|
HC ENDO SM INT W/ CONVERSION
|
Facility
|
IP
|
$5,788.00
|
|
|
Service Code
|
CPT 44373
|
| Hospital Charge Code |
906744373
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,157.60 |
| Max. Negotiated Rate |
$4,919.80 |
| Rate for Payer: Adventist Health Commercial |
$1,157.60
|
| Rate for Payer: Cash Price |
$2,604.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,315.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,315.20
|
| Rate for Payer: Galaxy Health WC |
$4,919.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,472.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,860.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,205.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,582.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,389.12
|
| Rate for Payer: Multiplan Commercial |
$4,630.40
|
| Rate for Payer: Networks By Design Commercial |
$3,762.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,919.80
|
|
|
HC ENDO SM INT W/FORCEPS
|
Facility
|
OP
|
$3,088.00
|
|
|
Service Code
|
CPT 44365
|
| Hospital Charge Code |
906744365
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$436.58 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$617.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,410.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,470.08
|
| Rate for Payer: Cash Price |
$1,389.60
|
| Rate for Payer: Cash Price |
$1,389.60
|
| Rate for Payer: Cash Price |
$1,389.60
|
| Rate for Payer: Cigna of CA HMO |
$1,976.32
|
| Rate for Payer: Cigna of CA PPO |
$2,285.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,651.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,410.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,253.93
|
| Rate for Payer: EPIC Health Plan Senior |
$2,410.32
|
| Rate for Payer: Galaxy Health WC |
$2,624.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,852.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$436.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,059.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$493.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$741.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,037.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,229.83
|
| Rate for Payer: Multiplan Commercial |
$2,470.40
|
| Rate for Payer: Networks By Design Commercial |
$2,007.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,624.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,852.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,892.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,410.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,410.32
|
|
|
HC ENDO SM INT W/FORCEPS
|
Facility
|
IP
|
$3,335.00
|
|
|
Service Code
|
CPT 44365
|
| Hospital Charge Code |
906744365
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$667.00 |
| Max. Negotiated Rate |
$2,834.75 |
| Rate for Payer: Adventist Health Commercial |
$667.00
|
| Rate for Payer: Cash Price |
$1,500.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,334.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,334.00
|
| Rate for Payer: Galaxy Health WC |
$2,834.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,001.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,224.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,270.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,064.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$800.40
|
| Rate for Payer: Multiplan Commercial |
$2,668.00
|
| Rate for Payer: Networks By Design Commercial |
$2,167.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,834.75
|
|
|
HC ENDO SM INT W/PLCMNT PERCUT
|
Facility
|
OP
|
$5,368.00
|
|
|
Service Code
|
CPT 44372
|
| Hospital Charge Code |
906744372
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$402.80 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$1,073.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,410.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,470.08
|
| Rate for Payer: Cash Price |
$2,415.60
|
| Rate for Payer: Cash Price |
$2,415.60
|
| Rate for Payer: Cash Price |
$2,415.60
|
| Rate for Payer: Cigna of CA HMO |
$3,435.52
|
| Rate for Payer: Cigna of CA PPO |
$3,972.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,651.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,410.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,253.93
|
| Rate for Payer: EPIC Health Plan Senior |
$2,410.32
|
| Rate for Payer: Galaxy Health WC |
$4,562.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,220.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$402.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,580.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$455.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,288.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,037.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,229.83
|
| Rate for Payer: Multiplan Commercial |
$4,294.40
|
| Rate for Payer: Networks By Design Commercial |
$3,489.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,562.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,220.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,892.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,410.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,410.32
|
|
|
HC ENDO SM INT W/PLCMNT PERCUT
|
Facility
|
IP
|
$5,796.00
|
|
|
Service Code
|
CPT 44372
|
| Hospital Charge Code |
906744372
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,159.20 |
| Max. Negotiated Rate |
$4,926.60 |
| Rate for Payer: Adventist Health Commercial |
$1,159.20
|
| Rate for Payer: Cash Price |
$2,608.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,318.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,318.40
|
| Rate for Payer: Galaxy Health WC |
$4,926.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,477.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,865.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,208.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,587.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,391.04
|
| Rate for Payer: Multiplan Commercial |
$4,636.80
|
| Rate for Payer: Networks By Design Commercial |
$3,767.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,926.60
|
|
|
HC ENDO SM INT W/RMVL FB
|
Facility
|
OP
|
$3,088.00
|
|
|
Service Code
|
CPT 44363
|
| Hospital Charge Code |
906744363
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$283.95 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$617.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,410.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,470.08
|
| Rate for Payer: Cash Price |
$1,389.60
|
| Rate for Payer: Cash Price |
$1,389.60
|
| Rate for Payer: Cash Price |
$1,389.60
|
| Rate for Payer: Cigna of CA HMO |
$1,976.32
|
| Rate for Payer: Cigna of CA PPO |
$2,285.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,651.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,410.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,253.93
|
| Rate for Payer: EPIC Health Plan Senior |
$2,410.32
|
| Rate for Payer: Galaxy Health WC |
$2,624.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,852.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$283.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,059.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$321.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$741.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,037.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,229.83
|
| Rate for Payer: Multiplan Commercial |
$2,470.40
|
| Rate for Payer: Networks By Design Commercial |
$2,007.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,624.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,852.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,892.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,410.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,410.32
|
|
|
HC ENDO SM INT W/RMVL FB
|
Facility
|
IP
|
$4,168.00
|
|
|
Service Code
|
CPT 44363
|
| Hospital Charge Code |
906744363
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$833.60 |
| Max. Negotiated Rate |
$3,542.80 |
| Rate for Payer: Adventist Health Commercial |
$833.60
|
| Rate for Payer: Cash Price |
$1,875.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,667.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,667.20
|
| Rate for Payer: Galaxy Health WC |
$3,542.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,500.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,780.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,588.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,579.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,000.32
|
| Rate for Payer: Multiplan Commercial |
$3,334.40
|
| Rate for Payer: Networks By Design Commercial |
$2,709.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,542.80
|
|
|
HC ENDO SM INT W/SNARE
|
Facility
|
OP
|
$3,088.00
|
|
|
Service Code
|
CPT 44364
|
| Hospital Charge Code |
906744364
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$340.87 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$617.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,410.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,470.08
|
| Rate for Payer: Cash Price |
$1,389.60
|
| Rate for Payer: Cash Price |
$1,389.60
|
| Rate for Payer: Cash Price |
$1,389.60
|
| Rate for Payer: Cigna of CA HMO |
$1,976.32
|
| Rate for Payer: Cigna of CA PPO |
$2,285.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,651.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,410.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,253.93
|
| Rate for Payer: EPIC Health Plan Senior |
$2,410.32
|
| Rate for Payer: Galaxy Health WC |
$2,624.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,852.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$340.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,059.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$385.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$741.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,037.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,229.83
|
| Rate for Payer: Multiplan Commercial |
$2,470.40
|
| Rate for Payer: Networks By Design Commercial |
$2,007.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,624.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,852.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,892.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,410.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,410.32
|
|
|
HC ENDO SM INT W/SNARE
|
Facility
|
IP
|
$3,335.00
|
|
|
Service Code
|
CPT 44364
|
| Hospital Charge Code |
906744364
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$667.00 |
| Max. Negotiated Rate |
$2,834.75 |
| Rate for Payer: Adventist Health Commercial |
$667.00
|
| Rate for Payer: Cash Price |
$1,500.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,334.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,334.00
|
| Rate for Payer: Galaxy Health WC |
$2,834.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,001.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,224.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,270.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,064.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$800.40
|
| Rate for Payer: Multiplan Commercial |
$2,668.00
|
| Rate for Payer: Networks By Design Commercial |
$2,167.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,834.75
|
|
|
HC ENDO SM INT W STENT PLCMNT
|
Facility
|
OP
|
$8,470.00
|
|
|
Service Code
|
CPT 44370
|
| Hospital Charge Code |
906744370
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$331.50 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$1,694.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13,086.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,345.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,320.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,563.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$7,415.66
|
| Rate for Payer: Cash Price |
$3,811.50
|
| Rate for Payer: Cash Price |
$3,811.50
|
| Rate for Payer: Cash Price |
$3,811.50
|
| Rate for Payer: Cigna of CA HMO |
$5,420.80
|
| Rate for Payer: Cigna of CA PPO |
$6,267.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,345.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,320.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,563.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,210.91
|
| Rate for Payer: EPIC Health Plan Senior |
$7,563.64
|
| Rate for Payer: Galaxy Health WC |
$7,199.50
|
| Rate for Payer: Global Benefits Group Commercial |
$5,082.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,404.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$331.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,563.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,649.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$374.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,563.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,032.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,530.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,135.28
|
| Rate for Payer: Multiplan Commercial |
$6,776.00
|
| Rate for Payer: Networks By Design Commercial |
$5,505.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,199.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,082.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,076.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,563.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,345.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,320.00
|
| Rate for Payer: Vantage Medical Group Senior |
$7,563.64
|
|
|
HC ENDO SM INT W STENT PLCMNT
|
Facility
|
IP
|
$9,147.00
|
|
|
Service Code
|
CPT 44370
|
| Hospital Charge Code |
906744370
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,829.40 |
| Max. Negotiated Rate |
$7,774.95 |
| Rate for Payer: Adventist Health Commercial |
$1,829.40
|
| Rate for Payer: Cash Price |
$4,116.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,658.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,658.80
|
| Rate for Payer: Galaxy Health WC |
$7,774.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5,488.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,101.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,485.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,661.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,195.28
|
| Rate for Payer: Multiplan Commercial |
$7,317.60
|
| Rate for Payer: Networks By Design Commercial |
$5,945.55
|
| Rate for Payer: Prime Health Services Commercial |
$7,774.95
|
|
|
HC ENDOTRACH 5.0MM W/CUFF PEDS
|
Facility
|
IP
|
$45.26
|
|
| Hospital Charge Code |
901698775
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.05 |
| Max. Negotiated Rate |
$38.47 |
| Rate for Payer: Adventist Health Commercial |
$9.05
|
| Rate for Payer: Cash Price |
$20.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.10
|
| Rate for Payer: EPIC Health Plan Senior |
$18.10
|
| Rate for Payer: Galaxy Health WC |
$38.47
|
| Rate for Payer: Global Benefits Group Commercial |
$27.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.86
|
| Rate for Payer: Multiplan Commercial |
$36.21
|
| Rate for Payer: Networks By Design Commercial |
$29.42
|
| Rate for Payer: Prime Health Services Commercial |
$38.47
|
|
|
HC ENDOTRACH 5.0MM W/CUFF PEDS
|
Facility
|
OP
|
$45.26
|
|
| Hospital Charge Code |
901698775
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.05 |
| Max. Negotiated Rate |
$38.47 |
| Rate for Payer: Adventist Health Commercial |
$9.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$29.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.79
|
| Rate for Payer: Cash Price |
$20.37
|
| Rate for Payer: Cigna of CA HMO |
$28.97
|
| Rate for Payer: Cigna of CA PPO |
$33.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$38.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.10
|
| Rate for Payer: EPIC Health Plan Senior |
$18.10
|
| Rate for Payer: Galaxy Health WC |
$38.47
|
| Rate for Payer: Global Benefits Group Commercial |
$27.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31.68
|
| Rate for Payer: Multiplan Commercial |
$36.21
|
| Rate for Payer: Networks By Design Commercial |
$29.42
|
| Rate for Payer: Prime Health Services Commercial |
$38.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.63
|
| Rate for Payer: United Healthcare All Other HMO |
$22.63
|
| Rate for Payer: United Healthcare HMO Rider |
$22.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.47
|
| Rate for Payer: Vantage Medical Group Senior |
$38.47
|
|
|
HC ENDOTRACH 5.5MM W/CUFF PEDS
|
Facility
|
OP
|
$45.26
|
|
| Hospital Charge Code |
901698774
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.05 |
| Max. Negotiated Rate |
$38.47 |
| Rate for Payer: Adventist Health Commercial |
$9.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$29.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.79
|
| Rate for Payer: Cash Price |
$20.37
|
| Rate for Payer: Cigna of CA HMO |
$28.97
|
| Rate for Payer: Cigna of CA PPO |
$33.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$38.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.10
|
| Rate for Payer: EPIC Health Plan Senior |
$18.10
|
| Rate for Payer: Galaxy Health WC |
$38.47
|
| Rate for Payer: Global Benefits Group Commercial |
$27.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31.68
|
| Rate for Payer: Multiplan Commercial |
$36.21
|
| Rate for Payer: Networks By Design Commercial |
$29.42
|
| Rate for Payer: Prime Health Services Commercial |
$38.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.63
|
| Rate for Payer: United Healthcare All Other HMO |
$22.63
|
| Rate for Payer: United Healthcare HMO Rider |
$22.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.47
|
| Rate for Payer: Vantage Medical Group Senior |
$38.47
|
|
|
HC ENDOTRACH 5.5MM W/CUFF PEDS
|
Facility
|
IP
|
$45.26
|
|
| Hospital Charge Code |
901698774
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.05 |
| Max. Negotiated Rate |
$38.47 |
| Rate for Payer: Adventist Health Commercial |
$9.05
|
| Rate for Payer: Cash Price |
$20.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.10
|
| Rate for Payer: EPIC Health Plan Senior |
$18.10
|
| Rate for Payer: Galaxy Health WC |
$38.47
|
| Rate for Payer: Global Benefits Group Commercial |
$27.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.86
|
| Rate for Payer: Multiplan Commercial |
$36.21
|
| Rate for Payer: Networks By Design Commercial |
$29.42
|
| Rate for Payer: Prime Health Services Commercial |
$38.47
|
|
|
HC ENDOTRACH 6.5MM W/CUFF ADULT
|
Facility
|
IP
|
$61.66
|
|
| Hospital Charge Code |
901698776
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.33 |
| Max. Negotiated Rate |
$52.41 |
| Rate for Payer: Adventist Health Commercial |
$12.33
|
| Rate for Payer: Cash Price |
$27.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.66
|
| Rate for Payer: EPIC Health Plan Senior |
$24.66
|
| Rate for Payer: Galaxy Health WC |
$52.41
|
| Rate for Payer: Global Benefits Group Commercial |
$37.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$41.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$38.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.80
|
| Rate for Payer: Multiplan Commercial |
$49.33
|
| Rate for Payer: Networks By Design Commercial |
$40.08
|
| Rate for Payer: Prime Health Services Commercial |
$52.41
|
|
|
HC ENDOTRACH 6.5MM W/CUFF ADULT
|
Facility
|
OP
|
$61.66
|
|
| Hospital Charge Code |
901698776
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.33 |
| Max. Negotiated Rate |
$52.41 |
| Rate for Payer: Adventist Health Commercial |
$12.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$40.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$46.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.87
|
| Rate for Payer: Cash Price |
$27.75
|
| Rate for Payer: Cigna of CA HMO |
$39.46
|
| Rate for Payer: Cigna of CA PPO |
$45.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$52.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.66
|
| Rate for Payer: EPIC Health Plan Senior |
$24.66
|
| Rate for Payer: Galaxy Health WC |
$52.41
|
| Rate for Payer: Global Benefits Group Commercial |
$37.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$41.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$38.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$43.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$43.16
|
| Rate for Payer: Multiplan Commercial |
$49.33
|
| Rate for Payer: Networks By Design Commercial |
$40.08
|
| Rate for Payer: Prime Health Services Commercial |
$52.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$37.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$37.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.83
|
| Rate for Payer: United Healthcare All Other HMO |
$30.83
|
| Rate for Payer: United Healthcare HMO Rider |
$30.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.41
|
| Rate for Payer: Vantage Medical Group Senior |
$52.41
|
|
|
HC ENDOTRACHEAL INTUBATION
|
Facility
|
OP
|
$1,954.00
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
900800115
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$112.48 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$390.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$295.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$879.30
|
| Rate for Payer: Cash Price |
$879.30
|
| Rate for Payer: Cash Price |
$879.30
|
| Rate for Payer: Cigna of CA HMO |
$1,250.56
|
| Rate for Payer: Cigna of CA PPO |
$1,445.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$442.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$295.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$398.33
|
| Rate for Payer: EPIC Health Plan Senior |
$295.06
|
| Rate for Payer: Galaxy Health WC |
$1,660.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,172.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$483.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$295.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,303.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$468.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$371.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$395.38
|
| Rate for Payer: Multiplan Commercial |
$1,563.20
|
| Rate for Payer: Multiplan WC |
$470.13
|
| Rate for Payer: Networks By Design Commercial |
$1,270.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,660.90
|
| Rate for Payer: Prime Health Services WC |
$465.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,172.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$977.00
|
| Rate for Payer: United Healthcare All Other HMO |
$977.00
|
| Rate for Payer: United Healthcare HMO Rider |
$977.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$977.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$295.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Vantage Medical Group Senior |
$295.06
|
|
|
HC ENDOTRACHEAL INTUBATION
|
Facility
|
IP
|
$1,954.00
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
900800115
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$390.80 |
| Max. Negotiated Rate |
$1,660.90 |
| Rate for Payer: Adventist Health Commercial |
$390.80
|
| Rate for Payer: Cash Price |
$879.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$781.60
|
| Rate for Payer: EPIC Health Plan Senior |
$781.60
|
| Rate for Payer: Galaxy Health WC |
$1,660.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,172.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,303.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$744.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,209.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$468.96
|
| Rate for Payer: Multiplan Commercial |
$1,563.20
|
| Rate for Payer: Networks By Design Commercial |
$1,270.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,660.90
|
|
|
HC ENDOTRACHEAL INTUBATION
|
Facility
|
OP
|
$1,954.00
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
900800115
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$99.46 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$390.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$295.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| 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 |
$879.30
|
| Rate for Payer: Cash Price |
$879.30
|
| Rate for Payer: Cash Price |
$879.30
|
| Rate for Payer: Cigna of CA HMO |
$1,250.56
|
| Rate for Payer: Cigna of CA PPO |
$1,445.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$442.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$295.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$398.33
|
| Rate for Payer: EPIC Health Plan Senior |
$295.06
|
| Rate for Payer: Galaxy Health WC |
$1,660.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,172.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$483.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$99.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$295.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,303.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$468.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$371.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$395.38
|
| Rate for Payer: Multiplan Commercial |
$1,563.20
|
| Rate for Payer: Networks By Design Commercial |
$1,270.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,660.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,172.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,172.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$295.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Vantage Medical Group Senior |
$295.06
|
|
|
HC ENDOTRACHEAL INTUBATION
|
Facility
|
IP
|
$1,954.00
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
900800115
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$390.80 |
| Max. Negotiated Rate |
$1,660.90 |
| Rate for Payer: Adventist Health Commercial |
$390.80
|
| Rate for Payer: Cash Price |
$879.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$781.60
|
| Rate for Payer: EPIC Health Plan Senior |
$781.60
|
| Rate for Payer: Galaxy Health WC |
$1,660.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,172.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,303.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$744.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,209.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$468.96
|
| Rate for Payer: Multiplan Commercial |
$1,563.20
|
| Rate for Payer: Networks By Design Commercial |
$1,270.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,660.90
|
|
|
HC ENDOTRACH STYLET FLEXSLIP 14FR
|
Facility
|
IP
|
$15.91
|
|
|
Service Code
|
CPT A4212
|
| Hospital Charge Code |
901698673
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.18 |
| Max. Negotiated Rate |
$13.52 |
| Rate for Payer: Adventist Health Commercial |
$3.18
|
| Rate for Payer: Cash Price |
$7.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.36
|
| Rate for Payer: EPIC Health Plan Senior |
$6.36
|
| Rate for Payer: Galaxy Health WC |
$13.52
|
| Rate for Payer: Global Benefits Group Commercial |
$9.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.82
|
| Rate for Payer: Multiplan Commercial |
$12.73
|
| Rate for Payer: Networks By Design Commercial |
$10.34
|
| Rate for Payer: Prime Health Services Commercial |
$13.52
|
|
|
HC ENDOTRACH STYLET FLEXSLIP 14FR
|
Facility
|
OP
|
$15.91
|
|
|
Service Code
|
CPT A4212
|
| Hospital Charge Code |
901698673
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.18 |
| Max. Negotiated Rate |
$13.52 |
| Rate for Payer: Adventist Health Commercial |
$3.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.77
|
| Rate for Payer: Cash Price |
$7.16
|
| Rate for Payer: Cigna of CA HMO |
$10.18
|
| Rate for Payer: Cigna of CA PPO |
$11.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.36
|
| Rate for Payer: EPIC Health Plan Senior |
$6.36
|
| Rate for Payer: Galaxy Health WC |
$13.52
|
| Rate for Payer: Global Benefits Group Commercial |
$9.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.14
|
| Rate for Payer: Multiplan Commercial |
$12.73
|
| Rate for Payer: Networks By Design Commercial |
$10.34
|
| Rate for Payer: Prime Health Services Commercial |
$13.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.96
|
| Rate for Payer: United Healthcare All Other HMO |
$7.96
|
| Rate for Payer: United Healthcare HMO Rider |
$7.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.52
|
| Rate for Payer: Vantage Medical Group Senior |
$13.52
|
|
|
HC ENDOTRACH TUBE INTRO 15FRX70CM
|
Facility
|
OP
|
$71.42
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901698805
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$60.71 |
| Rate for Payer: Adventist Health Commercial |
$14.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$46.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$60.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$53.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.86
|
| Rate for Payer: Cash Price |
$32.14
|
| Rate for Payer: Cigna of CA HMO |
$45.71
|
| Rate for Payer: Cigna of CA PPO |
$52.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$60.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$60.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$60.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.57
|
| Rate for Payer: EPIC Health Plan Senior |
$28.57
|
| Rate for Payer: Galaxy Health WC |
$60.71
|
| Rate for Payer: Global Benefits Group Commercial |
$42.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$44.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$49.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.99
|
| Rate for Payer: Multiplan Commercial |
$57.14
|
| Rate for Payer: Networks By Design Commercial |
$46.42
|
| Rate for Payer: Prime Health Services Commercial |
$60.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.71
|
| Rate for Payer: United Healthcare All Other HMO |
$35.71
|
| Rate for Payer: United Healthcare HMO Rider |
$35.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$60.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$60.71
|
| Rate for Payer: Vantage Medical Group Senior |
$60.71
|
|
|
HC ENDOTRACH TUBE INTRO 15FRX70CM
|
Facility
|
IP
|
$71.42
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901698805
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$60.71 |
| Rate for Payer: Adventist Health Commercial |
$14.28
|
| Rate for Payer: Cash Price |
$32.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.57
|
| Rate for Payer: EPIC Health Plan Senior |
$28.57
|
| Rate for Payer: Galaxy Health WC |
$60.71
|
| Rate for Payer: Global Benefits Group Commercial |
$42.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$44.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.14
|
| Rate for Payer: Multiplan Commercial |
$57.14
|
| Rate for Payer: Networks By Design Commercial |
$46.42
|
| Rate for Payer: Prime Health Services Commercial |
$60.71
|
|
