|
HC AUDITORY EP, LIMITED
|
Facility
|
IP
|
$291.00
|
|
|
Service Code
|
CPT 92586
|
| Hospital Charge Code |
900600216
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$58.20 |
| Max. Negotiated Rate |
$247.35 |
| Rate for Payer: Adventist Health Commercial |
$58.20
|
| Rate for Payer: Cash Price |
$130.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.40
|
| Rate for Payer: EPIC Health Plan Senior |
$116.40
|
| Rate for Payer: Galaxy Health WC |
$247.35
|
| Rate for Payer: Global Benefits Group Commercial |
$174.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$194.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$180.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.84
|
| Rate for Payer: Multiplan Commercial |
$232.80
|
| Rate for Payer: Networks By Design Commercial |
$189.15
|
| Rate for Payer: Prime Health Services Commercial |
$247.35
|
|
|
HC AUG/ALTR COMM
|
Facility
|
IP
|
$228.00
|
|
| Hospital Charge Code |
905601807
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$45.60 |
| Max. Negotiated Rate |
$193.80 |
| Rate for Payer: Adventist Health Commercial |
$45.60
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.20
|
| Rate for Payer: EPIC Health Plan Senior |
$91.20
|
| Rate for Payer: Galaxy Health WC |
$193.80
|
| Rate for Payer: Global Benefits Group Commercial |
$136.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$152.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$141.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.72
|
| Rate for Payer: Multiplan Commercial |
$182.40
|
| Rate for Payer: Networks By Design Commercial |
$148.20
|
| Rate for Payer: Prime Health Services Commercial |
$193.80
|
|
|
HC AUG/ALTR COMM
|
Facility
|
OP
|
$228.00
|
|
| Hospital Charge Code |
905601807
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$54.72 |
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$93.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$149.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$193.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$125.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.00
|
| 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 |
$102.60
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cigna of CA HMO |
$145.92
|
| Rate for Payer: Cigna of CA PPO |
$168.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$193.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$193.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$193.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.20
|
| Rate for Payer: EPIC Health Plan Senior |
$91.20
|
| Rate for Payer: Galaxy Health WC |
$193.80
|
| Rate for Payer: Global Benefits Group Commercial |
$136.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$152.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$141.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$159.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$159.60
|
| Rate for Payer: Multiplan Commercial |
$182.40
|
| Rate for Payer: Networks By Design Commercial |
$148.20
|
| Rate for Payer: Prime Health Services Commercial |
$193.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$136.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$136.80
|
| 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 |
$193.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$193.80
|
| Rate for Payer: Vantage Medical Group Senior |
$193.80
|
|
|
HC AUTO GRASP FEATURE, ADDITION
|
Facility
|
OP
|
$6,895.00
|
|
|
Service Code
|
CPT L6881
|
| Hospital Charge Code |
915356881
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,654.80 |
| Max. Negotiated Rate |
$5,860.75 |
| Rate for Payer: Adventist Health Commercial |
$2,826.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,860.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,792.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,171.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,993.58
|
| Rate for Payer: Blue Shield of California Commercial |
$5,088.51
|
| Rate for Payer: Blue Shield of California EPN |
$3,350.97
|
| Rate for Payer: Cash Price |
$3,102.75
|
| Rate for Payer: Cigna of CA HMO |
$4,826.50
|
| Rate for Payer: Cigna of CA PPO |
$4,826.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,860.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,860.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,860.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,758.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,758.00
|
| Rate for Payer: Galaxy Health WC |
$5,860.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,137.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,598.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,268.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,654.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,826.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,826.50
|
| Rate for Payer: Multiplan Commercial |
$5,516.00
|
| Rate for Payer: Networks By Design Commercial |
$3,447.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,860.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,137.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,137.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,587.69
|
| Rate for Payer: United Healthcare All Other HMO |
$2,518.74
|
| Rate for Payer: United Healthcare HMO Rider |
$2,464.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,258.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,860.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,860.75
|
| Rate for Payer: Vantage Medical Group Senior |
$5,860.75
|
|
|
HC AUTO GRASP FEATURE, ADDITION
|
Facility
|
OP
|
$6,895.00
|
|
|
Service Code
|
CPT L6881
|
| Hospital Charge Code |
905356881
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,654.80 |
| Max. Negotiated Rate |
$5,860.75 |
| Rate for Payer: EPIC Health Plan Commercial |
$2,758.00
|
| Rate for Payer: Adventist Health Commercial |
$2,826.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,860.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,792.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,171.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,993.58
|
| Rate for Payer: Blue Shield of California Commercial |
$5,088.51
|
| Rate for Payer: Blue Shield of California EPN |
$3,350.97
|
| Rate for Payer: Cash Price |
$3,102.75
|
| Rate for Payer: Cigna of CA HMO |
$4,826.50
|
| Rate for Payer: Cigna of CA PPO |
$4,826.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,860.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,860.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,860.75
|
| Rate for Payer: EPIC Health Plan Senior |
$2,758.00
|
| Rate for Payer: Galaxy Health WC |
$5,860.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,137.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,598.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,268.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,654.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,826.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,826.50
|
| Rate for Payer: Multiplan Commercial |
$5,516.00
|
| Rate for Payer: Networks By Design Commercial |
$3,447.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,860.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,137.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,137.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,587.69
|
| Rate for Payer: United Healthcare All Other HMO |
$2,518.74
|
| Rate for Payer: United Healthcare HMO Rider |
$2,464.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,258.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,860.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,860.75
|
| Rate for Payer: Vantage Medical Group Senior |
$5,860.75
|
|
|
HC AUTO GRASP FEATURE, ADDITION
|
Facility
|
IP
|
$6,895.00
|
|
|
Service Code
|
CPT L6881
|
| Hospital Charge Code |
915356881
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,379.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,379.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,102.75
|
| Rate for Payer: Cash Price |
$3,102.75
|
| Rate for Payer: Cigna of CA HMO |
$4,826.50
|
| Rate for Payer: Cigna of CA PPO |
$4,826.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,758.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,758.00
|
| Rate for Payer: Galaxy Health WC |
$5,860.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,137.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,598.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,626.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,268.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,654.80
|
| Rate for Payer: Multiplan Commercial |
$5,516.00
|
| Rate for Payer: Networks By Design Commercial |
$3,447.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,860.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,587.69
|
| Rate for Payer: United Healthcare All Other HMO |
$2,518.74
|
| Rate for Payer: United Healthcare HMO Rider |
$2,464.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,258.11
|
|
|
HC AUTO GRASP FEATURE, ADDITION
|
Facility
|
IP
|
$6,895.00
|
|
|
Service Code
|
CPT L6881
|
| Hospital Charge Code |
905356881
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,379.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,379.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,102.75
|
| Rate for Payer: Cash Price |
$3,102.75
|
| Rate for Payer: Cigna of CA HMO |
$4,826.50
|
| Rate for Payer: Cigna of CA PPO |
$4,826.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,758.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,758.00
|
| Rate for Payer: Galaxy Health WC |
$5,860.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,137.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,598.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,626.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,268.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,654.80
|
| Rate for Payer: Multiplan Commercial |
$5,516.00
|
| Rate for Payer: Networks By Design Commercial |
$3,447.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,860.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,587.69
|
| Rate for Payer: United Healthcare All Other HMO |
$2,518.74
|
| Rate for Payer: United Healthcare HMO Rider |
$2,464.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,258.11
|
|
|
HC AUTOIMMUNE PANEL
|
Facility
|
OP
|
$38.00
|
|
| Hospital Charge Code |
900913519
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$32.30 |
| Rate for Payer: Adventist Health Commercial |
$7.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.34
|
| Rate for Payer: Blue Shield of California Commercial |
$25.42
|
| Rate for Payer: Blue Shield of California EPN |
$16.80
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cigna of CA HMO |
$24.32
|
| Rate for Payer: Cigna of CA PPO |
$28.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$32.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.20
|
| Rate for Payer: EPIC Health Plan Senior |
$15.20
|
| Rate for Payer: Galaxy Health WC |
$32.30
|
| Rate for Payer: Global Benefits Group Commercial |
$22.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.60
|
| Rate for Payer: Multiplan Commercial |
$30.40
|
| Rate for Payer: Networks By Design Commercial |
$24.70
|
| Rate for Payer: Prime Health Services Commercial |
$32.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19.00
|
| Rate for Payer: United Healthcare HMO Rider |
$19.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.30
|
| Rate for Payer: Vantage Medical Group Senior |
$32.30
|
|
|
HC AVELLE NPWT DRSNG 12 X 31CM
|
Facility
|
OP
|
$273.91
|
|
| Hospital Charge Code |
901698548
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.78 |
| Max. Negotiated Rate |
$232.82 |
| Rate for Payer: Adventist Health Commercial |
$54.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$179.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$232.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$150.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$205.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$168.21
|
| Rate for Payer: Cash Price |
$123.26
|
| Rate for Payer: Cigna of CA HMO |
$175.30
|
| Rate for Payer: Cigna of CA PPO |
$202.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$232.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$232.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$232.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.56
|
| Rate for Payer: EPIC Health Plan Senior |
$109.56
|
| Rate for Payer: Galaxy Health WC |
$232.82
|
| Rate for Payer: Global Benefits Group Commercial |
$164.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$182.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$169.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$191.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$191.74
|
| Rate for Payer: Multiplan Commercial |
$219.13
|
| Rate for Payer: Networks By Design Commercial |
$178.04
|
| Rate for Payer: Prime Health Services Commercial |
$232.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$164.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$164.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$136.96
|
| Rate for Payer: United Healthcare All Other HMO |
$136.96
|
| Rate for Payer: United Healthcare HMO Rider |
$136.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$136.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$232.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$232.82
|
| Rate for Payer: Vantage Medical Group Senior |
$232.82
|
|
|
HC AVELLE NPWT DRSNG 12 X 31CM
|
Facility
|
IP
|
$273.91
|
|
| Hospital Charge Code |
901698548
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.78 |
| Max. Negotiated Rate |
$232.82 |
| Rate for Payer: Adventist Health Commercial |
$54.78
|
| Rate for Payer: Cash Price |
$123.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.56
|
| Rate for Payer: EPIC Health Plan Senior |
$109.56
|
| Rate for Payer: Galaxy Health WC |
$232.82
|
| Rate for Payer: Global Benefits Group Commercial |
$164.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$182.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$169.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.74
|
| Rate for Payer: Multiplan Commercial |
$219.13
|
| Rate for Payer: Networks By Design Commercial |
$178.04
|
| Rate for Payer: Prime Health Services Commercial |
$232.82
|
|
|
HC AVELLE NPWT DRSNG 12 X 41CM
|
Facility
|
OP
|
$333.13
|
|
| Hospital Charge Code |
901698549
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$66.63 |
| Max. Negotiated Rate |
$283.16 |
| Rate for Payer: Adventist Health Commercial |
$66.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$218.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$283.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$183.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$249.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$204.58
|
| Rate for Payer: Cash Price |
$149.91
|
| Rate for Payer: Cigna of CA HMO |
$213.20
|
| Rate for Payer: Cigna of CA PPO |
$246.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$283.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$283.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$133.25
|
| Rate for Payer: EPIC Health Plan Senior |
$133.25
|
| Rate for Payer: Galaxy Health WC |
$283.16
|
| Rate for Payer: Global Benefits Group Commercial |
$199.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$222.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$126.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$206.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$233.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$233.19
|
| Rate for Payer: Multiplan Commercial |
$266.50
|
| Rate for Payer: Networks By Design Commercial |
$216.53
|
| Rate for Payer: Prime Health Services Commercial |
$283.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$199.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$199.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$166.56
|
| Rate for Payer: United Healthcare All Other HMO |
$166.56
|
| Rate for Payer: United Healthcare HMO Rider |
$166.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$166.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$283.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.16
|
| Rate for Payer: Vantage Medical Group Senior |
$283.16
|
|
|
HC AVELLE NPWT DRSNG 12 X 41CM
|
Facility
|
IP
|
$333.13
|
|
| Hospital Charge Code |
901698549
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$66.63 |
| Max. Negotiated Rate |
$283.16 |
| Rate for Payer: Adventist Health Commercial |
$66.63
|
| Rate for Payer: Cash Price |
$149.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$133.25
|
| Rate for Payer: EPIC Health Plan Senior |
$133.25
|
| Rate for Payer: Galaxy Health WC |
$283.16
|
| Rate for Payer: Global Benefits Group Commercial |
$199.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$222.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$126.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$206.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.95
|
| Rate for Payer: Multiplan Commercial |
$266.50
|
| Rate for Payer: Networks By Design Commercial |
$216.53
|
| Rate for Payer: Prime Health Services Commercial |
$283.16
|
|
|
HC AVERA ARSTASIS HEMOSTASIS
|
Facility
|
IP
|
$1,012.00
|
|
| Hospital Charge Code |
906812522
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$202.40 |
| Max. Negotiated Rate |
$860.20 |
| Rate for Payer: Adventist Health Commercial |
$202.40
|
| Rate for Payer: Cash Price |
$455.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$404.80
|
| Rate for Payer: EPIC Health Plan Senior |
$404.80
|
| Rate for Payer: Galaxy Health WC |
$860.20
|
| Rate for Payer: Global Benefits Group Commercial |
$607.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$675.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$385.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$626.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$242.88
|
| Rate for Payer: Multiplan Commercial |
$809.60
|
| Rate for Payer: Networks By Design Commercial |
$657.80
|
| Rate for Payer: Prime Health Services Commercial |
$860.20
|
|
|
HC AVERA ARSTASIS HEMOSTASIS
|
Facility
|
OP
|
$1,012.00
|
|
| Hospital Charge Code |
906812522
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$202.40 |
| Max. Negotiated Rate |
$860.20 |
| Rate for Payer: Adventist Health Commercial |
$202.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$663.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$860.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$556.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$759.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$621.47
|
| Rate for Payer: Cash Price |
$455.40
|
| Rate for Payer: Cigna of CA HMO |
$647.68
|
| Rate for Payer: Cigna of CA PPO |
$748.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$860.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$860.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$860.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$404.80
|
| Rate for Payer: EPIC Health Plan Senior |
$404.80
|
| Rate for Payer: Galaxy Health WC |
$860.20
|
| Rate for Payer: Global Benefits Group Commercial |
$607.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$675.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$385.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$626.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$242.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$708.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$708.40
|
| Rate for Payer: Multiplan Commercial |
$809.60
|
| Rate for Payer: Networks By Design Commercial |
$657.80
|
| Rate for Payer: Prime Health Services Commercial |
$860.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$607.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$607.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$506.00
|
| Rate for Payer: United Healthcare HMO Rider |
$506.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$506.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$860.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$860.20
|
| Rate for Payer: Vantage Medical Group Senior |
$860.20
|
|
|
HC AVUL OF NAIL PL PART OR COMPL
|
Facility
|
OP
|
$773.00
|
|
|
Service Code
|
CPT 11730
|
| Hospital Charge Code |
900501015
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$60.84 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$154.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$347.85
|
| Rate for Payer: Cash Price |
$347.85
|
| Rate for Payer: Cash Price |
$347.85
|
| Rate for Payer: Cigna of CA HMO |
$494.72
|
| Rate for Payer: Cigna of CA PPO |
$572.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.83
|
| Rate for Payer: EPIC Health Plan Senior |
$252.47
|
| Rate for Payer: Galaxy Health WC |
$657.05
|
| Rate for Payer: Global Benefits Group Commercial |
$463.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$414.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$515.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$318.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.31
|
| Rate for Payer: Multiplan Commercial |
$618.40
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$502.45
|
| Rate for Payer: Prime Health Services Commercial |
$657.05
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$463.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$386.50
|
| Rate for Payer: United Healthcare All Other HMO |
$386.50
|
| Rate for Payer: United Healthcare HMO Rider |
$386.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$386.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$252.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
HC AVUL OF NAIL PL PART OR COMPL
|
Facility
|
IP
|
$773.00
|
|
|
Service Code
|
CPT 11730
|
| Hospital Charge Code |
900501015
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$154.60 |
| Max. Negotiated Rate |
$657.05 |
| Rate for Payer: Adventist Health Commercial |
$154.60
|
| Rate for Payer: Cash Price |
$347.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.20
|
| Rate for Payer: EPIC Health Plan Senior |
$309.20
|
| Rate for Payer: Galaxy Health WC |
$657.05
|
| Rate for Payer: Global Benefits Group Commercial |
$463.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$515.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$294.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$478.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.52
|
| Rate for Payer: Multiplan Commercial |
$618.40
|
| Rate for Payer: Networks By Design Commercial |
$502.45
|
| Rate for Payer: Prime Health Services Commercial |
$657.05
|
|
|
HC AVULSION EA ADD'L NAIL PLATE
|
Facility
|
OP
|
$413.00
|
|
|
Service Code
|
CPT 11732
|
| Hospital Charge Code |
900501224
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$58.42 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$82.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$351.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$227.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$309.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$185.85
|
| Rate for Payer: Cash Price |
$185.85
|
| Rate for Payer: Cash Price |
$185.85
|
| Rate for Payer: Cigna of CA HMO |
$264.32
|
| Rate for Payer: Cigna of CA PPO |
$305.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$351.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$351.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$351.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$165.20
|
| Rate for Payer: EPIC Health Plan Senior |
$165.20
|
| Rate for Payer: Galaxy Health WC |
$351.05
|
| Rate for Payer: Global Benefits Group Commercial |
$247.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$275.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$255.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$289.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$289.10
|
| Rate for Payer: Multiplan Commercial |
$330.40
|
| Rate for Payer: Networks By Design Commercial |
$268.45
|
| Rate for Payer: Prime Health Services Commercial |
$351.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$247.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$206.50
|
| Rate for Payer: United Healthcare All Other HMO |
$206.50
|
| Rate for Payer: United Healthcare HMO Rider |
$206.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$351.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$351.05
|
| Rate for Payer: Vantage Medical Group Senior |
$351.05
|
|
|
HC AVULSION EA ADD'L NAIL PLATE
|
Facility
|
IP
|
$413.00
|
|
|
Service Code
|
CPT 11732
|
| Hospital Charge Code |
900501224
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$82.60 |
| Max. Negotiated Rate |
$351.05 |
| Rate for Payer: Adventist Health Commercial |
$82.60
|
| Rate for Payer: Cash Price |
$185.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$165.20
|
| Rate for Payer: EPIC Health Plan Senior |
$165.20
|
| Rate for Payer: Galaxy Health WC |
$351.05
|
| Rate for Payer: Global Benefits Group Commercial |
$247.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$275.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$157.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$255.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.12
|
| Rate for Payer: Multiplan Commercial |
$330.40
|
| Rate for Payer: Networks By Design Commercial |
$268.45
|
| Rate for Payer: Prime Health Services Commercial |
$351.05
|
|
|
HC AVX ANGIOJET, CATH
|
Facility
|
IP
|
$1,620.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909080036
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$324.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$324.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$729.00
|
| Rate for Payer: Cash Price |
$729.00
|
| Rate for Payer: Cigna of CA HMO |
$1,134.00
|
| Rate for Payer: Cigna of CA PPO |
$1,134.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.00
|
| Rate for Payer: EPIC Health Plan Senior |
$648.00
|
| Rate for Payer: Galaxy Health WC |
$1,377.00
|
| Rate for Payer: Global Benefits Group Commercial |
$972.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,080.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$617.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,002.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$388.80
|
| Rate for Payer: Multiplan Commercial |
$1,296.00
|
| Rate for Payer: Networks By Design Commercial |
$810.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,377.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$607.99
|
| Rate for Payer: United Healthcare All Other HMO |
$591.79
|
| Rate for Payer: United Healthcare HMO Rider |
$578.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$530.55
|
|
|
HC AVX ANGIOJET, CATH
|
Facility
|
OP
|
$1,620.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909080036
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$324.00 |
| Max. Negotiated Rate |
$1,377.00 |
| Rate for Payer: Adventist Health Commercial |
$324.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,377.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$891.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,215.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$938.30
|
| Rate for Payer: Blue Shield of California Commercial |
$1,195.56
|
| Rate for Payer: Blue Shield of California EPN |
$787.32
|
| Rate for Payer: Cash Price |
$729.00
|
| Rate for Payer: Cigna of CA HMO |
$1,134.00
|
| Rate for Payer: Cigna of CA PPO |
$1,134.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,377.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,377.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,377.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.00
|
| Rate for Payer: EPIC Health Plan Senior |
$648.00
|
| Rate for Payer: Galaxy Health WC |
$1,377.00
|
| Rate for Payer: Global Benefits Group Commercial |
$972.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,080.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$617.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,002.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$388.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,134.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,134.00
|
| Rate for Payer: Multiplan Commercial |
$1,296.00
|
| Rate for Payer: Networks By Design Commercial |
$810.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,377.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$972.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$972.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$607.99
|
| Rate for Payer: United Healthcare All Other HMO |
$591.79
|
| Rate for Payer: United Healthcare HMO Rider |
$578.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$530.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,377.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,377.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,377.00
|
|
|
HC AXILLARY CRUTCH EXTENSION
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
CPT L0978
|
| Hospital Charge Code |
915350978
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$96.00 |
| Max. Negotiated Rate |
$340.00 |
| Rate for Payer: Adventist Health Commercial |
$164.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$340.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$220.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$300.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$231.68
|
| Rate for Payer: Blue Shield of California Commercial |
$295.20
|
| Rate for Payer: Blue Shield of California EPN |
$194.40
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cigna of CA HMO |
$280.00
|
| Rate for Payer: Cigna of CA PPO |
$280.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$340.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$340.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$340.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.00
|
| Rate for Payer: EPIC Health Plan Senior |
$160.00
|
| Rate for Payer: Galaxy Health WC |
$340.00
|
| Rate for Payer: Global Benefits Group Commercial |
$240.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$259.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$266.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$293.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$247.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$280.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$280.00
|
| Rate for Payer: Multiplan Commercial |
$320.00
|
| Rate for Payer: Networks By Design Commercial |
$200.00
|
| Rate for Payer: Prime Health Services Commercial |
$340.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$240.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$240.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$150.12
|
| Rate for Payer: United Healthcare All Other HMO |
$146.12
|
| Rate for Payer: United Healthcare HMO Rider |
$142.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$131.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$340.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$340.00
|
| Rate for Payer: Vantage Medical Group Senior |
$340.00
|
|
|
HC AXILLARY CRUTCH EXTENSION
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
CPT L0978
|
| Hospital Charge Code |
905350978
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$80.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$80.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cigna of CA HMO |
$280.00
|
| Rate for Payer: Cigna of CA PPO |
$280.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.00
|
| Rate for Payer: EPIC Health Plan Senior |
$160.00
|
| Rate for Payer: Galaxy Health WC |
$340.00
|
| Rate for Payer: Global Benefits Group Commercial |
$240.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$266.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$152.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$247.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.00
|
| Rate for Payer: Multiplan Commercial |
$320.00
|
| Rate for Payer: Networks By Design Commercial |
$200.00
|
| Rate for Payer: Prime Health Services Commercial |
$340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$150.12
|
| Rate for Payer: United Healthcare All Other HMO |
$146.12
|
| Rate for Payer: United Healthcare HMO Rider |
$142.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$131.00
|
|
|
HC AXILLARY CRUTCH EXTENSION
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
CPT L0978
|
| Hospital Charge Code |
905350978
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$96.00 |
| Max. Negotiated Rate |
$340.00 |
| Rate for Payer: Adventist Health Commercial |
$164.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$340.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$220.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$300.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$231.68
|
| Rate for Payer: Blue Shield of California Commercial |
$295.20
|
| Rate for Payer: Blue Shield of California EPN |
$194.40
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cigna of CA HMO |
$280.00
|
| Rate for Payer: Cigna of CA PPO |
$280.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$340.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$340.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$340.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.00
|
| Rate for Payer: EPIC Health Plan Senior |
$160.00
|
| Rate for Payer: Galaxy Health WC |
$340.00
|
| Rate for Payer: Global Benefits Group Commercial |
$240.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$259.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$266.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$293.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$247.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$280.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$280.00
|
| Rate for Payer: Multiplan Commercial |
$320.00
|
| Rate for Payer: Networks By Design Commercial |
$200.00
|
| Rate for Payer: Prime Health Services Commercial |
$340.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$240.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$240.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$150.12
|
| Rate for Payer: United Healthcare All Other HMO |
$146.12
|
| Rate for Payer: United Healthcare HMO Rider |
$142.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$131.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$340.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$340.00
|
| Rate for Payer: Vantage Medical Group Senior |
$340.00
|
|
|
HC AXILLARY CRUTCH EXTENSION
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
CPT L0978
|
| Hospital Charge Code |
915350978
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$80.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$80.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cigna of CA HMO |
$280.00
|
| Rate for Payer: Cigna of CA PPO |
$280.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.00
|
| Rate for Payer: EPIC Health Plan Senior |
$160.00
|
| Rate for Payer: Galaxy Health WC |
$340.00
|
| Rate for Payer: Global Benefits Group Commercial |
$240.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$266.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$152.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$247.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.00
|
| Rate for Payer: Multiplan Commercial |
$320.00
|
| Rate for Payer: Networks By Design Commercial |
$200.00
|
| Rate for Payer: Prime Health Services Commercial |
$340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$150.12
|
| Rate for Payer: United Healthcare All Other HMO |
$146.12
|
| Rate for Payer: United Healthcare HMO Rider |
$142.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$131.00
|
|
|
HC AZUR HYRDOCOIL
|
Facility
|
OP
|
$3,900.00
|
|
| Hospital Charge Code |
909020139
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,315.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,558.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,394.99
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cigna of CA HMO |
$2,496.00
|
| Rate for Payer: Cigna of CA PPO |
$2,886.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$936.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,730.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$3,120.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,340.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,950.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,950.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,950.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,950.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
