|
HC CANN TRACH SHILEY SIZE 6
|
Facility
|
OP
|
$24.93
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
901600966
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.99 |
| Max. Negotiated Rate |
$21.19 |
| Rate for Payer: Adventist Health Commercial |
$4.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.00
|
| Rate for Payer: Cash Price |
$11.22
|
| Rate for Payer: Cash Price |
$11.22
|
| Rate for Payer: Cigna of CA HMO |
$15.96
|
| Rate for Payer: Cigna of CA PPO |
$18.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.97
|
| Rate for Payer: EPIC Health Plan Senior |
$9.97
|
| Rate for Payer: Galaxy Health WC |
$21.19
|
| Rate for Payer: Global Benefits Group Commercial |
$14.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.45
|
| Rate for Payer: Multiplan Commercial |
$19.94
|
| Rate for Payer: Networks By Design Commercial |
$16.20
|
| Rate for Payer: Prime Health Services Commercial |
$21.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.46
|
| Rate for Payer: United Healthcare All Other HMO |
$12.46
|
| Rate for Payer: United Healthcare HMO Rider |
$12.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.19
|
| Rate for Payer: Vantage Medical Group Senior |
$21.19
|
|
|
HC CANN TRACH SHILEY SIZE 8
|
Facility
|
OP
|
$32.96
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
901600967
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$28.02 |
| Rate for Payer: Adventist Health Commercial |
$6.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.15
|
| Rate for Payer: Cash Price |
$14.83
|
| Rate for Payer: Cash Price |
$14.83
|
| Rate for Payer: Cigna of CA HMO |
$21.09
|
| Rate for Payer: Cigna of CA PPO |
$24.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$28.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.18
|
| Rate for Payer: EPIC Health Plan Senior |
$13.18
|
| Rate for Payer: Galaxy Health WC |
$28.02
|
| Rate for Payer: Global Benefits Group Commercial |
$19.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.07
|
| Rate for Payer: Multiplan Commercial |
$26.37
|
| Rate for Payer: Networks By Design Commercial |
$21.42
|
| Rate for Payer: Prime Health Services Commercial |
$28.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.48
|
| Rate for Payer: United Healthcare All Other HMO |
$16.48
|
| Rate for Payer: United Healthcare HMO Rider |
$16.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.02
|
| Rate for Payer: Vantage Medical Group Senior |
$28.02
|
|
|
HC CANN TRACH SHILEY SIZE 8
|
Facility
|
IP
|
$32.96
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
901600967
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$28.02 |
| Rate for Payer: Adventist Health Commercial |
$6.59
|
| Rate for Payer: Cash Price |
$14.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.18
|
| Rate for Payer: EPIC Health Plan Senior |
$13.18
|
| Rate for Payer: Galaxy Health WC |
$28.02
|
| Rate for Payer: Global Benefits Group Commercial |
$19.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.91
|
| Rate for Payer: Multiplan Commercial |
$26.37
|
| Rate for Payer: Networks By Design Commercial |
$21.42
|
| Rate for Payer: Prime Health Services Commercial |
$28.02
|
|
|
HC CANTHOTOMY
|
Facility
|
OP
|
$5,079.00
|
|
|
Service Code
|
CPT 67715
|
| Hospital Charge Code |
900501183
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$60.13 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$1,015.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,363.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,057.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$2,285.55
|
| Rate for Payer: Cash Price |
$2,285.55
|
| Rate for Payer: Cash Price |
$2,285.55
|
| Rate for Payer: Cigna of CA HMO |
$3,250.56
|
| Rate for Payer: Cigna of CA PPO |
$3,758.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,363.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,057.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,555.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,045.44
|
| Rate for Payer: EPIC Health Plan Senior |
$3,363.62
|
| Rate for Payer: Galaxy Health WC |
$4,317.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,047.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5,014.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,057.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,225.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$60.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,287.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,218.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,852.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,097.51
|
| Rate for Payer: Multiplan Commercial |
$4,063.20
|
| Rate for Payer: Multiplan WC |
$4,723.01
|
| Rate for Payer: Networks By Design Commercial |
$3,301.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,317.15
|
| Rate for Payer: Prime Health Services WC |
$4,674.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,047.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,539.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,539.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,539.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,539.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,057.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,363.62
|
| Rate for Payer: Vantage Medical Group Senior |
$3,057.84
|
|
|
HC CANTHOTOMY
|
Facility
|
IP
|
$5,079.00
|
|
|
Service Code
|
CPT 67715
|
| Hospital Charge Code |
900501183
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,015.80 |
| Max. Negotiated Rate |
$4,317.15 |
| Rate for Payer: EPIC Health Plan Commercial |
$2,031.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,031.60
|
| Rate for Payer: Galaxy Health WC |
$4,317.15
|
| Rate for Payer: Adventist Health Commercial |
$1,015.80
|
| Rate for Payer: Cash Price |
$2,285.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,555.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,047.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,225.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,996.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,218.96
|
| Rate for Payer: Multiplan Commercial |
$4,063.20
|
| Rate for Payer: Networks By Design Commercial |
$3,301.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,317.15
|
|
|
HC CANVAS VEST SO
|
Facility
|
IP
|
$323.00
|
|
|
Service Code
|
CPT L3675
|
| Hospital Charge Code |
905353675
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$64.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$64.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$145.35
|
| Rate for Payer: Cash Price |
$145.35
|
| Rate for Payer: Cigna of CA HMO |
$226.10
|
| Rate for Payer: Cigna of CA PPO |
$226.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$226.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$129.20
|
| Rate for Payer: EPIC Health Plan Senior |
$129.20
|
| Rate for Payer: Galaxy Health WC |
$274.55
|
| Rate for Payer: Global Benefits Group Commercial |
$193.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$205.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$190.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.52
|
| Rate for Payer: Multiplan Commercial |
$258.40
|
| Rate for Payer: Networks By Design Commercial |
$209.95
|
| Rate for Payer: Prime Health Services Commercial |
$274.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$121.22
|
| Rate for Payer: United Healthcare All Other HMO |
$117.99
|
| Rate for Payer: United Healthcare HMO Rider |
$115.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$105.78
|
|
|
HC CANVAS VEST SO
|
Facility
|
OP
|
$323.00
|
|
|
Service Code
|
CPT L3675
|
| Hospital Charge Code |
905353675
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$77.52 |
| Max. Negotiated Rate |
$274.55 |
| Rate for Payer: Adventist Health Commercial |
$132.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$274.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$177.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$242.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$195.51
|
| Rate for Payer: Blue Shield of California Commercial |
$248.39
|
| Rate for Payer: Blue Shield of California Commercial |
$163.76
|
| Rate for Payer: Cash Price |
$145.35
|
| Rate for Payer: Cash Price |
$145.35
|
| Rate for Payer: Cigna of CA HMO |
$226.10
|
| Rate for Payer: Cigna of CA PPO |
$226.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$274.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$274.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$274.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$226.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$129.20
|
| Rate for Payer: EPIC Health Plan Senior |
$129.20
|
| Rate for Payer: Galaxy Health WC |
$274.55
|
| Rate for Payer: Global Benefits Group Commercial |
$193.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$147.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$205.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$166.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$190.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$226.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$226.10
|
| Rate for Payer: Multiplan Commercial |
$258.40
|
| Rate for Payer: Networks By Design Commercial |
$161.50
|
| Rate for Payer: Prime Health Services Commercial |
$274.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$193.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$193.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$121.22
|
| Rate for Payer: United Healthcare All Other HMO |
$117.99
|
| Rate for Payer: United Healthcare HMO Rider |
$115.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$105.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$274.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$274.55
|
| Rate for Payer: Vantage Medical Group Senior |
$274.55
|
|
|
HC CANVAS VEST SO
|
Facility
|
IP
|
$323.00
|
|
|
Service Code
|
CPT L3675
|
| Hospital Charge Code |
915353675
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$64.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$64.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$145.35
|
| Rate for Payer: Cash Price |
$145.35
|
| Rate for Payer: Cigna of CA HMO |
$226.10
|
| Rate for Payer: Cigna of CA PPO |
$226.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$226.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$129.20
|
| Rate for Payer: EPIC Health Plan Senior |
$129.20
|
| Rate for Payer: Galaxy Health WC |
$274.55
|
| Rate for Payer: Global Benefits Group Commercial |
$193.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$205.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$190.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.52
|
| Rate for Payer: Multiplan Commercial |
$258.40
|
| Rate for Payer: Networks By Design Commercial |
$209.95
|
| Rate for Payer: Prime Health Services Commercial |
$274.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$121.22
|
| Rate for Payer: United Healthcare All Other HMO |
$117.99
|
| Rate for Payer: United Healthcare HMO Rider |
$115.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$105.78
|
|
|
HC CANVAS VEST SO
|
Facility
|
OP
|
$323.00
|
|
|
Service Code
|
CPT L3675
|
| Hospital Charge Code |
915353675
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$77.52 |
| Max. Negotiated Rate |
$274.55 |
| Rate for Payer: Adventist Health Commercial |
$132.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$274.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$177.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$242.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$195.51
|
| Rate for Payer: Blue Shield of California Commercial |
$248.39
|
| Rate for Payer: Blue Shield of California Commercial |
$163.76
|
| Rate for Payer: Cash Price |
$145.35
|
| Rate for Payer: Cash Price |
$145.35
|
| Rate for Payer: Cigna of CA HMO |
$226.10
|
| Rate for Payer: Cigna of CA PPO |
$226.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$274.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$274.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$274.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$226.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$129.20
|
| Rate for Payer: EPIC Health Plan Senior |
$129.20
|
| Rate for Payer: Galaxy Health WC |
$274.55
|
| Rate for Payer: Global Benefits Group Commercial |
$193.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$147.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$205.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$166.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$190.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$226.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$226.10
|
| Rate for Payer: Multiplan Commercial |
$258.40
|
| Rate for Payer: Networks By Design Commercial |
$161.50
|
| Rate for Payer: Prime Health Services Commercial |
$274.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$193.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$193.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$121.22
|
| Rate for Payer: United Healthcare All Other HMO |
$117.99
|
| Rate for Payer: United Healthcare HMO Rider |
$115.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$105.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$274.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$274.55
|
| Rate for Payer: Vantage Medical Group Senior |
$274.55
|
|
|
HC CAPD DAILY TREATMENT
|
Facility
|
OP
|
$1,040.00
|
|
|
Service Code
|
CPT 90945
|
| Hospital Charge Code |
944000101
|
|
Hospital Revenue Code
|
803
|
| Min. Negotiated Rate |
$121.23 |
| Max. Negotiated Rate |
$885.51 |
| Rate for Payer: Adventist Health Commercial |
$208.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$543.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$805.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$590.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$536.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$667.37
|
| Rate for Payer: Cash Price |
$468.00
|
| Rate for Payer: Cash Price |
$468.00
|
| Rate for Payer: Cigna of CA HMO |
$665.60
|
| Rate for Payer: Cigna of CA PPO |
$769.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$805.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$590.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$536.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$728.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$885.51
|
| Rate for Payer: EPIC Health Plan Senior |
$590.34
|
| Rate for Payer: Galaxy Health WC |
$884.00
|
| Rate for Payer: Global Benefits Group Commercial |
$624.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$880.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$121.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$536.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$660.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$137.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$751.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$249.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$676.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$719.14
|
| Rate for Payer: Multiplan Commercial |
$832.00
|
| Rate for Payer: Networks By Design Commercial |
$676.00
|
| Rate for Payer: Prime Health Services Commercial |
$884.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$624.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$624.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$520.00
|
| Rate for Payer: United Healthcare All Other HMO |
$520.00
|
| Rate for Payer: United Healthcare HMO Rider |
$520.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$520.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$536.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$805.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$590.34
|
| Rate for Payer: Vantage Medical Group Senior |
$536.67
|
|
|
HC CAPD DAILY TREATMENT
|
Facility
|
IP
|
$1,040.00
|
|
|
Service Code
|
CPT 90945
|
| Hospital Charge Code |
944000101
|
|
Hospital Revenue Code
|
803
|
| Min. Negotiated Rate |
$208.00 |
| Max. Negotiated Rate |
$884.00 |
| Rate for Payer: Adventist Health Commercial |
$208.00
|
| Rate for Payer: Cash Price |
$468.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$728.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$416.00
|
| Rate for Payer: EPIC Health Plan Senior |
$416.00
|
| Rate for Payer: Galaxy Health WC |
$884.00
|
| Rate for Payer: Global Benefits Group Commercial |
$624.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$660.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$613.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$249.60
|
| Rate for Payer: Multiplan Commercial |
$832.00
|
| Rate for Payer: Networks By Design Commercial |
$676.00
|
| Rate for Payer: Prime Health Services Commercial |
$884.00
|
|
|
HC CAP HEAD POST TORTLE 24-27CM
|
Facility
|
OP
|
$447.30
|
|
| Hospital Charge Code |
901698211
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$89.46 |
| Max. Negotiated Rate |
$380.20 |
| Rate for Payer: Adventist Health Commercial |
$89.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$293.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$380.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$246.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$335.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$287.03
|
| Rate for Payer: Cash Price |
$201.28
|
| Rate for Payer: Cigna of CA HMO |
$286.27
|
| Rate for Payer: Cigna of CA PPO |
$331.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$380.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$380.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$380.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$313.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$178.92
|
| Rate for Payer: EPIC Health Plan Senior |
$178.92
|
| Rate for Payer: Galaxy Health WC |
$380.20
|
| Rate for Payer: Global Benefits Group Commercial |
$268.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$284.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$162.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$263.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$313.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$313.11
|
| Rate for Payer: Multiplan Commercial |
$357.84
|
| Rate for Payer: Networks By Design Commercial |
$290.75
|
| Rate for Payer: Prime Health Services Commercial |
$380.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$268.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$268.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$223.65
|
| Rate for Payer: United Healthcare All Other HMO |
$223.65
|
| Rate for Payer: United Healthcare HMO Rider |
$223.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$223.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$380.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$380.20
|
| Rate for Payer: Vantage Medical Group Senior |
$380.20
|
|
|
HC CAP HEAD POST TORTLE 24-27CM
|
Facility
|
IP
|
$447.30
|
|
| Hospital Charge Code |
901698211
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$89.46 |
| Max. Negotiated Rate |
$380.20 |
| Rate for Payer: Adventist Health Commercial |
$89.46
|
| Rate for Payer: Cash Price |
$201.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$313.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$178.92
|
| Rate for Payer: EPIC Health Plan Senior |
$178.92
|
| Rate for Payer: Galaxy Health WC |
$380.20
|
| Rate for Payer: Global Benefits Group Commercial |
$268.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$284.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$263.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.35
|
| Rate for Payer: Multiplan Commercial |
$357.84
|
| Rate for Payer: Networks By Design Commercial |
$290.75
|
| Rate for Payer: Prime Health Services Commercial |
$380.20
|
|
|
HC CAP HEAD POST TORTLE 27-31CM
|
Facility
|
IP
|
$447.30
|
|
| Hospital Charge Code |
901698212
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$89.46 |
| Max. Negotiated Rate |
$380.20 |
| Rate for Payer: Adventist Health Commercial |
$89.46
|
| Rate for Payer: Cash Price |
$201.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$313.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$178.92
|
| Rate for Payer: EPIC Health Plan Senior |
$178.92
|
| Rate for Payer: Galaxy Health WC |
$380.20
|
| Rate for Payer: Global Benefits Group Commercial |
$268.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$284.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$263.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.35
|
| Rate for Payer: Multiplan Commercial |
$357.84
|
| Rate for Payer: Networks By Design Commercial |
$290.75
|
| Rate for Payer: Prime Health Services Commercial |
$380.20
|
|
|
HC CAP HEAD POST TORTLE 27-31CM
|
Facility
|
OP
|
$447.30
|
|
| Hospital Charge Code |
901698212
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$89.46 |
| Max. Negotiated Rate |
$380.20 |
| Rate for Payer: Cigna of CA PPO |
$331.00
|
| Rate for Payer: Adventist Health Commercial |
$89.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$293.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$380.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$246.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$335.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$287.03
|
| Rate for Payer: Cash Price |
$201.28
|
| Rate for Payer: Cigna of CA HMO |
$286.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$380.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$380.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$380.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$313.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$178.92
|
| Rate for Payer: EPIC Health Plan Senior |
$178.92
|
| Rate for Payer: Galaxy Health WC |
$380.20
|
| Rate for Payer: Global Benefits Group Commercial |
$268.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$284.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$162.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$263.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$313.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$313.11
|
| Rate for Payer: Multiplan Commercial |
$357.84
|
| Rate for Payer: Networks By Design Commercial |
$290.75
|
| Rate for Payer: Prime Health Services Commercial |
$380.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$268.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$268.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$223.65
|
| Rate for Payer: United Healthcare All Other HMO |
$223.65
|
| Rate for Payer: United Healthcare HMO Rider |
$223.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$223.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$380.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$380.20
|
| Rate for Payer: Vantage Medical Group Senior |
$380.20
|
|
|
HC CAP HEAD POST TORTLE 32-37CM
|
Facility
|
OP
|
$447.30
|
|
| Hospital Charge Code |
901698213
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$89.46 |
| Max. Negotiated Rate |
$380.20 |
| Rate for Payer: Adventist Health Commercial |
$89.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$293.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$380.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$246.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$335.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$287.03
|
| Rate for Payer: Cash Price |
$201.28
|
| Rate for Payer: Cigna of CA HMO |
$286.27
|
| Rate for Payer: Cigna of CA PPO |
$331.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$380.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$380.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$380.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$313.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$178.92
|
| Rate for Payer: EPIC Health Plan Senior |
$178.92
|
| Rate for Payer: Galaxy Health WC |
$380.20
|
| Rate for Payer: Global Benefits Group Commercial |
$268.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$284.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$162.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$263.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$313.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$313.11
|
| Rate for Payer: Multiplan Commercial |
$357.84
|
| Rate for Payer: Networks By Design Commercial |
$290.75
|
| Rate for Payer: Prime Health Services Commercial |
$380.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$268.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$268.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$223.65
|
| Rate for Payer: United Healthcare All Other HMO |
$223.65
|
| Rate for Payer: United Healthcare HMO Rider |
$223.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$223.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$380.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$380.20
|
| Rate for Payer: Vantage Medical Group Senior |
$380.20
|
|
|
HC CAP HEAD POST TORTLE 32-37CM
|
Facility
|
IP
|
$447.30
|
|
| Hospital Charge Code |
901698213
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$89.46 |
| Max. Negotiated Rate |
$380.20 |
| Rate for Payer: Adventist Health Commercial |
$89.46
|
| Rate for Payer: Cash Price |
$201.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$313.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$178.92
|
| Rate for Payer: EPIC Health Plan Senior |
$178.92
|
| Rate for Payer: Galaxy Health WC |
$380.20
|
| Rate for Payer: Global Benefits Group Commercial |
$268.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$284.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$263.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.35
|
| Rate for Payer: Multiplan Commercial |
$357.84
|
| Rate for Payer: Networks By Design Commercial |
$290.75
|
| Rate for Payer: Prime Health Services Commercial |
$380.20
|
|
|
HC CAPILLARY BLOOD DRAW HEEL FNGR EAR
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT 36416
|
| Hospital Charge Code |
902400137
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$10.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$44.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$39.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$36.24
|
| Rate for Payer: Blue Shield of California Commercial |
$23.97
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna of CA HMO |
$33.28
|
| Rate for Payer: Cigna of CA PPO |
$38.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$44.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$44.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$36.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.80
|
| Rate for Payer: EPIC Health Plan Senior |
$20.80
|
| Rate for Payer: Galaxy Health WC |
$44.20
|
| Rate for Payer: Global Benefits Group Commercial |
$31.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$33.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$36.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36.40
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: Networks By Design Commercial |
$33.80
|
| Rate for Payer: Prime Health Services Commercial |
$44.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.52
|
| Rate for Payer: United Healthcare All Other HMO |
$2.52
|
| Rate for Payer: United Healthcare HMO Rider |
$2.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$44.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$44.20
|
| Rate for Payer: Vantage Medical Group Senior |
$44.20
|
|
|
HC CAPILLARY BLOOD DRAW HEEL FNGR EAR
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
CPT 36416
|
| Hospital Charge Code |
900802002
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$44.20 |
| Rate for Payer: Adventist Health Commercial |
$10.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$36.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.80
|
| Rate for Payer: EPIC Health Plan Senior |
$20.80
|
| Rate for Payer: Galaxy Health WC |
$44.20
|
| Rate for Payer: Global Benefits Group Commercial |
$31.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$33.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.48
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: Networks By Design Commercial |
$33.80
|
| Rate for Payer: Prime Health Services Commercial |
$44.20
|
|
|
HC CAPILLARY BLOOD DRAW HEEL FNGR EAR
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT 36416
|
| Hospital Charge Code |
900802002
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Dignity Health Medi-Cal |
$44.20
|
| Rate for Payer: Adventist Health Commercial |
$10.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$44.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$39.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$36.24
|
| Rate for Payer: Blue Shield of California Commercial |
$23.97
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna of CA HMO |
$33.28
|
| Rate for Payer: Cigna of CA PPO |
$38.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$44.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$36.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.80
|
| Rate for Payer: EPIC Health Plan Senior |
$20.80
|
| Rate for Payer: Galaxy Health WC |
$44.20
|
| Rate for Payer: Global Benefits Group Commercial |
$31.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$33.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$36.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36.40
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: Networks By Design Commercial |
$33.80
|
| Rate for Payer: Prime Health Services Commercial |
$44.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.52
|
| Rate for Payer: United Healthcare All Other HMO |
$2.52
|
| Rate for Payer: United Healthcare HMO Rider |
$2.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$44.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$44.20
|
| Rate for Payer: Vantage Medical Group Senior |
$44.20
|
|
|
HC CAPILLARY BLOOD DRAW HEEL FNGR EAR
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
CPT 36416
|
| Hospital Charge Code |
902400137
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$44.20 |
| Rate for Payer: Adventist Health Commercial |
$10.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$36.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.80
|
| Rate for Payer: EPIC Health Plan Senior |
$20.80
|
| Rate for Payer: Galaxy Health WC |
$44.20
|
| Rate for Payer: Global Benefits Group Commercial |
$31.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$33.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.48
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: Networks By Design Commercial |
$33.80
|
| Rate for Payer: Prime Health Services Commercial |
$44.20
|
|
|
HC CAPILLARY HA1C
|
Facility
|
OP
|
$80.00
|
|
|
Service Code
|
CPT 83036
|
| Hospital Charge Code |
902501902
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.87 |
| Max. Negotiated Rate |
$100.20 |
| Rate for Payer: Adventist Health Commercial |
$16.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$80.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$100.20
|
| Rate for Payer: Blue Shield of California Commercial |
$36.88
|
| Rate for Payer: Blue Shield of California Commercial |
$55.76
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna of CA HMO |
$51.20
|
| Rate for Payer: Cigna of CA PPO |
$59.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$56.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.02
|
| Rate for Payer: EPIC Health Plan Senior |
$10.68
|
| Rate for Payer: Galaxy Health WC |
$68.00
|
| Rate for Payer: Global Benefits Group Commercial |
$48.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$50.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.01
|
| Rate for Payer: Multiplan Commercial |
$64.00
|
| Rate for Payer: Networks By Design Commercial |
$52.00
|
| Rate for Payer: Prime Health Services Commercial |
$68.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$48.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$48.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.87
|
| Rate for Payer: United Healthcare All Other HMO |
$7.87
|
| Rate for Payer: United Healthcare HMO Rider |
$7.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.87
|
| Rate for Payer: Upland Medical Group Pediatric |
$9.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.68
|
| Rate for Payer: Vantage Medical Group Senior |
$9.71
|
|
|
HC CAPILLARY HA1C
|
Facility
|
IP
|
$80.00
|
|
|
Service Code
|
CPT 83036
|
| Hospital Charge Code |
902501902
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$68.00 |
| Rate for Payer: Adventist Health Commercial |
$16.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$56.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.00
|
| Rate for Payer: EPIC Health Plan Senior |
$32.00
|
| Rate for Payer: Galaxy Health WC |
$68.00
|
| Rate for Payer: Global Benefits Group Commercial |
$48.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$50.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$47.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.20
|
| Rate for Payer: Multiplan Commercial |
$64.00
|
| Rate for Payer: Networks By Design Commercial |
$52.00
|
| Rate for Payer: Prime Health Services Commercial |
$68.00
|
|
|
HC CAP NEWBORN LRG 16IN PINK
|
Facility
|
IP
|
$481.40
|
|
| Hospital Charge Code |
901608014
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$96.28 |
| Max. Negotiated Rate |
$409.19 |
| Rate for Payer: Adventist Health Commercial |
$96.28
|
| Rate for Payer: Cash Price |
$216.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$336.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.56
|
| Rate for Payer: EPIC Health Plan Senior |
$192.56
|
| Rate for Payer: Galaxy Health WC |
$409.19
|
| Rate for Payer: Global Benefits Group Commercial |
$288.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$305.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$284.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.54
|
| Rate for Payer: Multiplan Commercial |
$385.12
|
| Rate for Payer: Networks By Design Commercial |
$312.91
|
| Rate for Payer: Prime Health Services Commercial |
$409.19
|
|
|
HC CAP NEWBORN LRG 16IN PINK
|
Facility
|
OP
|
$481.40
|
|
| Hospital Charge Code |
901608014
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$96.28 |
| Max. Negotiated Rate |
$409.19 |
| Rate for Payer: Cigna of CA PPO |
$356.24
|
| Rate for Payer: Adventist Health Commercial |
$96.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$315.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$409.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$264.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$361.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$308.91
|
| Rate for Payer: Cash Price |
$216.63
|
| Rate for Payer: Cigna of CA HMO |
$308.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$409.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$409.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$409.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$336.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.56
|
| Rate for Payer: EPIC Health Plan Senior |
$192.56
|
| Rate for Payer: Galaxy Health WC |
$409.19
|
| Rate for Payer: Global Benefits Group Commercial |
$288.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$305.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$174.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$284.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$336.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$336.98
|
| Rate for Payer: Multiplan Commercial |
$385.12
|
| Rate for Payer: Networks By Design Commercial |
$312.91
|
| Rate for Payer: Prime Health Services Commercial |
$409.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$288.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$288.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$240.70
|
| Rate for Payer: United Healthcare All Other HMO |
$240.70
|
| Rate for Payer: United Healthcare HMO Rider |
$240.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$240.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$409.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$409.19
|
| Rate for Payer: Vantage Medical Group Senior |
$409.19
|
|
