|
HC TUBE TRACH SHILEY PEDS 5MM
|
Facility
|
IP
|
$224.98
|
|
| Hospital Charge Code |
901603786
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$191.23 |
| Rate for Payer: Adventist Health Commercial |
$45.00
|
| Rate for Payer: Cash Price |
$123.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.99
|
| Rate for Payer: EPIC Health Plan Senior |
$89.99
|
| Rate for Payer: Galaxy Health WC |
$191.23
|
| Rate for Payer: Global Benefits Group Commercial |
$134.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$150.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$139.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.00
|
| Rate for Payer: Multiplan Commercial |
$179.98
|
| Rate for Payer: Networks By Design Commercial |
$146.24
|
| Rate for Payer: Prime Health Services Commercial |
$191.23
|
|
|
HC TUBE TRANSFER CAPD REG 48"
|
Facility
|
IP
|
$95.91
|
|
| Hospital Charge Code |
901601947
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.18 |
| Max. Negotiated Rate |
$81.52 |
| Rate for Payer: Adventist Health Commercial |
$19.18
|
| Rate for Payer: Cash Price |
$52.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.36
|
| Rate for Payer: EPIC Health Plan Senior |
$38.36
|
| Rate for Payer: Galaxy Health WC |
$81.52
|
| Rate for Payer: Global Benefits Group Commercial |
$57.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$63.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.02
|
| Rate for Payer: Multiplan Commercial |
$76.73
|
| Rate for Payer: Networks By Design Commercial |
$62.34
|
| Rate for Payer: Prime Health Services Commercial |
$81.52
|
|
|
HC TUBE TRANSFER CAPD REG 48"
|
Facility
|
OP
|
$95.91
|
|
| Hospital Charge Code |
901601947
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.18 |
| Max. Negotiated Rate |
$81.52 |
| Rate for Payer: Adventist Health Commercial |
$19.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$62.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$81.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$71.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$58.90
|
| Rate for Payer: Cash Price |
$52.75
|
| Rate for Payer: Cigna of CA HMO |
$61.38
|
| Rate for Payer: Cigna of CA PPO |
$70.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$81.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$81.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$81.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.36
|
| Rate for Payer: EPIC Health Plan Senior |
$38.36
|
| Rate for Payer: Galaxy Health WC |
$81.52
|
| Rate for Payer: Global Benefits Group Commercial |
$57.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$63.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$67.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$67.14
|
| Rate for Payer: Multiplan Commercial |
$76.73
|
| Rate for Payer: Networks By Design Commercial |
$62.34
|
| Rate for Payer: Prime Health Services Commercial |
$81.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$47.95
|
| Rate for Payer: United Healthcare All Other HMO |
$47.95
|
| Rate for Payer: United Healthcare HMO Rider |
$47.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$47.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$81.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$81.52
|
| Rate for Payer: Vantage Medical Group Senior |
$81.52
|
|
|
HC TUBE VAC ULTA VERATRAC DUO SET
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901698620
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.28 |
| Max. Negotiated Rate |
$493.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$380.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$356.18
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Cigna of CA HMO |
$371.20
|
| Rate for Payer: Cigna of CA PPO |
$429.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$493.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$406.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$290.00
|
| Rate for Payer: United Healthcare All Other HMO |
$290.00
|
| Rate for Payer: United Healthcare HMO Rider |
$290.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC TUBE VAC ULTA VERATRAC DUO SET
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901698620
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$493.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.20
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
|
|
HC TUBE YANKAUER SUCTION REG
|
Facility
|
IP
|
$5.99
|
|
|
Service Code
|
CPT A4628
|
| Hospital Charge Code |
901698726
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$5.09 |
| Rate for Payer: Adventist Health Commercial |
$1.20
|
| Rate for Payer: Cash Price |
$3.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2.40
|
| Rate for Payer: Galaxy Health WC |
$5.09
|
| Rate for Payer: Global Benefits Group Commercial |
$3.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: Multiplan Commercial |
$4.79
|
| Rate for Payer: Networks By Design Commercial |
$3.89
|
| Rate for Payer: Prime Health Services Commercial |
$5.09
|
|
|
HC TUBE YANKAUER SUCTION REG
|
Facility
|
OP
|
$5.99
|
|
|
Service Code
|
CPT A4628
|
| Hospital Charge Code |
901698726
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$5.09 |
| Rate for Payer: Adventist Health Commercial |
$1.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.68
|
| Rate for Payer: Cash Price |
$3.29
|
| Rate for Payer: Cigna of CA HMO |
$3.83
|
| Rate for Payer: Cigna of CA PPO |
$4.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2.40
|
| Rate for Payer: Galaxy Health WC |
$5.09
|
| Rate for Payer: Global Benefits Group Commercial |
$3.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.19
|
| Rate for Payer: Multiplan Commercial |
$4.79
|
| Rate for Payer: Networks By Design Commercial |
$3.89
|
| Rate for Payer: Prime Health Services Commercial |
$5.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.09
|
| Rate for Payer: Vantage Medical Group Senior |
$5.09
|
|
|
HC TUMOR LOCAL I-111 ZEVALIN DIAGNOSTIC
|
Facility
|
OP
|
$3,544.00
|
|
|
Service Code
|
CPT 78804
|
| Hospital Charge Code |
909301340
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$318.70 |
| Max. Negotiated Rate |
$3,012.40 |
| Rate for Payer: Adventist Health Commercial |
$708.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,324.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,488.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,824.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,658.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,176.37
|
| Rate for Payer: Blue Shield of California Commercial |
$2,168.93
|
| Rate for Payer: Blue Shield of California EPN |
$1,431.78
|
| Rate for Payer: Cash Price |
$1,949.20
|
| Rate for Payer: Cash Price |
$1,949.20
|
| Rate for Payer: Cigna of CA HMO |
$2,268.16
|
| Rate for Payer: Cigna of CA PPO |
$2,622.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,488.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,824.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,658.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,239.30
|
| Rate for Payer: EPIC Health Plan Senior |
$1,658.74
|
| Rate for Payer: Galaxy Health WC |
$3,012.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,126.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,720.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$318.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,658.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,363.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$360.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,658.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$850.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,090.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,222.71
|
| Rate for Payer: Multiplan Commercial |
$2,835.20
|
| Rate for Payer: Networks By Design Commercial |
$2,303.60
|
| Rate for Payer: Prime Health Services Commercial |
$3,012.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,126.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,126.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,519.84
|
| Rate for Payer: United Healthcare All Other HMO |
$2,519.84
|
| Rate for Payer: United Healthcare HMO Rider |
$2,519.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,519.84
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,658.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,488.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,824.61
|
| Rate for Payer: Vantage Medical Group Senior |
$1,658.74
|
|
|
HC TUMOR LOCAL I-111 ZEVALIN DIAGNOSTIC
|
Facility
|
IP
|
$3,544.00
|
|
|
Service Code
|
CPT 78804
|
| Hospital Charge Code |
909301340
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$708.80 |
| Max. Negotiated Rate |
$3,012.40 |
| Rate for Payer: Adventist Health Commercial |
$708.80
|
| Rate for Payer: Cash Price |
$1,949.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,417.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,417.60
|
| Rate for Payer: Galaxy Health WC |
$3,012.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,126.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,363.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,350.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,193.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$850.56
|
| Rate for Payer: Multiplan Commercial |
$2,835.20
|
| Rate for Payer: Networks By Design Commercial |
$2,303.60
|
| Rate for Payer: Prime Health Services Commercial |
$3,012.40
|
|
|
HC TUMOR LOCLIZATN SPECT SNGL DAY
|
Facility
|
IP
|
$4,359.00
|
|
|
Service Code
|
CPT 78803
|
| Hospital Charge Code |
909301254
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$871.80 |
| Max. Negotiated Rate |
$3,705.15 |
| Rate for Payer: Adventist Health Commercial |
$871.80
|
| Rate for Payer: Cash Price |
$2,397.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,743.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,743.60
|
| Rate for Payer: Galaxy Health WC |
$3,705.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,615.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,907.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,660.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,698.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,046.16
|
| Rate for Payer: Multiplan Commercial |
$3,487.20
|
| Rate for Payer: Networks By Design Commercial |
$2,833.35
|
| Rate for Payer: Prime Health Services Commercial |
$3,705.15
|
|
|
HC TUMOR LOCLIZATN SPECT SNGL DAY
|
Facility
|
OP
|
$4,359.00
|
|
|
Service Code
|
CPT 78803
|
| Hospital Charge Code |
909301254
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$871.80 |
| Max. Negotiated Rate |
$3,705.15 |
| Rate for Payer: Adventist Health Commercial |
$871.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,859.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,488.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,824.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,658.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,676.86
|
| Rate for Payer: Blue Shield of California Commercial |
$2,667.71
|
| Rate for Payer: Blue Shield of California EPN |
$1,761.04
|
| Rate for Payer: Cash Price |
$2,397.45
|
| Rate for Payer: Cash Price |
$2,397.45
|
| Rate for Payer: Cigna of CA HMO |
$2,789.76
|
| Rate for Payer: Cigna of CA PPO |
$3,225.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,488.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,824.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,658.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,239.30
|
| Rate for Payer: EPIC Health Plan Senior |
$1,658.74
|
| Rate for Payer: Galaxy Health WC |
$3,705.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,615.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,720.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,658.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,907.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,660.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,658.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,046.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,090.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,222.71
|
| Rate for Payer: Multiplan Commercial |
$3,487.20
|
| Rate for Payer: Networks By Design Commercial |
$2,833.35
|
| Rate for Payer: Prime Health Services Commercial |
$3,705.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,615.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,615.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,260.70
|
| Rate for Payer: United Healthcare All Other HMO |
$1,260.70
|
| Rate for Payer: United Healthcare HMO Rider |
$1,260.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,260.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,658.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,488.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,824.61
|
| Rate for Payer: Vantage Medical Group Senior |
$1,658.74
|
|
|
HC TURBO TRACKER 2-TIP
|
Facility
|
IP
|
$1,170.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909081811
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$234.00 |
| Max. Negotiated Rate |
$994.50 |
| Rate for Payer: Adventist Health Commercial |
$234.00
|
| Rate for Payer: Cash Price |
$643.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$468.00
|
| Rate for Payer: EPIC Health Plan Senior |
$468.00
|
| Rate for Payer: Galaxy Health WC |
$994.50
|
| Rate for Payer: Global Benefits Group Commercial |
$702.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$780.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$445.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$724.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$280.80
|
| Rate for Payer: Multiplan Commercial |
$936.00
|
| Rate for Payer: Networks By Design Commercial |
$760.50
|
| Rate for Payer: Prime Health Services Commercial |
$994.50
|
|
|
HC TURBO TRACKER 2-TIP
|
Facility
|
OP
|
$1,170.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909081811
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$234.00 |
| Max. Negotiated Rate |
$994.50 |
| Rate for Payer: Adventist Health Commercial |
$234.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$767.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$994.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$643.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$877.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$718.50
|
| Rate for Payer: Cash Price |
$643.50
|
| Rate for Payer: Cigna of CA HMO |
$748.80
|
| Rate for Payer: Cigna of CA PPO |
$865.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$994.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$994.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$994.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$468.00
|
| Rate for Payer: EPIC Health Plan Senior |
$468.00
|
| Rate for Payer: Galaxy Health WC |
$994.50
|
| Rate for Payer: Global Benefits Group Commercial |
$702.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$780.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$445.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$724.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$280.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$819.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$819.00
|
| Rate for Payer: Multiplan Commercial |
$936.00
|
| Rate for Payer: Networks By Design Commercial |
$760.50
|
| Rate for Payer: Prime Health Services Commercial |
$994.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$702.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$702.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$585.00
|
| Rate for Payer: United Healthcare All Other HMO |
$585.00
|
| Rate for Payer: United Healthcare HMO Rider |
$585.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$585.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$994.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$994.50
|
| Rate for Payer: Vantage Medical Group Senior |
$994.50
|
|
|
HC TVSWG VARIABLESTIFFNESS(TAD/II
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081230
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.60 |
| Max. Negotiated Rate |
$79.05 |
| Rate for Payer: Adventist Health Commercial |
$18.60
|
| Rate for Payer: Cash Price |
$51.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.20
|
| Rate for Payer: EPIC Health Plan Senior |
$37.20
|
| Rate for Payer: Galaxy Health WC |
$79.05
|
| Rate for Payer: Global Benefits Group Commercial |
$55.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$62.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$57.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.32
|
| Rate for Payer: Multiplan Commercial |
$74.40
|
| Rate for Payer: Networks By Design Commercial |
$60.45
|
| Rate for Payer: Prime Health Services Commercial |
$79.05
|
|
|
HC TVSWG VARIABLESTIFFNESS(TAD/II
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081230
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.60 |
| Max. Negotiated Rate |
$79.05 |
| Rate for Payer: Adventist Health Commercial |
$18.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$61.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$79.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$51.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$69.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.11
|
| Rate for Payer: Cash Price |
$51.15
|
| Rate for Payer: Cigna of CA HMO |
$59.52
|
| Rate for Payer: Cigna of CA PPO |
$68.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$79.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$79.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$79.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.20
|
| Rate for Payer: EPIC Health Plan Senior |
$37.20
|
| Rate for Payer: Galaxy Health WC |
$79.05
|
| Rate for Payer: Global Benefits Group Commercial |
$55.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$62.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$57.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$65.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$65.10
|
| Rate for Payer: Multiplan Commercial |
$74.40
|
| Rate for Payer: Networks By Design Commercial |
$60.45
|
| Rate for Payer: Prime Health Services Commercial |
$79.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$55.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$55.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$46.50
|
| Rate for Payer: United Healthcare All Other HMO |
$46.50
|
| Rate for Payer: United Healthcare HMO Rider |
$46.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$46.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$79.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$79.05
|
| Rate for Payer: Vantage Medical Group Senior |
$79.05
|
|
|
HC U1RNP AUTO AB
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913524
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$34.20 |
| Max. Negotiated Rate |
$145.35 |
| Rate for Payer: Adventist Health Commercial |
$34.20
|
| Rate for Payer: Cash Price |
$94.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.40
|
| Rate for Payer: EPIC Health Plan Senior |
$68.40
|
| Rate for Payer: Galaxy Health WC |
$145.35
|
| Rate for Payer: Global Benefits Group Commercial |
$102.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$114.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$105.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.04
|
| Rate for Payer: Multiplan Commercial |
$136.80
|
| Rate for Payer: Networks By Design Commercial |
$111.15
|
| Rate for Payer: Prime Health Services Commercial |
$145.35
|
|
|
HC U1RNP AUTO AB
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913524
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.53 |
| Max. Negotiated Rate |
$150.42 |
| Rate for Payer: Adventist Health Commercial |
$34.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$112.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.42
|
| Rate for Payer: Blue Shield of California Commercial |
$114.40
|
| Rate for Payer: Blue Shield of California EPN |
$75.58
|
| Rate for Payer: Cash Price |
$94.05
|
| Rate for Payer: Cash Price |
$94.05
|
| Rate for Payer: Cigna of CA HMO |
$109.44
|
| Rate for Payer: Cigna of CA PPO |
$126.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.21
|
| Rate for Payer: EPIC Health Plan Senior |
$17.93
|
| Rate for Payer: Galaxy Health WC |
$145.35
|
| Rate for Payer: Global Benefits Group Commercial |
$102.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$114.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.03
|
| Rate for Payer: Multiplan Commercial |
$136.80
|
| Rate for Payer: Networks By Design Commercial |
$111.15
|
| Rate for Payer: Prime Health Services Commercial |
$145.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$102.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$102.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.53
|
| Rate for Payer: United Healthcare All Other HMO |
$14.53
|
| Rate for Payer: United Healthcare HMO Rider |
$14.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC UE ADD DISCON LOCK WRIST UNIT
|
Facility
|
IP
|
$570.00
|
|
|
Service Code
|
CPT L6615
|
| Hospital Charge Code |
915356615
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$114.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$114.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$313.50
|
| Rate for Payer: Cash Price |
$313.50
|
| Rate for Payer: Cigna of CA HMO |
$399.00
|
| Rate for Payer: Cigna of CA PPO |
$399.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$228.00
|
| Rate for Payer: EPIC Health Plan Senior |
$228.00
|
| Rate for Payer: Galaxy Health WC |
$484.50
|
| Rate for Payer: Global Benefits Group Commercial |
$342.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$380.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$217.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$352.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.80
|
| Rate for Payer: Multiplan Commercial |
$456.00
|
| Rate for Payer: Networks By Design Commercial |
$285.00
|
| Rate for Payer: Prime Health Services Commercial |
$484.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$213.92
|
| Rate for Payer: United Healthcare All Other HMO |
$208.22
|
| Rate for Payer: United Healthcare HMO Rider |
$203.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$186.68
|
|
|
HC UE ADD DISCON LOCK WRIST UNIT
|
Facility
|
OP
|
$570.00
|
|
|
Service Code
|
CPT L6615
|
| Hospital Charge Code |
905356615
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$119.65 |
| Max. Negotiated Rate |
$484.50 |
| Rate for Payer: Adventist Health Commercial |
$233.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$484.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$313.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$427.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$330.14
|
| Rate for Payer: Blue Shield of California Commercial |
$420.66
|
| Rate for Payer: Blue Shield of California EPN |
$277.02
|
| Rate for Payer: Cash Price |
$313.50
|
| Rate for Payer: Cash Price |
$313.50
|
| Rate for Payer: Cigna of CA HMO |
$399.00
|
| Rate for Payer: Cigna of CA PPO |
$399.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$484.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$484.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$484.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$228.00
|
| Rate for Payer: EPIC Health Plan Senior |
$228.00
|
| Rate for Payer: Galaxy Health WC |
$484.50
|
| Rate for Payer: Global Benefits Group Commercial |
$342.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$119.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$380.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$135.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$352.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$399.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$399.00
|
| Rate for Payer: Multiplan Commercial |
$456.00
|
| Rate for Payer: Networks By Design Commercial |
$285.00
|
| Rate for Payer: Prime Health Services Commercial |
$484.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$342.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$342.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$213.92
|
| Rate for Payer: United Healthcare All Other HMO |
$208.22
|
| Rate for Payer: United Healthcare HMO Rider |
$203.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$186.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$484.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$484.50
|
| Rate for Payer: Vantage Medical Group Senior |
$484.50
|
|
|
HC UE ADD DISCON LOCK WRIST UNIT
|
Facility
|
IP
|
$570.00
|
|
|
Service Code
|
CPT L6615
|
| Hospital Charge Code |
905356615
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$114.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Networks By Design Commercial |
$285.00
|
| Rate for Payer: Adventist Health Commercial |
$114.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$313.50
|
| Rate for Payer: Cash Price |
$313.50
|
| Rate for Payer: Cigna of CA HMO |
$399.00
|
| Rate for Payer: Cigna of CA PPO |
$399.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$228.00
|
| Rate for Payer: EPIC Health Plan Senior |
$228.00
|
| Rate for Payer: Galaxy Health WC |
$484.50
|
| Rate for Payer: Global Benefits Group Commercial |
$342.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$380.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$217.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$352.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.80
|
| Rate for Payer: Multiplan Commercial |
$456.00
|
| Rate for Payer: Prime Health Services Commercial |
$484.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$213.92
|
| Rate for Payer: United Healthcare All Other HMO |
$208.22
|
| Rate for Payer: United Healthcare HMO Rider |
$203.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$186.68
|
|
|
HC UE ADD DISCON LOCK WRIST UNIT
|
Facility
|
OP
|
$570.00
|
|
|
Service Code
|
CPT L6615
|
| Hospital Charge Code |
915356615
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$119.65 |
| Max. Negotiated Rate |
$484.50 |
| Rate for Payer: Adventist Health Commercial |
$233.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$484.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$313.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$427.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$330.14
|
| Rate for Payer: Blue Shield of California Commercial |
$420.66
|
| Rate for Payer: Blue Shield of California EPN |
$277.02
|
| Rate for Payer: Cash Price |
$313.50
|
| Rate for Payer: Cash Price |
$313.50
|
| Rate for Payer: Cigna of CA HMO |
$399.00
|
| Rate for Payer: Cigna of CA PPO |
$399.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$484.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$484.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$484.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$228.00
|
| Rate for Payer: EPIC Health Plan Senior |
$228.00
|
| Rate for Payer: Galaxy Health WC |
$484.50
|
| Rate for Payer: Global Benefits Group Commercial |
$342.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$119.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$380.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$135.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$352.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$399.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$399.00
|
| Rate for Payer: Multiplan Commercial |
$456.00
|
| Rate for Payer: Networks By Design Commercial |
$285.00
|
| Rate for Payer: Prime Health Services Commercial |
$484.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$342.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$342.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$213.92
|
| Rate for Payer: United Healthcare All Other HMO |
$208.22
|
| Rate for Payer: United Healthcare HMO Rider |
$203.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$186.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$484.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$484.50
|
| Rate for Payer: Vantage Medical Group Senior |
$484.50
|
|
|
HC UE ADD EXCUR AMPL LEVER TYPE
|
Facility
|
OP
|
$337.00
|
|
|
Service Code
|
CPT L6642
|
| Hospital Charge Code |
915356642
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$80.88 |
| Max. Negotiated Rate |
$286.45 |
| Rate for Payer: Adventist Health Commercial |
$138.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$286.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$185.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$195.19
|
| Rate for Payer: Blue Shield of California Commercial |
$248.71
|
| Rate for Payer: Blue Shield of California EPN |
$163.78
|
| Rate for Payer: Cash Price |
$185.35
|
| Rate for Payer: Cash Price |
$185.35
|
| Rate for Payer: Cigna of CA HMO |
$235.90
|
| Rate for Payer: Cigna of CA PPO |
$235.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$286.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$286.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$286.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.80
|
| Rate for Payer: EPIC Health Plan Senior |
$134.80
|
| Rate for Payer: Galaxy Health WC |
$286.45
|
| Rate for Payer: Global Benefits Group Commercial |
$202.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$217.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$224.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$246.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$208.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$235.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$235.90
|
| Rate for Payer: Multiplan Commercial |
$269.60
|
| Rate for Payer: Networks By Design Commercial |
$168.50
|
| Rate for Payer: Prime Health Services Commercial |
$286.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$202.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$202.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$126.48
|
| Rate for Payer: United Healthcare All Other HMO |
$123.11
|
| Rate for Payer: United Healthcare HMO Rider |
$120.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$110.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$286.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$286.45
|
| Rate for Payer: Vantage Medical Group Senior |
$286.45
|
|
|
HC UE ADD EXCUR AMPL LEVER TYPE
|
Facility
|
IP
|
$337.00
|
|
|
Service Code
|
CPT L6642
|
| Hospital Charge Code |
915356642
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$67.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$67.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$185.35
|
| Rate for Payer: Cash Price |
$185.35
|
| Rate for Payer: Cigna of CA HMO |
$235.90
|
| Rate for Payer: Cigna of CA PPO |
$235.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.80
|
| Rate for Payer: EPIC Health Plan Senior |
$134.80
|
| Rate for Payer: Galaxy Health WC |
$286.45
|
| Rate for Payer: Global Benefits Group Commercial |
$202.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$224.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$208.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.88
|
| Rate for Payer: Multiplan Commercial |
$269.60
|
| Rate for Payer: Networks By Design Commercial |
$168.50
|
| Rate for Payer: Prime Health Services Commercial |
$286.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$126.48
|
| Rate for Payer: United Healthcare All Other HMO |
$123.11
|
| Rate for Payer: United Healthcare HMO Rider |
$120.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$110.37
|
|
|
HC UE ADD EXCUR AMPL LEVER TYPE
|
Facility
|
OP
|
$337.00
|
|
|
Service Code
|
CPT L6642
|
| Hospital Charge Code |
905356642
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$80.88 |
| Max. Negotiated Rate |
$286.45 |
| Rate for Payer: Adventist Health Commercial |
$138.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$286.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$185.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$195.19
|
| Rate for Payer: Blue Shield of California Commercial |
$248.71
|
| Rate for Payer: Blue Shield of California EPN |
$163.78
|
| Rate for Payer: Cash Price |
$185.35
|
| Rate for Payer: Cash Price |
$185.35
|
| Rate for Payer: Cigna of CA HMO |
$235.90
|
| Rate for Payer: Cigna of CA PPO |
$235.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$286.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$286.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$286.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.80
|
| Rate for Payer: EPIC Health Plan Senior |
$134.80
|
| Rate for Payer: Galaxy Health WC |
$286.45
|
| Rate for Payer: Global Benefits Group Commercial |
$202.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$217.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$224.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$246.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$208.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$235.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$235.90
|
| Rate for Payer: Multiplan Commercial |
$269.60
|
| Rate for Payer: Networks By Design Commercial |
$168.50
|
| Rate for Payer: Prime Health Services Commercial |
$286.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$202.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$202.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$126.48
|
| Rate for Payer: United Healthcare All Other HMO |
$123.11
|
| Rate for Payer: United Healthcare HMO Rider |
$120.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$110.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$286.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$286.45
|
| Rate for Payer: Vantage Medical Group Senior |
$286.45
|
|
|
HC UE ADD EXCUR AMPL LEVER TYPE
|
Facility
|
IP
|
$337.00
|
|
|
Service Code
|
CPT L6642
|
| Hospital Charge Code |
905356642
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$67.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$67.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$185.35
|
| Rate for Payer: Cash Price |
$185.35
|
| Rate for Payer: Cigna of CA HMO |
$235.90
|
| Rate for Payer: Cigna of CA PPO |
$235.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.80
|
| Rate for Payer: EPIC Health Plan Senior |
$134.80
|
| Rate for Payer: Galaxy Health WC |
$286.45
|
| Rate for Payer: Global Benefits Group Commercial |
$202.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$224.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$208.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.88
|
| Rate for Payer: Multiplan Commercial |
$269.60
|
| Rate for Payer: Networks By Design Commercial |
$168.50
|
| Rate for Payer: Prime Health Services Commercial |
$286.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$126.48
|
| Rate for Payer: United Healthcare All Other HMO |
$123.11
|
| Rate for Payer: United Healthcare HMO Rider |
$120.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$110.37
|
|
