|
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 |
$6.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.62
|
| 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 Foundation Hospitals Commercial/Self Funded |
$9.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.95
|
| 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 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 |
$34.97 |
| Rate for Payer: Adventist Health Commercial |
$3.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$34.97
|
| 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 |
$9.73
|
| Rate for Payer: Cash Price |
$6.83
|
| Rate for Payer: Cash Price |
$6.83
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.62
|
| 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 Foundation Hospitals Commercial/Self Funded |
$9.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.95
|
| 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 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 |
$63.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$98.53
|
| 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 Foundation Hospitals Commercial/Self Funded |
$89.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$83.04
|
| 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 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 |
$33.65
|
| 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 |
$90.32
|
| Rate for Payer: Cash Price |
$63.34
|
| Rate for Payer: Cash Price |
$63.34
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$98.53
|
| 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 Foundation Hospitals Commercial/Self Funded |
$89.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$51.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$83.04
|
| 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 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 |
$2.84
|
| Rate for Payer: Cash Price |
$1.99
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.09
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.61
|
| 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 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 |
$1.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.09
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.61
|
| 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 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 |
$2.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.02
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.39
|
| 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 |
$3.68
|
| Rate for Payer: Cash Price |
$2.58
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.02
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.39
|
| 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 |
$1,155.59 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,155.59
|
| 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 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 |
$157.50
|
| 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 Medicare Advantage |
$206.50
|
| 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
|
456
|
| Min. Negotiated Rate |
$242.80 |
| Max. Negotiated Rate |
$1,031.90 |
| Rate for Payer: Adventist Health Commercial |
$242.80
|
| Rate for Payer: Cash Price |
$546.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$849.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$770.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$716.26
|
| 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
|
456
|
| Min. Negotiated Rate |
$291.36 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$497.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,656.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$317.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$546.30
|
| Rate for Payer: Cash Price |
$546.30
|
| Rate for Payer: Cash Price |
$546.30
|
| 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 |
$475.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$348.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$317.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$849.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| 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/Senior |
$520.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$770.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$293.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$291.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$399.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$425.13
|
| 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: TriValley Medical Group Commercial/Senior |
$728.40
|
| 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 |
$317.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Vantage Medical Group Senior |
$317.26
|
|
|
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 |
$546.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$849.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$770.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$716.26
|
| 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 |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$242.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$317.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$546.30
|
| Rate for Payer: Cash Price |
$546.30
|
| Rate for Payer: Cash Price |
$546.30
|
| 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 |
$475.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$348.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$317.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$849.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| 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/Senior |
$520.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$770.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$293.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$291.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$399.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$425.13
|
| 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 |
$317.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Vantage Medical Group Senior |
$317.26
|
|
|
HC TREAT FX RADIUS & ULNA
|
Facility
|
IP
|
$18,300.00
|
|
|
Service Code
|
CPT 25575
|
| Hospital Charge Code |
900501765
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,660.00 |
| Max. Negotiated Rate |
$15,555.00 |
| Rate for Payer: Adventist Health Commercial |
$3,660.00
|
| Rate for Payer: Cash Price |
$8,235.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12,810.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,320.00
|
| Rate for Payer: EPIC Health Plan Senior |
$7,320.00
|
| Rate for Payer: Galaxy Health WC |
$15,555.00
|
| Rate for Payer: Global Benefits Group Commercial |
$10,980.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11,620.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,797.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,392.00
|
| Rate for Payer: Multiplan Commercial |
$14,640.00
|
| Rate for Payer: Networks By Design Commercial |
$11,895.00
|
| Rate for Payer: Prime Health Services Commercial |
$15,555.00
|
|
|
HC TREAT FX RADIUS & ULNA
|
Facility
|
OP
|
$18,300.00
|
|
|
Service Code
|
CPT 25575
|
| Hospital Charge Code |
900501765
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$961.32 |
| Max. Negotiated Rate |
$15,555.00 |
| Rate for Payer: Adventist Health Commercial |
$3,660.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,332.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| Rate for Payer: Cash Price |
$8,235.00
|
| Rate for Payer: Cash Price |
$8,235.00
|
| Rate for Payer: Cash Price |
$8,235.00
|
| Rate for Payer: Cigna of CA HMO |
$11,712.00
|
| Rate for Payer: Cigna of CA PPO |
$13,542.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,265.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,332.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12,810.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,398.95
|
| Rate for Payer: EPIC Health Plan Senior |
$10,265.97
|
| Rate for Payer: Galaxy Health WC |
$15,555.00
|
| Rate for Payer: Global Benefits Group Commercial |
$10,980.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15,305.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,332.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11,620.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$961.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,032.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,392.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,759.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,505.82
|
| Rate for Payer: Multiplan Commercial |
$14,640.00
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: Networks By Design Commercial |
$11,895.00
|
| Rate for Payer: Prime Health Services Commercial |
$15,555.00
|
| Rate for Payer: Prime Health Services WC |
$14,314.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,980.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,150.00
|
| Rate for Payer: United Healthcare All Other HMO |
$9,150.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,150.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,150.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$9,332.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Vantage Medical Group Senior |
$9,332.70
|
|
|
HC TREAT HIP DISLOC W/O ANESTH/MA
|
Facility
|
OP
|
$1,515.00
|
|
|
Service Code
|
CPT 27256
|
| Hospital Charge Code |
900501604
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$284.56 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$303.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$317.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$681.75
|
| Rate for Payer: Cash Price |
$681.75
|
| Rate for Payer: Cash Price |
$681.75
|
| Rate for Payer: Cigna of CA HMO |
$969.60
|
| Rate for Payer: Cigna of CA PPO |
$1,121.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$475.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$348.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$317.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,060.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$1,287.75
|
| Rate for Payer: Global Benefits Group Commercial |
$909.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$520.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$962.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$284.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$363.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$399.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$1,212.00
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$984.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,287.75
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$909.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$757.50
|
| Rate for Payer: United Healthcare All Other HMO |
$757.50
|
| Rate for Payer: United Healthcare HMO Rider |
$757.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$757.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$317.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Vantage Medical Group Senior |
$317.26
|
|
|
HC TREAT HIP DISLOC W/O ANESTH/MA
|
Facility
|
IP
|
$1,515.00
|
|
|
Service Code
|
CPT 27256
|
| Hospital Charge Code |
900501604
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$303.00 |
| Max. Negotiated Rate |
$1,287.75 |
| Rate for Payer: Adventist Health Commercial |
$303.00
|
| Rate for Payer: Cash Price |
$681.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,060.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$606.00
|
| Rate for Payer: EPIC Health Plan Senior |
$606.00
|
| Rate for Payer: Galaxy Health WC |
$1,287.75
|
| Rate for Payer: Global Benefits Group Commercial |
$909.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$962.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$893.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$363.60
|
| Rate for Payer: Multiplan Commercial |
$1,212.00
|
| Rate for Payer: Networks By Design Commercial |
$984.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,287.75
|
|
|
HC TREAT HIP SOCKET FRACTURE
|
Facility
|
IP
|
$556.00
|
|
|
Service Code
|
CPT 27222
|
| Hospital Charge Code |
900507222
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$111.20 |
| Max. Negotiated Rate |
$472.60 |
| Rate for Payer: Adventist Health Commercial |
$111.20
|
| Rate for Payer: Cash Price |
$250.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$389.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$222.40
|
| Rate for Payer: EPIC Health Plan Senior |
$222.40
|
| Rate for Payer: Galaxy Health WC |
$472.60
|
| Rate for Payer: Global Benefits Group Commercial |
$333.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$353.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$328.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.44
|
| Rate for Payer: Multiplan Commercial |
$444.80
|
| Rate for Payer: Networks By Design Commercial |
$361.40
|
| Rate for Payer: Prime Health Services Commercial |
$472.60
|
|
|
HC TREAT HIP SOCKET FRACTURE
|
Facility
|
OP
|
$556.00
|
|
|
Service Code
|
CPT 27222
|
| Hospital Charge Code |
900507222
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$111.20 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$111.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$317.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Cash Price |
$250.20
|
| Rate for Payer: Cash Price |
$250.20
|
| Rate for Payer: Cash Price |
$250.20
|
| Rate for Payer: Cigna of CA HMO |
$355.84
|
| Rate for Payer: Cigna of CA PPO |
$411.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$475.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$348.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$317.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$389.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$472.60
|
| Rate for Payer: Global Benefits Group Commercial |
$333.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$520.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$652.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$353.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$737.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$444.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$399.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$444.80
|
| Rate for Payer: Networks By Design Commercial |
$361.40
|
| Rate for Payer: Prime Health Services Commercial |
$472.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$333.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$278.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$317.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Vantage Medical Group Senior |
$317.26
|
|
|
HC TREAT HIP SOCKET FX
|
Facility
|
OP
|
$470.00
|
|
|
Service Code
|
CPT 27220
|
| Hospital Charge Code |
900501683
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Vantage Medical Group Senior |
$317.26
|
| Rate for Payer: Adventist Health Commercial |
$94.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$317.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Cigna of CA HMO |
$300.80
|
| Rate for Payer: Cigna of CA PPO |
$347.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$475.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$348.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$317.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$329.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$399.50
|
| Rate for Payer: Global Benefits Group Commercial |
$282.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$520.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$298.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$161.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$399.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$376.00
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$305.50
|
| Rate for Payer: Prime Health Services Commercial |
$399.50
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$282.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$235.00
|
| Rate for Payer: United Healthcare All Other HMO |
$235.00
|
| Rate for Payer: United Healthcare HMO Rider |
$235.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$235.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$317.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.99
|
|
|
HC TREAT HIP SOCKET FX
|
Facility
|
IP
|
$470.00
|
|
|
Service Code
|
CPT 27220
|
| Hospital Charge Code |
900501683
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$399.50 |
| Rate for Payer: Adventist Health Commercial |
$94.00
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$329.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$188.00
|
| Rate for Payer: EPIC Health Plan Senior |
$188.00
|
| Rate for Payer: Galaxy Health WC |
$399.50
|
| Rate for Payer: Global Benefits Group Commercial |
$282.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$298.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.80
|
| Rate for Payer: Multiplan Commercial |
$376.00
|
| Rate for Payer: Networks By Design Commercial |
$305.50
|
| Rate for Payer: Prime Health Services Commercial |
$399.50
|
|
|
HC TREAT INCOMPLETE ABORTION SURG
|
Facility
|
OP
|
$8,010.00
|
|
|
Service Code
|
CPT 59812
|
| Hospital Charge Code |
900501515
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$320.44 |
| Max. Negotiated Rate |
$8,240.00 |
| Rate for Payer: Adventist Health Commercial |
$3,284.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,047.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,163.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| Rate for Payer: Cash Price |
$3,604.50
|
| Rate for Payer: Cash Price |
$3,604.50
|
| Rate for Payer: Cash Price |
$3,604.50
|
| Rate for Payer: Cigna of CA HMO |
$5,126.40
|
| Rate for Payer: Cigna of CA PPO |
$5,927.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,579.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,163.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,607.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,869.74
|
| Rate for Payer: EPIC Health Plan Senior |
$4,579.83
|
| Rate for Payer: Galaxy Health WC |
$6,808.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,806.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,828.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,163.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,086.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$320.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,475.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,922.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,245.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,579.06
|
| Rate for Payer: Multiplan Commercial |
$6,408.00
|
| Rate for Payer: Multiplan WC |
$6,436.87
|
| Rate for Payer: Networks By Design Commercial |
$5,206.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,808.50
|
| Rate for Payer: Prime Health Services WC |
$6,371.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,806.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,806.00
|
| 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 |
$4,163.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Vantage Medical Group Senior |
$4,163.48
|
|
|
HC TREAT INCOMPLETE ABORTION SURG
|
Facility
|
IP
|
$8,010.00
|
|
|
Service Code
|
CPT 59812
|
| Hospital Charge Code |
900501515
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$1,602.00 |
| Max. Negotiated Rate |
$6,808.50 |
| Rate for Payer: Adventist Health Commercial |
$1,602.00
|
| Rate for Payer: Cash Price |
$3,604.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,607.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,204.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,204.00
|
| Rate for Payer: Galaxy Health WC |
$6,808.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,806.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,086.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,725.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,922.40
|
| Rate for Payer: Multiplan Commercial |
$6,408.00
|
| Rate for Payer: Networks By Design Commercial |
$5,206.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,808.50
|
|
|
HC TREAT INCOMPLETE ABORTION SURG
|
Facility
|
IP
|
$8,010.00
|
|
|
Service Code
|
CPT 59812
|
| Hospital Charge Code |
900501515
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,602.00 |
| Max. Negotiated Rate |
$6,808.50 |
| Rate for Payer: Adventist Health Commercial |
$1,602.00
|
| Rate for Payer: Cash Price |
$3,604.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,607.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,204.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,204.00
|
| Rate for Payer: Galaxy Health WC |
$6,808.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,806.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,086.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,725.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,922.40
|
| Rate for Payer: Multiplan Commercial |
$6,408.00
|
| Rate for Payer: Networks By Design Commercial |
$5,206.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,808.50
|
|
