|
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 |
$33.91
|
| 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 |
$33.91
|
| 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
|
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 |
$1,074.70
|
| 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 |
$1,074.70
|
| Rate for Payer: Cash Price |
$1,074.70
|
| Rate for Payer: Cash Price |
$1,074.70
|
| 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
|
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 |
$1,074.70
|
| Rate for Payer: Cash Price |
$1,074.70
|
| Rate for Payer: Cash Price |
$1,074.70
|
| 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
|
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 |
$1,074.70
|
| 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 |
$8.75
|
| 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 |
$8.75
|
| 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
|
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 |
$39.28
|
| 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
|
|
|
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 |
$39.28
|
| 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 VENTISEAL 5.5MM CUFF
|
Facility
|
OP
|
$30.34
|
|
| Hospital Charge Code |
901698780
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.07 |
| Max. Negotiated Rate |
$25.79 |
| Rate for Payer: Adventist Health Commercial |
$6.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.63
|
| Rate for Payer: Cash Price |
$16.69
|
| Rate for Payer: Cigna of CA HMO |
$19.42
|
| Rate for Payer: Cigna of CA PPO |
$22.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.79
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.14
|
| Rate for Payer: EPIC Health Plan Senior |
$12.14
|
| Rate for Payer: Galaxy Health WC |
$25.79
|
| Rate for Payer: Global Benefits Group Commercial |
$18.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.24
|
| Rate for Payer: Multiplan Commercial |
$24.27
|
| Rate for Payer: Networks By Design Commercial |
$19.72
|
| Rate for Payer: Prime Health Services Commercial |
$25.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.17
|
| Rate for Payer: United Healthcare All Other HMO |
$15.17
|
| Rate for Payer: United Healthcare HMO Rider |
$15.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.79
|
| Rate for Payer: Vantage Medical Group Senior |
$25.79
|
|
|
HC ENDOTRACH VENTISEAL 5.5MM CUFF
|
Facility
|
IP
|
$30.34
|
|
| Hospital Charge Code |
901698780
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.07 |
| Max. Negotiated Rate |
$25.79 |
| Rate for Payer: Adventist Health Commercial |
$6.07
|
| Rate for Payer: Cash Price |
$16.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.14
|
| Rate for Payer: EPIC Health Plan Senior |
$12.14
|
| Rate for Payer: Galaxy Health WC |
$25.79
|
| Rate for Payer: Global Benefits Group Commercial |
$18.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.28
|
| Rate for Payer: Multiplan Commercial |
$24.27
|
| Rate for Payer: Networks By Design Commercial |
$19.72
|
| Rate for Payer: Prime Health Services Commercial |
$25.79
|
|
|
HC ENDOTRACH VENTISEAL 6.5MM CUFF
|
Facility
|
IP
|
$42.72
|
|
| Hospital Charge Code |
901698787
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.54 |
| Max. Negotiated Rate |
$36.31 |
| Rate for Payer: Adventist Health Commercial |
$8.54
|
| Rate for Payer: Cash Price |
$23.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.09
|
| Rate for Payer: EPIC Health Plan Senior |
$17.09
|
| Rate for Payer: Galaxy Health WC |
$36.31
|
| Rate for Payer: Global Benefits Group Commercial |
$25.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.25
|
| Rate for Payer: Multiplan Commercial |
$34.18
|
| Rate for Payer: Networks By Design Commercial |
$27.77
|
| Rate for Payer: Prime Health Services Commercial |
$36.31
|
|
|
HC ENDOTRACH VENTISEAL 6.5MM CUFF
|
Facility
|
OP
|
$42.72
|
|
| Hospital Charge Code |
901698787
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.54 |
| Max. Negotiated Rate |
$36.31 |
| Rate for Payer: Adventist Health Commercial |
$8.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$32.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.23
|
| Rate for Payer: Cash Price |
$23.50
|
| Rate for Payer: Cigna of CA HMO |
$27.34
|
| Rate for Payer: Cigna of CA PPO |
$31.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$36.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.09
|
| Rate for Payer: EPIC Health Plan Senior |
$17.09
|
| Rate for Payer: Galaxy Health WC |
$36.31
|
| Rate for Payer: Global Benefits Group Commercial |
$25.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.90
|
| Rate for Payer: Multiplan Commercial |
$34.18
|
| Rate for Payer: Networks By Design Commercial |
$27.77
|
| Rate for Payer: Prime Health Services Commercial |
$36.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.36
|
| Rate for Payer: United Healthcare All Other HMO |
$21.36
|
| Rate for Payer: United Healthcare HMO Rider |
$21.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.31
|
| Rate for Payer: Vantage Medical Group Senior |
$36.31
|
|
|
HC ENDOVASC REPAIR DES THORACIC AO
|
Facility
|
IP
|
$4,140.00
|
|
|
Service Code
|
CPT 33881
|
| Hospital Charge Code |
906811483
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$828.00 |
| Max. Negotiated Rate |
$3,519.00 |
| Rate for Payer: Adventist Health Commercial |
$828.00
|
| Rate for Payer: Cash Price |
$2,277.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,656.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,656.00
|
| Rate for Payer: Galaxy Health WC |
$3,519.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,484.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,761.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,577.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,562.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$993.60
|
| Rate for Payer: Multiplan Commercial |
$3,312.00
|
| Rate for Payer: Networks By Design Commercial |
$2,691.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,519.00
|
|
|
HC ENDOVASC REPAIR DES THORACIC AO
|
Facility
|
OP
|
$4,140.00
|
|
|
Service Code
|
CPT 33881
|
| Hospital Charge Code |
906811483
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$431.58 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$828.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,519.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,277.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,105.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,561.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$2,277.00
|
| Rate for Payer: Cash Price |
$2,277.00
|
| Rate for Payer: Cash Price |
$2,277.00
|
| Rate for Payer: Cigna of CA HMO |
$2,649.60
|
| Rate for Payer: Cigna of CA PPO |
$3,063.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,519.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,519.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,519.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,656.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,656.00
|
| Rate for Payer: Galaxy Health WC |
$3,519.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,484.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$431.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,761.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$488.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,562.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$993.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,898.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,898.00
|
| Rate for Payer: Multiplan Commercial |
$3,312.00
|
| Rate for Payer: Networks By Design Commercial |
$2,691.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,519.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,484.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,519.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,519.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,519.00
|
|
|
HC ENDOVASC TEMP VESSEL OCCLUSION
|
Facility
|
IP
|
$22,326.00
|
|
|
Service Code
|
CPT 61623
|
| Hospital Charge Code |
909081670
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$4,465.20 |
| Max. Negotiated Rate |
$18,977.10 |
| Rate for Payer: Adventist Health Commercial |
$4,465.20
|
| Rate for Payer: Cash Price |
$12,279.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,930.40
|
| Rate for Payer: EPIC Health Plan Senior |
$8,930.40
|
| Rate for Payer: Galaxy Health WC |
$18,977.10
|
| Rate for Payer: Global Benefits Group Commercial |
$13,395.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,891.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,506.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,819.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,358.24
|
| Rate for Payer: Multiplan Commercial |
$17,860.80
|
| Rate for Payer: Networks By Design Commercial |
$14,511.90
|
| Rate for Payer: Prime Health Services Commercial |
$18,977.10
|
|
|
HC ENDOVASC TEMP VESSEL OCCLUSION
|
Facility
|
OP
|
$22,326.00
|
|
|
Service Code
|
CPT 61623
|
| Hospital Charge Code |
909081670
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$100.70 |
| Max. Negotiated Rate |
$23,631.30 |
| Rate for Payer: Adventist Health Commercial |
$4,465.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13,494.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,712.00
|
| Rate for Payer: Blue Shield of California Commercial |
$13,663.51
|
| Rate for Payer: Blue Shield of California EPN |
$9,019.70
|
| Rate for Payer: Cash Price |
$12,279.30
|
| Rate for Payer: Cash Price |
$12,279.30
|
| Rate for Payer: Cash Price |
$12,279.30
|
| Rate for Payer: Cigna of CA HMO |
$14,288.64
|
| Rate for Payer: Cigna of CA PPO |
$16,521.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,452.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14,409.33
|
| Rate for Payer: Galaxy Health WC |
$18,977.10
|
| Rate for Payer: Global Benefits Group Commercial |
$13,395.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$23,631.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$100.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,891.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,409.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,358.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,155.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,308.50
|
| Rate for Payer: Multiplan Commercial |
$17,860.80
|
| Rate for Payer: Networks By Design Commercial |
$14,511.90
|
| Rate for Payer: Prime Health Services Commercial |
$18,977.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13,395.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13,395.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,163.00
|
| Rate for Payer: United Healthcare All Other HMO |
$11,163.00
|
| Rate for Payer: United Healthcare HMO Rider |
$11,163.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,163.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,409.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC ENOVENOUS ABLATION THERAPY
|
Facility
|
IP
|
$9,602.00
|
|
|
Service Code
|
CPT 36475
|
| Hospital Charge Code |
909080041
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,920.40 |
| Max. Negotiated Rate |
$8,161.70 |
| Rate for Payer: Adventist Health Commercial |
$1,920.40
|
| Rate for Payer: Cash Price |
$5,281.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,840.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,840.80
|
| Rate for Payer: Galaxy Health WC |
$8,161.70
|
| Rate for Payer: Global Benefits Group Commercial |
$5,761.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,404.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,658.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,943.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,304.48
|
| Rate for Payer: Multiplan Commercial |
$7,681.60
|
| Rate for Payer: Networks By Design Commercial |
$6,241.30
|
| Rate for Payer: Prime Health Services Commercial |
$8,161.70
|
|
|
HC ENOVENOUS ABLATION THERAPY
|
Facility
|
OP
|
$9,602.00
|
|
|
Service Code
|
CPT 36475
|
| Hospital Charge Code |
909080041
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,920.40 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$1,920.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$3,968.41
|
| Rate for Payer: Cash Price |
$5,281.10
|
| Rate for Payer: Cash Price |
$5,281.10
|
| Rate for Payer: Cash Price |
$5,281.10
|
| Rate for Payer: Cigna of CA HMO |
$6,145.28
|
| Rate for Payer: Cigna of CA PPO |
$7,105.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$8,161.70
|
| Rate for Payer: Global Benefits Group Commercial |
$5,761.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,341.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,404.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,779.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,304.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$7,681.60
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$6,241.30
|
| Rate for Payer: Prime Health Services Commercial |
$8,161.70
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,761.20
|
| 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 |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC ENTERCOLYSIS DBL CNTRST
|
Facility
|
OP
|
$1,544.00
|
|
|
Service Code
|
CPT 74251
|
| Hospital Charge Code |
909001852
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$226.19 |
| Max. Negotiated Rate |
$1,312.40 |
| Rate for Payer: Adventist Health Commercial |
$308.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,012.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$370.72
|
| Rate for Payer: Blue Shield of California Commercial |
$944.93
|
| Rate for Payer: Blue Shield of California EPN |
$623.78
|
| Rate for Payer: Cash Price |
$849.20
|
| Rate for Payer: Cash Price |
$849.20
|
| Rate for Payer: Cigna of CA HMO |
$988.16
|
| Rate for Payer: Cigna of CA PPO |
$1,142.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.36
|
| Rate for Payer: EPIC Health Plan Senior |
$226.19
|
| Rate for Payer: Galaxy Health WC |
$1,312.40
|
| Rate for Payer: Global Benefits Group Commercial |
$926.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$611.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,029.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$691.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$370.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$303.09
|
| Rate for Payer: Multiplan Commercial |
$1,235.20
|
| Rate for Payer: Networks By Design Commercial |
$1,003.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,312.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$926.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$926.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$364.06
|
| Rate for Payer: United Healthcare All Other HMO |
$364.06
|
| Rate for Payer: United Healthcare HMO Rider |
$364.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$364.06
|
| Rate for Payer: Upland Medical Group Pediatric |
$226.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
|
HC ENTERCOLYSIS DBL CNTRST
|
Facility
|
IP
|
$1,544.00
|
|
|
Service Code
|
CPT 74251
|
| Hospital Charge Code |
909001852
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$308.80 |
| Max. Negotiated Rate |
$1,312.40 |
| Rate for Payer: Adventist Health Commercial |
$308.80
|
| Rate for Payer: Cash Price |
$849.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$617.60
|
| Rate for Payer: EPIC Health Plan Senior |
$617.60
|
| Rate for Payer: Galaxy Health WC |
$1,312.40
|
| Rate for Payer: Global Benefits Group Commercial |
$926.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,029.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$588.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$955.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$370.56
|
| Rate for Payer: Multiplan Commercial |
$1,235.20
|
| Rate for Payer: Networks By Design Commercial |
$1,003.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,312.40
|
|
|
HC EO DBL UPRIGHT ADJ POS LOCK
|
Facility
|
OP
|
$2,892.00
|
|
|
Service Code
|
CPT L3740
|
| Hospital Charge Code |
915353740
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$694.08 |
| Max. Negotiated Rate |
$2,458.20 |
| Rate for Payer: Adventist Health Commercial |
$1,185.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,458.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,590.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,169.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,675.05
|
| Rate for Payer: Blue Shield of California Commercial |
$2,134.30
|
| Rate for Payer: Blue Shield of California EPN |
$1,405.51
|
| Rate for Payer: Cash Price |
$1,590.60
|
| Rate for Payer: Cash Price |
$1,590.60
|
| Rate for Payer: Cigna of CA HMO |
$2,024.40
|
| Rate for Payer: Cigna of CA PPO |
$2,024.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,458.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,458.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,458.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,156.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,156.80
|
| Rate for Payer: Galaxy Health WC |
$2,458.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,735.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,414.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,928.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,600.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,790.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$694.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,024.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,024.40
|
| Rate for Payer: Multiplan Commercial |
$2,313.60
|
| Rate for Payer: Networks By Design Commercial |
$1,446.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,458.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,735.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,735.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,085.37
|
| Rate for Payer: United Healthcare All Other HMO |
$1,056.45
|
| Rate for Payer: United Healthcare HMO Rider |
$1,033.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$947.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,458.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,458.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,458.20
|
|
|
HC EO DBL UPRIGHT ADJ POS LOCK
|
Facility
|
IP
|
$2,892.00
|
|
|
Service Code
|
CPT L3740
|
| Hospital Charge Code |
905353740
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$578.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$578.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,590.60
|
| Rate for Payer: Cash Price |
$1,590.60
|
| Rate for Payer: Cigna of CA HMO |
$2,024.40
|
| Rate for Payer: Cigna of CA PPO |
$2,024.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,156.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,156.80
|
| Rate for Payer: Galaxy Health WC |
$2,458.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,735.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,928.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,101.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,790.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$694.08
|
| Rate for Payer: Multiplan Commercial |
$2,313.60
|
| Rate for Payer: Networks By Design Commercial |
$1,446.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,458.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,085.37
|
| Rate for Payer: United Healthcare All Other HMO |
$1,056.45
|
| Rate for Payer: United Healthcare HMO Rider |
$1,033.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$947.13
|
|
|
HC EO DBL UPRIGHT ADJ POS LOCK
|
Facility
|
IP
|
$2,892.00
|
|
|
Service Code
|
CPT L3740
|
| Hospital Charge Code |
915353740
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$578.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$578.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,590.60
|
| Rate for Payer: Cash Price |
$1,590.60
|
| Rate for Payer: Cigna of CA HMO |
$2,024.40
|
| Rate for Payer: Cigna of CA PPO |
$2,024.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,156.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,156.80
|
| Rate for Payer: Galaxy Health WC |
$2,458.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,735.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,928.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,101.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,790.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$694.08
|
| Rate for Payer: Multiplan Commercial |
$2,313.60
|
| Rate for Payer: Networks By Design Commercial |
$1,446.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,458.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,085.37
|
| Rate for Payer: United Healthcare All Other HMO |
$1,056.45
|
| Rate for Payer: United Healthcare HMO Rider |
$1,033.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$947.13
|
|
