Galaxy Health WC |
$197.20
|
| Rate for Payer: Global Benefits Group Commercial |
$139.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$147.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$136.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$162.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$162.40
|
| Rate for Payer: Multiplan Commercial |
$185.60
|
| Rate for Payer: Networks By Design Commercial |
$150.80
|
| Rate for Payer: Prime Health Services Commercial |
$197.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$139.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$139.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$197.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$197.20
|
| Rate for Payer: Vantage Medical Group Senior |
$197.20
|
|
|
HC TRACTION MECHANICAL MCARE COMM
|
Facility
|
IP
|
$232.00
|
|
|
Service Code
|
CPT 97012
|
| Hospital Charge Code |
900407037
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$46.40 |
| Max. Negotiated Rate |
$197.20 |
| Rate for Payer: Adventist Health Commercial |
$46.40
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$162.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.80
|
| Rate for Payer: EPIC Health Plan Senior |
$92.80
|
| Rate for Payer: Galaxy Health WC |
$197.20
|
| Rate for Payer: Global Benefits Group Commercial |
$139.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$147.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$136.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.68
|
| Rate for Payer: Multiplan Commercial |
$185.60
|
| Rate for Payer: Networks By Design Commercial |
$150.80
|
| Rate for Payer: Prime Health Services Commercial |
$197.20
|
|
|
HC TRANSABD AMNIOINFUSION ADDL FETUS
|
Facility
|
IP
|
$517.00
|
|
|
Service Code
|
CPT 59070
|
| Hospital Charge Code |
910400089
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$103.40 |
| Max. Negotiated Rate |
$439.45 |
| Rate for Payer: Adventist Health Commercial |
$103.40
|
| Rate for Payer: Cash Price |
$232.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$361.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$206.80
|
| Rate for Payer: EPIC Health Plan Senior |
$206.80
|
| Rate for Payer: Galaxy Health WC |
$439.45
|
| Rate for Payer: Global Benefits Group Commercial |
$310.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$328.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$305.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.08
|
| Rate for Payer: Multiplan Commercial |
$413.60
|
| Rate for Payer: Networks By Design Commercial |
$336.05
|
| Rate for Payer: Prime Health Services Commercial |
$439.45
|
|
|
HC TRANSABD AMNIOINFUSION ADDL FETUS
|
Facility
|
OP
|
$517.00
|
|
|
Service Code
|
CPT 59070
|
| Hospital Charge Code |
902400112
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$103.40 |
| Max. Negotiated Rate |
$8,240.00 |
| Rate for Payer: Adventist Health Commercial |
$103.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,143.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$587.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$391.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| Rate for Payer: Cash Price |
$232.65
|
| Rate for Payer: Cash Price |
$232.65
|
| Rate for Payer: Cash Price |
$232.65
|
| Rate for Payer: Cash Price |
$232.65
|
| Rate for Payer: Cigna of CA HMO |
$330.88
|
| Rate for Payer: Cigna of CA PPO |
$382.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$587.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$391.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$361.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$646.68
|
| Rate for Payer: EPIC Health Plan Senior |
$431.12
|
| Rate for Payer: Galaxy Health WC |
$439.45
|
| Rate for Payer: Global Benefits Group Commercial |
$310.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$642.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$556.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$391.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$328.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$629.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$548.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$493.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$525.19
|
| Rate for Payer: Multiplan Commercial |
$413.60
|
| Rate for Payer: Networks By Design Commercial |
$336.05
|
| Rate for Payer: Prime Health Services Commercial |
$439.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$310.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$310.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,091.00
|
| Rate for Payer: United Healthcare All Other HMO |
$839.00
|
| Rate for Payer: United Healthcare HMO Rider |
$635.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$581.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$391.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$587.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.12
|
| Rate for Payer: Vantage Medical Group Senior |
$391.93
|
|
|
HC TRANSABD AMNIOINFUSION ADDL FETUS
|
Facility
|
IP
|
$517.00
|
|
|
Service Code
|
CPT 59070
|
| Hospital Charge Code |
902400112
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$103.40 |
| Max. Negotiated Rate |
$439.45 |
| Rate for Payer: Adventist Health Commercial |
$103.40
|
| Rate for Payer: Cash Price |
$232.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$361.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$206.80
|
| Rate for Payer: EPIC Health Plan Senior |
$206.80
|
| Rate for Payer: Galaxy Health WC |
$439.45
|
| Rate for Payer: Global Benefits Group Commercial |
$310.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$328.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$305.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.08
|
| Rate for Payer: Multiplan Commercial |
$413.60
|
| Rate for Payer: Networks By Design Commercial |
$336.05
|
| Rate for Payer: Prime Health Services Commercial |
$439.45
|
|
|
HC TRANSABD AMNIOINFUSION ADDL FETUS
|
Facility
|
OP
|
$517.00
|
|
|
Service Code
|
CPT 59070
|
| Hospital Charge Code |
910400089
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$103.40 |
| Max. Negotiated Rate |
$8,240.00 |
| Rate for Payer: Adventist Health Commercial |
$103.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,143.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$587.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$391.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| Rate for Payer: Cash Price |
$232.65
|
| Rate for Payer: Cash Price |
$232.65
|
| Rate for Payer: Cash Price |
$232.65
|
| Rate for Payer: Cigna of CA HMO |
$330.88
|
| Rate for Payer: Cigna of CA PPO |
$382.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$587.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$391.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$361.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$646.68
|
| Rate for Payer: EPIC Health Plan Senior |
$431.12
|
| Rate for Payer: Galaxy Health WC |
$439.45
|
| Rate for Payer: Global Benefits Group Commercial |
$310.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$642.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$556.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$391.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$328.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$629.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$548.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$493.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$525.19
|
| Rate for Payer: Multiplan Commercial |
$413.60
|
| Rate for Payer: Networks By Design Commercial |
$336.05
|
| Rate for Payer: Prime Health Services Commercial |
$439.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$310.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$310.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$258.50
|
| Rate for Payer: United Healthcare All Other HMO |
$258.50
|
| Rate for Payer: United Healthcare HMO Rider |
$258.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$258.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$391.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$587.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.12
|
| Rate for Payer: Vantage Medical Group Senior |
$391.93
|
|
|
HC TRANSABDOMINAL AMNIOINFUSION
|
Facility
|
IP
|
$517.00
|
|
|
Service Code
|
CPT 59070
|
| Hospital Charge Code |
910400088
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$103.40 |
| Max. Negotiated Rate |
$439.45 |
| Rate for Payer: Networks By Design Commercial |
$336.05
|
| Rate for Payer: Adventist Health Commercial |
$103.40
|
| Rate for Payer: Cash Price |
$232.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$361.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$206.80
|
| Rate for Payer: EPIC Health Plan Senior |
$206.80
|
| Rate for Payer: Galaxy Health WC |
$439.45
|
| Rate for Payer: Global Benefits Group Commercial |
$310.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$328.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$305.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.08
|
| Rate for Payer: Multiplan Commercial |
$413.60
|
| Rate for Payer: Prime Health Services Commercial |
$439.45
|
|
|
HC TRANSABDOMINAL AMNIOINFUSION
|
Facility
|
OP
|
$517.00
|
|
|
Service Code
|
CPT 59070
|
| Hospital Charge Code |
910400088
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$103.40 |
| Max. Negotiated Rate |
$8,240.00 |
| Rate for Payer: Adventist Health Commercial |
$103.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,143.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$587.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$391.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| Rate for Payer: Cash Price |
$232.65
|
| Rate for Payer: Cash Price |
$232.65
|
| Rate for Payer: Cash Price |
$232.65
|
| Rate for Payer: Cash Price |
$232.65
|
| Rate for Payer: Cigna of CA HMO |
$330.88
|
| Rate for Payer: Cigna of CA PPO |
$382.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$587.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$391.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$361.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$646.68
|
| Rate for Payer: EPIC Health Plan Senior |
$431.12
|
| Rate for Payer: Galaxy Health WC |
$439.45
|
| Rate for Payer: Global Benefits Group Commercial |
$310.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$642.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$556.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$391.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$328.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$629.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$548.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$493.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$525.19
|
| Rate for Payer: Multiplan Commercial |
$413.60
|
| Rate for Payer: Networks By Design Commercial |
$336.05
|
| Rate for Payer: Prime Health Services Commercial |
$439.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$310.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$310.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,091.00
|
| Rate for Payer: United Healthcare All Other HMO |
$839.00
|
| Rate for Payer: United Healthcare HMO Rider |
$635.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$581.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$391.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$587.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.12
|
| Rate for Payer: Vantage Medical Group Senior |
$391.93
|
|
