|
HC A.C. JOINTS
|
Facility
|
IP
|
$889.00
|
|
|
Service Code
|
CPT 73050
|
| Hospital Charge Code |
909001501
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$177.80 |
| Max. Negotiated Rate |
$755.65 |
| Rate for Payer: Adventist Health Commercial |
$177.80
|
| Rate for Payer: Cash Price |
$400.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$355.60
|
| Rate for Payer: EPIC Health Plan Senior |
$355.60
|
| Rate for Payer: Galaxy Health WC |
$755.65
|
| Rate for Payer: Global Benefits Group Commercial |
$533.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$592.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$338.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$550.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.36
|
| Rate for Payer: Multiplan Commercial |
$711.20
|
| Rate for Payer: Networks By Design Commercial |
$577.85
|
| Rate for Payer: Prime Health Services Commercial |
$755.65
|
|
|
HC A.C. JOINTS
|
Facility
|
OP
|
$889.00
|
|
|
Service Code
|
CPT 73050
|
| Hospital Charge Code |
909001501
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.51 |
| Max. Negotiated Rate |
$755.65 |
| Rate for Payer: Adventist Health Commercial |
$177.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$583.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$189.38
|
| Rate for Payer: Blue Shield of California Commercial |
$544.07
|
| Rate for Payer: Blue Shield of California EPN |
$359.16
|
| Rate for Payer: Cash Price |
$400.05
|
| Rate for Payer: Cash Price |
$400.05
|
| Rate for Payer: Cigna of CA HMO |
$568.96
|
| Rate for Payer: Cigna of CA PPO |
$657.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$755.65
|
| Rate for Payer: Global Benefits Group Commercial |
$533.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$43.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$592.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$711.20
|
| Rate for Payer: Networks By Design Commercial |
$577.85
|
| Rate for Payer: Prime Health Services Commercial |
$755.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$533.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$533.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC ACQ-CADAVERIC-HEART
|
Facility
|
OP
|
$124,136.00
|
|
| Hospital Charge Code |
902200101
|
|
Hospital Revenue Code
|
812
|
| Min. Negotiated Rate |
$24,827.20 |
| Max. Negotiated Rate |
$105,515.60 |
| Rate for Payer: Adventist Health Commercial |
$24,827.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$81,420.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$105,515.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68,274.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$93,102.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76,231.92
|
| Rate for Payer: Cash Price |
$55,861.20
|
| Rate for Payer: Cigna of CA HMO |
$79,447.04
|
| Rate for Payer: Cigna of CA PPO |
$91,860.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$105,515.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$105,515.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$105,515.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$49,654.40
|
| Rate for Payer: EPIC Health Plan Senior |
$49,654.40
|
| Rate for Payer: Galaxy Health WC |
$105,515.60
|
| Rate for Payer: Global Benefits Group Commercial |
$74,481.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$82,798.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47,295.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76,840.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29,792.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$86,895.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$86,895.20
|
| Rate for Payer: Multiplan Commercial |
$99,308.80
|
| Rate for Payer: Networks By Design Commercial |
$80,688.40
|
| Rate for Payer: Prime Health Services Commercial |
$105,515.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$74,481.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$74,481.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$62,068.00
|
| Rate for Payer: United Healthcare All Other HMO |
$62,068.00
|
| Rate for Payer: United Healthcare HMO Rider |
$62,068.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$62,068.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$105,515.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$105,515.60
|
| Rate for Payer: Vantage Medical Group Senior |
$105,515.60
|
|
|
HC ACQ-CADAVERIC-HEART
|
Facility
|
IP
|
$124,136.00
|
|
| Hospital Charge Code |
902200101
|
|
Hospital Revenue Code
|
812
|
| Min. Negotiated Rate |
$24,827.20 |
| Max. Negotiated Rate |
$105,515.60 |
| Rate for Payer: Adventist Health Commercial |
$24,827.20
|
| Rate for Payer: Cash Price |
$55,861.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$49,654.40
|
| Rate for Payer: EPIC Health Plan Senior |
$49,654.40
|
| Rate for Payer: Galaxy Health WC |
$105,515.60
|
| Rate for Payer: Global Benefits Group Commercial |
$74,481.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$82,798.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47,295.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76,840.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29,792.64
|
| Rate for Payer: Multiplan Commercial |
$99,308.80
|
| Rate for Payer: Networks By Design Commercial |
$80,688.40
|
| Rate for Payer: Prime Health Services Commercial |
$105,515.60
|
|
|
HC ACTH
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT 82024
|
| Hospital Charge Code |
900912120
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.80 |
| Max. Negotiated Rate |
$381.49 |
| Rate for Payer: Adventist Health Commercial |
$24.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$81.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$57.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$42.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$38.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$381.49
|
| Rate for Payer: Blue Shield of California Commercial |
$82.96
|
| Rate for Payer: Blue Shield of California EPN |
$54.81
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna of CA HMO |
$79.36
|
| Rate for Payer: Cigna of CA PPO |
$91.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$57.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$38.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.14
|
| Rate for Payer: EPIC Health Plan Senior |
$38.62
|
| Rate for Payer: Galaxy Health WC |
$105.40
|
| Rate for Payer: Global Benefits Group Commercial |
$74.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$63.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$57.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$38.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$82.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$38.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$48.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$51.75
|
| Rate for Payer: Multiplan Commercial |
$99.20
|
| Rate for Payer: Networks By Design Commercial |
$80.60
|
| Rate for Payer: Prime Health Services Commercial |
$105.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$74.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$74.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.28
|
| Rate for Payer: United Healthcare All Other HMO |
$31.28
|
| Rate for Payer: United Healthcare HMO Rider |
$31.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.28
|
| Rate for Payer: Upland Medical Group Pediatric |
$38.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$57.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.48
|
| Rate for Payer: Vantage Medical Group Senior |
$38.62
|
|
|
HC ACTH
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
CPT 82024
|
| Hospital Charge Code |
900912120
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.00 |
| Max. Negotiated Rate |
$140.25 |
| Rate for Payer: Adventist Health Commercial |
$33.00
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.00
|
| Rate for Payer: EPIC Health Plan Senior |
$66.00
|
| Rate for Payer: Galaxy Health WC |
$140.25
|
| Rate for Payer: Global Benefits Group Commercial |
$99.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$110.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$102.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.60
|
| Rate for Payer: Multiplan Commercial |
$132.00
|
| Rate for Payer: Networks By Design Commercial |
$107.25
|
| Rate for Payer: Prime Health Services Commercial |
$140.25
|
|
|
HC ACTIGRAPHY RECORDING ANALYSIS I & R
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
CPT 95803
|
| Hospital Charge Code |
903695803
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$34.40 |
| Max. Negotiated Rate |
$146.20 |
| Rate for Payer: Adventist Health Commercial |
$34.40
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.80
|
| Rate for Payer: EPIC Health Plan Senior |
$68.80
|
| Rate for Payer: Galaxy Health WC |
$146.20
|
| Rate for Payer: Global Benefits Group Commercial |
$103.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$114.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$106.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.28
|
| Rate for Payer: Multiplan Commercial |
$137.60
|
| Rate for Payer: Networks By Design Commercial |
$111.80
|
| Rate for Payer: Prime Health Services Commercial |
$146.20
|
|
|
HC ACTIGRAPHY RECORDING ANALYSIS I & R
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
CPT 95803
|
| Hospital Charge Code |
903695803
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$34.40 |
| Max. Negotiated Rate |
$1,021.00 |
| Rate for Payer: Adventist Health Commercial |
$34.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$112.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$105.63
|
| Rate for Payer: Blue Shield of California Commercial |
$105.26
|
| Rate for Payer: Blue Shield of California EPN |
$69.49
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cigna of CA HMO |
$110.08
|
| Rate for Payer: Cigna of CA PPO |
$127.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.88
|
| Rate for Payer: EPIC Health Plan Senior |
$75.47
|
| Rate for Payer: Galaxy Health WC |
$146.20
|
| Rate for Payer: Global Benefits Group Commercial |
$103.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$123.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$114.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.13
|
| Rate for Payer: Multiplan Commercial |
$137.60
|
| Rate for Payer: Networks By Design Commercial |
$111.80
|
| Rate for Payer: Prime Health Services Commercial |
$146.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$103.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$103.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,021.00
|
| Rate for Payer: United Healthcare All Other HMO |
$803.00
|
| Rate for Payer: United Healthcare HMO Rider |
$608.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$558.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$75.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Vantage Medical Group Senior |
$75.47
|
|
|
HC ACT LOW RANGE/PLUS (POC)
|
Facility
|
IP
|
$214.00
|
|
|
Service Code
|
CPT 85347
|
| Hospital Charge Code |
900912013
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.80 |
| Max. Negotiated Rate |
$181.90 |
| Rate for Payer: Adventist Health Commercial |
$42.80
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.60
|
| Rate for Payer: EPIC Health Plan Senior |
$85.60
|
| Rate for Payer: Galaxy Health WC |
$181.90
|
| Rate for Payer: Global Benefits Group Commercial |
$128.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$142.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$132.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.36
|
| Rate for Payer: Multiplan Commercial |
$171.20
|
| Rate for Payer: Networks By Design Commercial |
$139.10
|
| Rate for Payer: Prime Health Services Commercial |
$181.90
|
|
|
HC ACT LOW RANGE/PLUS (POC)
|
Facility
|
OP
|
$214.00
|
|
|
Service Code
|
CPT 85347
|
| Hospital Charge Code |
900912013
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$181.90 |
| Rate for Payer: Adventist Health Commercial |
$42.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$140.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.03
|
| Rate for Payer: Blue Shield of California Commercial |
$143.17
|
| Rate for Payer: Blue Shield of California EPN |
$94.59
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna of CA HMO |
$136.96
|
| Rate for Payer: Cigna of CA PPO |
$158.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.78
|
| Rate for Payer: EPIC Health Plan Senior |
$4.28
|
| Rate for Payer: Galaxy Health WC |
$181.90
|
| Rate for Payer: Global Benefits Group Commercial |
$128.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$142.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.74
|
| Rate for Payer: Multiplan Commercial |
$171.20
|
| Rate for Payer: Networks By Design Commercial |
$139.10
|
| Rate for Payer: Prime Health Services Commercial |
$181.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$128.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$128.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.46
|
| Rate for Payer: United Healthcare All Other HMO |
$3.46
|
| Rate for Payer: United Healthcare HMO Rider |
$3.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.71
|
| Rate for Payer: Vantage Medical Group Senior |
$4.28
|
|
|
HC ACUTE ABD SERIES
|
Facility
|
IP
|
$616.00
|
|
|
Service Code
|
CPT 74022
|
| Hospital Charge Code |
909001701
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$123.20 |
| Max. Negotiated Rate |
$523.60 |
| Rate for Payer: Adventist Health Commercial |
$123.20
|
| Rate for Payer: Cash Price |
$277.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$246.40
|
| Rate for Payer: EPIC Health Plan Senior |
$246.40
|
| Rate for Payer: Galaxy Health WC |
$523.60
|
| Rate for Payer: Global Benefits Group Commercial |
$369.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$410.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$234.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$381.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$147.84
|
| Rate for Payer: Multiplan Commercial |
$492.80
|
| Rate for Payer: Networks By Design Commercial |
$400.40
|
| Rate for Payer: Prime Health Services Commercial |
$523.60
|
|
|
HC ACUTE ABD SERIES
|
Facility
|
OP
|
$616.00
|
|
|
Service Code
|
CPT 74022
|
| Hospital Charge Code |
909001701
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$66.23 |
| Max. Negotiated Rate |
$523.60 |
| Rate for Payer: Adventist Health Commercial |
$123.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$404.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$209.53
|
| Rate for Payer: Blue Shield of California Commercial |
$376.99
|
| Rate for Payer: Blue Shield of California EPN |
$248.86
|
| Rate for Payer: Cash Price |
$277.20
|
| Rate for Payer: Cash Price |
$277.20
|
| Rate for Payer: Cigna of CA HMO |
$394.24
|
| Rate for Payer: Cigna of CA PPO |
$455.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$523.60
|
| Rate for Payer: Global Benefits Group Commercial |
$369.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$66.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$410.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$147.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$492.80
|
| Rate for Payer: Networks By Design Commercial |
$400.40
|
| Rate for Payer: Prime Health Services Commercial |
$523.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$369.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$369.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$193.23
|
| Rate for Payer: United Healthcare All Other HMO |
$193.23
|
| Rate for Payer: United Healthcare HMO Rider |
$193.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$193.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC ACUTE HEPATITIS PANEL
|
Facility
|
IP
|
$867.00
|
|
|
Service Code
|
CPT 80074
|
| Hospital Charge Code |
900910701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$173.40 |
| Max. Negotiated Rate |
$736.95 |
| Rate for Payer: Adventist Health Commercial |
$173.40
|
| Rate for Payer: Cash Price |
$390.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$346.80
|
| Rate for Payer: EPIC Health Plan Senior |
$346.80
|
| Rate for Payer: Galaxy Health WC |
$736.95
|
| Rate for Payer: Global Benefits Group Commercial |
$520.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$578.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$330.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$536.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.08
|
| Rate for Payer: Multiplan Commercial |
$693.60
|
| Rate for Payer: Networks By Design Commercial |
$563.55
|
| Rate for Payer: Prime Health Services Commercial |
$736.95
|
|
|
HC ACUTE HEPATITIS PANEL
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT 80074
|
| Hospital Charge Code |
900910701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$399.45 |
| Rate for Payer: Adventist Health Commercial |
$33.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$110.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$71.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$47.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$399.45
|
| Rate for Payer: Blue Shield of California Commercial |
$112.39
|
| Rate for Payer: Blue Shield of California EPN |
$74.26
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cigna of CA HMO |
$107.52
|
| Rate for Payer: Cigna of CA PPO |
$124.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$71.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$47.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.30
|
| Rate for Payer: EPIC Health Plan Senior |
$47.63
|
| Rate for Payer: Galaxy Health WC |
$142.80
|
| Rate for Payer: Global Benefits Group Commercial |
$100.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$78.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$58.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$47.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$112.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$60.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$63.82
|
| Rate for Payer: Multiplan Commercial |
$134.40
|
| Rate for Payer: Networks By Design Commercial |
$109.20
|
| Rate for Payer: Prime Health Services Commercial |
$142.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$100.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$38.58
|
| Rate for Payer: United Healthcare All Other HMO |
$38.58
|
| Rate for Payer: United Healthcare HMO Rider |
$38.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$38.58
|
| Rate for Payer: Upland Medical Group Pediatric |
$47.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$71.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.39
|
| Rate for Payer: Vantage Medical Group Senior |
$47.63
|
|
|
HC ADAPTER MED KIT LEAD 5866-38M
|
Facility
|
IP
|
$1,093.00
|
|
|
Service Code
|
CPT C1883
|
| Hospital Charge Code |
906812499
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$218.60 |
| Max. Negotiated Rate |
$929.05 |
| Rate for Payer: Adventist Health Commercial |
$218.60
|
| Rate for Payer: Cash Price |
$491.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$437.20
|
| Rate for Payer: EPIC Health Plan Senior |
$437.20
|
| Rate for Payer: Galaxy Health WC |
$929.05
|
| Rate for Payer: Global Benefits Group Commercial |
$655.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$729.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$416.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$676.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$262.32
|
| Rate for Payer: Multiplan Commercial |
$874.40
|
| Rate for Payer: Networks By Design Commercial |
$710.45
|
| Rate for Payer: Prime Health Services Commercial |
$929.05
|
|
|
HC ADAPTER MED KIT LEAD 5866-38M
|
Facility
|
OP
|
$1,093.00
|
|
|
Service Code
|
CPT C1883
|
| Hospital Charge Code |
906812499
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$218.60 |
| Max. Negotiated Rate |
$929.05 |
| Rate for Payer: Adventist Health Commercial |
$218.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$716.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$929.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$601.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$819.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$671.21
|
| Rate for Payer: Cash Price |
$491.85
|
| Rate for Payer: Cigna of CA HMO |
$699.52
|
| Rate for Payer: Cigna of CA PPO |
$808.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$929.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$929.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$929.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$437.20
|
| Rate for Payer: EPIC Health Plan Senior |
$437.20
|
| Rate for Payer: Galaxy Health WC |
$929.05
|
| Rate for Payer: Global Benefits Group Commercial |
$655.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$729.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$416.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$676.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$262.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$765.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$765.10
|
| Rate for Payer: Multiplan Commercial |
$874.40
|
| Rate for Payer: Networks By Design Commercial |
$710.45
|
| Rate for Payer: Prime Health Services Commercial |
$929.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$655.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$655.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$546.50
|
| Rate for Payer: United Healthcare All Other HMO |
$546.50
|
| Rate for Payer: United Healthcare HMO Rider |
$546.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$546.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$929.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$929.05
|
| Rate for Payer: Vantage Medical Group Senior |
$929.05
|
|
|
HC ADAPTER RT ANGLE Y PORT 12" AMT BUTTON
|
Facility
|
OP
|
$66.42
|
|
| Hospital Charge Code |
901698132
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.28 |
| Max. Negotiated Rate |
$56.46 |
| Rate for Payer: Adventist Health Commercial |
$13.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$43.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$56.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$36.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$49.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.79
|
| Rate for Payer: Cash Price |
$29.89
|
| Rate for Payer: Cigna of CA HMO |
$42.51
|
| Rate for Payer: Cigna of CA PPO |
$49.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$56.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.57
|
| Rate for Payer: EPIC Health Plan Senior |
$26.57
|
| Rate for Payer: Galaxy Health WC |
$56.46
|
| Rate for Payer: Global Benefits Group Commercial |
$39.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$46.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$46.49
|
| Rate for Payer: Multiplan Commercial |
$53.14
|
| Rate for Payer: Networks By Design Commercial |
$43.17
|
| Rate for Payer: Prime Health Services Commercial |
$56.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.21
|
| Rate for Payer: United Healthcare All Other HMO |
$33.21
|
| Rate for Payer: United Healthcare HMO Rider |
$33.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$33.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.46
|
| Rate for Payer: Vantage Medical Group Senior |
$56.46
|
|
|
HC ADAPTER RT ANGLE Y PORT 12" AMT BUTTON
|
Facility
|
IP
|
$66.42
|
|
| Hospital Charge Code |
901698132
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.28 |
| Max. Negotiated Rate |
$56.46 |
| Rate for Payer: Adventist Health Commercial |
$13.28
|
| Rate for Payer: Cash Price |
$29.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.57
|
| Rate for Payer: EPIC Health Plan Senior |
$26.57
|
| Rate for Payer: Galaxy Health WC |
$56.46
|
| Rate for Payer: Global Benefits Group Commercial |
$39.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.94
|
| Rate for Payer: Multiplan Commercial |
$53.14
|
| Rate for Payer: Networks By Design Commercial |
$43.17
|
| Rate for Payer: Prime Health Services Commercial |
$56.46
|
|
|
HC ADAPTION/TRAIN SPEECH DEVICE MCAL
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
CPT 92606
|
| Hospital Charge Code |
907000001
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$34.20 |
| Max. Negotiated Rate |
$145.35 |
| Rate for Payer: Adventist Health Commercial |
$34.20
|
| Rate for Payer: Cash Price |
$76.95
|
| 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 ADAPTION/TRAIN SPEECH DEVICE MCAL
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
CPT 92606
|
| Hospital Charge Code |
907000001
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$41.04 |
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$70.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$112.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$145.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$94.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$128.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: Cash Price |
$76.95
|
| 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 |
$145.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$145.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$145.35
|
| 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: Inland Empire Health Plan (IEHP) Medi-Cal |
$58.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$114.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.04
|
| 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: Molina Healthcare of CA Medi-Cal |
$119.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$119.70
|
| 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 |
$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 |
$145.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$145.35
|
| Rate for Payer: Vantage Medical Group Senior |
$145.35
|
|
|
HC ADAPTOR BS BRADY
|
Facility
|
OP
|
$1,150.00
|
|
|
Service Code
|
CPT C1883
|
| Hospital Charge Code |
906812515
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$230.00 |
| Max. Negotiated Rate |
$977.50 |
| Rate for Payer: Adventist Health Commercial |
$230.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$754.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$977.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$632.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$862.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$706.22
|
| Rate for Payer: Cash Price |
$517.50
|
| Rate for Payer: Cigna of CA HMO |
$736.00
|
| Rate for Payer: Cigna of CA PPO |
$851.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$977.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$977.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$977.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$460.00
|
| Rate for Payer: EPIC Health Plan Senior |
$460.00
|
| Rate for Payer: Galaxy Health WC |
$977.50
|
| Rate for Payer: Global Benefits Group Commercial |
$690.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$767.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$438.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$711.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$276.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$805.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$805.00
|
| Rate for Payer: Multiplan Commercial |
$920.00
|
| Rate for Payer: Networks By Design Commercial |
$747.50
|
| Rate for Payer: Prime Health Services Commercial |
$977.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$690.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$690.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$575.00
|
| Rate for Payer: United Healthcare All Other HMO |
$575.00
|
| Rate for Payer: United Healthcare HMO Rider |
$575.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$575.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$977.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$977.50
|
| Rate for Payer: Vantage Medical Group Senior |
$977.50
|
|
|
HC ADAPTOR BS BRADY
|
Facility
|
IP
|
$1,150.00
|
|
|
Service Code
|
CPT C1883
|
| Hospital Charge Code |
906812515
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$230.00 |
| Max. Negotiated Rate |
$977.50 |
| Rate for Payer: Adventist Health Commercial |
$230.00
|
| Rate for Payer: Cash Price |
$517.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$460.00
|
| Rate for Payer: EPIC Health Plan Senior |
$460.00
|
| Rate for Payer: Galaxy Health WC |
$977.50
|
| Rate for Payer: Global Benefits Group Commercial |
$690.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$767.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$438.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$711.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$276.00
|
| Rate for Payer: Multiplan Commercial |
$920.00
|
| Rate for Payer: Networks By Design Commercial |
$747.50
|
| Rate for Payer: Prime Health Services Commercial |
$977.50
|
|
|
HC ADAPTOR BS TACHY
|
Facility
|
OP
|
$1,610.00
|
|
|
Service Code
|
CPT C1883
|
| Hospital Charge Code |
906812516
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$322.00 |
| Max. Negotiated Rate |
$1,368.50 |
| Rate for Payer: Adventist Health Commercial |
$322.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,056.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,368.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$885.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,207.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$988.70
|
| Rate for Payer: Cash Price |
$724.50
|
| Rate for Payer: Cigna of CA HMO |
$1,030.40
|
| Rate for Payer: Cigna of CA PPO |
$1,191.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,368.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,368.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,368.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$644.00
|
| Rate for Payer: EPIC Health Plan Senior |
$644.00
|
| Rate for Payer: Galaxy Health WC |
$1,368.50
|
| Rate for Payer: Global Benefits Group Commercial |
$966.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,073.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$613.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$996.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$386.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,127.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,127.00
|
| Rate for Payer: Multiplan Commercial |
$1,288.00
|
| Rate for Payer: Networks By Design Commercial |
$1,046.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,368.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$966.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$966.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$805.00
|
| Rate for Payer: United Healthcare All Other HMO |
$805.00
|
| Rate for Payer: United Healthcare HMO Rider |
$805.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$805.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,368.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,368.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,368.50
|
|
|
HC ADAPTOR BS TACHY
|
Facility
|
IP
|
$1,610.00
|
|
|
Service Code
|
CPT C1883
|
| Hospital Charge Code |
906812516
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$322.00 |
| Max. Negotiated Rate |
$1,368.50 |
| Rate for Payer: Adventist Health Commercial |
$322.00
|
| Rate for Payer: Cash Price |
$724.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$644.00
|
| Rate for Payer: EPIC Health Plan Senior |
$644.00
|
| Rate for Payer: Galaxy Health WC |
$1,368.50
|
| Rate for Payer: Global Benefits Group Commercial |
$966.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,073.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$613.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$996.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$386.40
|
| Rate for Payer: Multiplan Commercial |
$1,288.00
|
| Rate for Payer: Networks By Design Commercial |
$1,046.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,368.50
|
|
|
HC ADAPTOR MED KIT BLV-BIS-10
|
Facility
|
OP
|
$1,955.00
|
|
|
Service Code
|
CPT C1883
|
| Hospital Charge Code |
906812495
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$391.00 |
| Max. Negotiated Rate |
$1,661.75 |
| Rate for Payer: Adventist Health Commercial |
$391.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,282.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,661.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,075.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,466.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,200.57
|
| Rate for Payer: Cash Price |
$879.75
|
| Rate for Payer: Cigna of CA HMO |
$1,251.20
|
| Rate for Payer: Cigna of CA PPO |
$1,446.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,661.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,661.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,661.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$782.00
|
| Rate for Payer: EPIC Health Plan Senior |
$782.00
|
| Rate for Payer: Galaxy Health WC |
$1,661.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,173.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,303.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$744.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,210.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$469.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,368.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,368.50
|
| Rate for Payer: Multiplan Commercial |
$1,564.00
|
| Rate for Payer: Networks By Design Commercial |
$1,270.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,661.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,173.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,173.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$977.50
|
| Rate for Payer: United Healthcare All Other HMO |
$977.50
|
| Rate for Payer: United Healthcare HMO Rider |
$977.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$977.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,661.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,661.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,661.75
|
|
